Table 3 Practical robust implementation and sustainability model (PRISM) components
PRISM domain | What are we assessing? | How will data be collected? | How will data be used? |
|---|---|---|---|
Organizational perspective | • Preferred mechanisms to relay program changes and education to clinicians • Baseline antibiotic prescribing patterns for AOM • Contextual factors that may facilitate/impede watchful waiting • Contextual factors that may facilitate/impede implementation of intervention components | • Key informant interviews (clinicians and administrators) • Process mapping interviews (clinicians and administrators) • Electronic health record (EHR) data | • Adapt implementation plan to meet local needs and address barriers • Feedback baseline data to clinicians |
Patient perspective | • Receptiveness to use of watchful waiting for AOM • Contextual factors that may facilitate/impede the acceptance of watchful waiting • Parent preferences for SDM process | • Key informant focus groups (parents) | • Adapt SDM process and education for clinicians to meet parent needs (Hybrid only) • Adapt communication education for clinicians • Adapt patient education materials |
External environment | • HEDISa measures for antibiotic prescribing for acute respiratory tract infections • Cosmopolitanism | • Key informant interviews (clinicians and administrators) • EHR data to compute HEDIS measure | • Incorporate into clinician education and use for administrative buy-in if needed |
Implementation and sustainability infrastructure | • Current resources and resource utilization for AOM management (e.g., EHR-tools, education materials) and stewardship • Baseline workflow for AOM • Perceived facilitators/barriers to sustainability | • Key informant interviews (clinicians and administrators) • Process mapping interviews (clinicians and administrators) | • Adapt sustainability plan and EHR workflow • Develop workflow for SDM (Hybrid only) |
Organizational characteristics | • Existing collaborations and information flow between clinics • Administrative support • Shared goals | • Key informant interviews (clinicians and administrators) | • Modify communication plan and add administrative support if needed |
Patient characteristics | • Demographics • Urban, suburban, rural designation | • EHR data collection • Clinic zip codes | • Use data for covariate-constrained cluster randomization |