Loading
Life sciences · Journal article
Implementation Science Communications · September 5, 2026
Encouraging direction, but not yet definitive.
This pragmatic trial demonstrates that an embedded EHR-based shared decision-making tool achieved modest adoption (4.9% to 8% of encounters) when supported by tailored implementation strategies including at-the-elbow coaching and clinical champions across three U.S. healthcare systems. Clinician perceptions of tool advantage and time burden were key determinants, and moderate fidelity was observed in video-recorded encounters, though effectiveness outcomes were not assessed.
Pragmatic implementation trial with mixed methods evaluation using RE-AIM framework. Clinicians and patients at 15 primary care and preventive cardiology sites. Seventy-six clinicians participated; patients included those presenting to participating sites during the study period, with preferential tool use in older patients and those with prehypertension or borderline-high total ch…. Intervention: CV Prevention Choice, an EHR-embedded shared decision-making tool for cardiovascular disease primary prevention, implemented with tailored strategies including at-the-elbow demonstrations using patient cases during site visits and engageme…. Compared with: Usual care (0.8% baseline tool use rate reported). Three U.S. healthcare systems (specific locations not named).
Tool use increased from 0.8% of encounters in usual care to 4.9% in active implementation and 8% in the maintenance phase 76 clinicians (43%) were adopters; top quartile used tool in median 20% of encounters (range 10–53%) Median tool use among adopters was 22 times (IQR 5–61, range 2–330)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should recognize that embedding SDM tools in EHRs alone is insufficient; adoption requires active implementation strategies including on-site coaching and clinical champions. The modest adoption rate (8% in maintenance) suggests that workflow integration, perceived time burden, and competing EHR resources remain substantial barriers to scaling SDM in routine practice, and improvement in tool functionality and care team involvement may be necessary.
A pragmatic implementation trial in real-world primary care showing modest adoption of an SDM tool with tailored strategies, using mixed methods and RE-AIM framework; results are encouraging but effect sizes are small and effectiveness is not reported.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that embedding SDM tools in EHRs alone is insufficient; adoption requires active implementation strategies including on-site coaching and clinical champions. The modest adoption rate (8% in maintenance) suggests that workflow integration, perceived time burden, and competing EHR resources remain substantial barriers to scaling SDM in routine practice, and improvement in tool functionality and care team involvement may be necessary.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Shared decision making (SDM) is guideline-recommended for primary prevention of cardiovascular (CV) disease, but there are barriers to routine adoption of tools to promote SDM. This pragmatic trial evaluated the effect of tailored strategies on implementation of an SDM tool ( CV Prevention Choice ) used during clinical encounters. Fifteen primary care and preventive cardiology sites within three U.S. healthcare systems participated. Outcomes were organized using the RE-AIM evaluation framework and included reach (number, proportion and characteristics of patient encounters), adoption (clinician uptake), implementation (fidelity), and maintenance (sustained use). Effectiveness is not reported here. Data included electronic health record (EHR) encounter data, surveys and interviews with clinicians and administrators, periodic reflections with implementation facilitators, and site visits. Surveys and EHR data were analyzed descriptively. Qualitative data were analyzed using content analysis and the Consolidated Framework for Implementation Research. We explored fidelity by reviewing a sample of video-recorded encounters. Between May 2021 and January 2025, 136 surveys, 38 interviews, 65 periodic reflections, and 6 site visits were completed. CV Prevention Choice was used with 3031 patients. The 76 clinicians (43%) considered adopters used the tool a median of 22 times (IQR 5–61, range 2 to 330). The top quartile of adopters (≥ 61 encounters with tool use) used the tool in a median 20% (range 10 to 53%) of encounters. The tool was used with older patients, more likely to have prehypertension and borderline-high total cholesterol. Key determinants of implementation were clinician perceptions about the SDM tool, its advantage compared to extant EHR resources, and the perceived time it would take to use it. The most successful strategies were at-the-elbow demonstration, using patient cases and conducted during site visits, and site-level clinical champions. Tool use increased from 0.8% of encounters in usual care to 4.9% in active implementation and 8% in the maintenance phase. While exploratory, analysis of video-recorded encounters suggests moderate fidelity to implementation. Integration of an SDM tool in the EHR led to modest adoption, which increased with tailored strategies. Sustainability should focus on improved functionality of embedded tools, workflow adaptations to expand care team involvement, and potentially EHR alerts that identify eligible patients. SDM tools may support organizational initiatives connecting SDM to quality metrics. The protocol described herein was registered with ClinicalTrials.gov on 22 June 2020 (No. NCT04450914).
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.