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Since the early 1980s, human factors professionals have leveraged macroergonomic approaches to build and design complex systems. Macroergonomics is of increasing relevance and interest to modern human factors experts working to address societal and organizational problems. New questions within existing domains necessitate development of new macroergonomic methods. Additionally, modern research needs drive the development of novel approaches in new domains. In this session, panelists will provide expert perspectives on the dynamic evolution of systems analysis, innovative implementation of participatory ergonomics programs, new hazard recognition approaches based on cognitive mnemonics, new applications of improvisation that enhance team performance, and a synthesized method seeking to elucidate micro to macro systems components. After each panelist has presented, we will then facilitate a discussion with the audience and panelists about the responsibilities and opportunities to derive human factors tools and methods that address the challenges and limitations of modern macroergonomics.

Patients with rheumatologic conditions are at elevated risk of cardiovascular disease (CVD) due to inflammatory and traditional risk factors, such as high blood pressure (BP) and smoking. However, rheumatology clinics rarely address traditional risk factors, although they are routinely assessed and modifiable in primary care. The present study sought to (1) characterize rheumatology clinic staff's work process for addressing high BP and smoking and (2) identify barriers and strategies for effective management of these risk factors.We conducted 7 focus groups with medical assistants, nurses, and scheduling staff from 4 adult rheumatology clinics across 2 health systems (BP focus groups, n = 23; smoking, n = 20). Transcripts were analyzed using thematic analysis to elucidate barriers and strategies.We found 3 clinic work processes for the management of high BP and smoking risk: (1) risk identification, (2) follow-up within the clinic, and (3) follow-up with primary care and community resources. Within these processes, we identified barriers and strategies grouped into themes: (1) time, (2) clinic workflows, (3) technology and resources, (4) staff's attitudes and knowledge, and (5) staff's perceptions of patients. The most pervasive barriers were (1) no structured system for follow-up and (2) staff confidence and skill in initiating conversations about health-related behavior change.Our study identified generalizable gaps in rheumatology staff's work processes and competencies for addressing high BP and smoking in patients. Future efforts to support staff needs should target (1) systems for follow-up within and outside the clinic and (2) conversation support tools.

Develop and evaluate the implementation of a proposed model for large-scale data-driven quality improvement in assisted living.We conducted a mixed-methods evaluation of the implementation of a large-scale data-driven quality improvement collaborative of Wisconsin assisted living communities (ALCs).The model has been voluntarily implemented by 810 Wisconsin-licensed ALCs serving20,000 residents.The model was codesigned iteratively 2009-2012 by a public-private multistakeholder advisory group. Using system usage statistics and project records, we evaluated implementation outcomes: appropriateness, acceptability, adoption, feasibility, fidelity, penetration, and sustainability.Implementation for ≥1 quarter was feasible for 92% of the 810 ALCs that enrolled. The model has been deemed appropriate and acceptable by public-private stakeholders representing residents, providers, regulators, and payers, and appropriateness for ALCs serving different populations has been iteratively improved through targeted workgroups. The model is currently adopted in Wisconsin by 31% of the 1573 ALCs in provider associations. Among adopters, 88% on average implemented the model with fidelity to key membership rules per quarter. The model achieved demographic and institutional penetration by currently reaching 24% of Wisconsin ALC residents and by leveraging initial grant funding to become integrated in Wisconsin's annual Medicaid budget and being central to Wisconsin's incentive program to managed care organizations. Model implementation for 8 years has been sustained by member enrollment for nearly 4 years on average, with 71% of members enrolled2 years and sustained early adopters representing 37% that have been enrolled5 years.This is the first implementation study of large-scale data-driven quality improvement in assisted living, despite its demonstrated value in other health care sectors. The article proposes a model with core components and implementation strategies drawing on a decade-long public-private collaboration. The implementation study findings establish a promising path and future directions for wider implementation.

One of our greatest challenges to achieving improved health for all is closing the gap between scientific discovery and real-world practice: the gap between what we know works to improve health and what is actually implemented in clinical and community settings. The field of implementation science has emerged over the past 3 decades, applying scientific rigor from diverse disciplines to close this gap. The goal of implementation science is to increase our understanding of how to get evidence-based interventions into practice to maximize the likelihood that interventions are equitably adopted and sustained, shorten time to widespread use, and ultimately, maximize impact on health. This work also sometimes calls for de-implementing ineffective interventions or adapting implementation strategies to different contexts to avoid perpetuating or exacerbating health disparities.

Workflows associated with health care delivery vary between settings, and understanding similarities and dissimilarities can inform context-sensitive practice change. Clinical workflows are complex...

Healthcare systems have begun to recognize the value of Human Factors and Ergonomics (HFE) and have started to create dedicated roles within their organizational structure for HFE practitioners and researchers to work with safety and quality groups to enhance safety, productivity, and overall system efficiencies. This panel brings together HFE personnel from different organizations, who will share their experiences working with clinical partners, in healthcare systems. Specifically, the panelists will lead an interactive discussion with audience members on strategies for changing the safety culture required to achieve the status of a high reliability organization (HRO). The panel will also share methods for demonstrating return on investment for HFE and techniques for successful implementation to continue the long-term integration of HFE into safety and quality improvement projects within healthcare organizations.

BACKGROUND Rheumatologists face time pressures similar to primary care but have not generally benefitted from optimized team-based rooming during the time from the waiting room until the rheumatologist enters the room. OBJECTIVE The aim of this study was to assess current capacity for population management in rheumatology clinics; we aimed to measure the tasks performed by rheumatology clinic staff (medical assistants or nurses) during rooming. METHODS We performed a cross-sectional time-study and work-system analysis to measure rooming workflows at 3 rheumatology clinics in an academic multispecialty practice during 2014-2015. We calculated descriptive statistics and compared frequencies and durations using Fisher exact test and analysis of variance. RESULTS Observing 190 rheumatology clinic previsit rooming sequences (1419 minutes), we found many significant variations. Total rooming duration varied by clinic (median, 6.75-8.25 minutes; p < 0.001). Vital sign measurement and medication reconciliation accounted for more than half of rooming duration. Among 3 clinics, two of 15 tasks varied significantly in duration, and 9 varied in frequency. Findings led clinic leaders to modify policies and procedures regarding 6 high-variation tasks streamlining assessment of weight, height, pain scores, tobacco use, disease activity, and refill needs. CONCLUSIONS Assessing rheumatology rooming tasks identified key opportunities to improve quality and efficiency without burdening providers. This project demonstrated user-friendly methods to identify opportunities to standardize rooming and support data-driven decisions regarding rheumatology clinic practice changes to improve population management in rheumatology.

Background Prescription opioid misuse is a serious national crisis; in 2018 the top drugs involved in prescription overdose deaths included pain medications (opioids), benzodiazepines, and stimulants. Health information technology (health IT) provides a means to address this crisis through technologies that streamline the prescribing and discontinuation process. CancelRx is a health IT function that communicates when medications, such as controlled substances, are discontinued at the clinic and therefore should not be filled at the pharmacy. Prior to CancelRx, the communication of discontinued medications was a manual process, requiring the patient or a clinic staff member to personally contact the pharmacy to inform them of the change. The objective of this study was to assess how controlled substance medication discontinuations were communicated over time, before and after the implementation of CancelRx. Methods Secondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation. The study utilized an interrupted time series analysis (ITSA) to capture the percentage of controlled substance medications that were discontinued in the clinic’s electronic health record and discontinued in the pharmacy’s dispensing software. The ITSA plotted the percentage of successful discontinuation messages over time, particularly after the health system’s implementation of CancelRx, a novel technology. Results After CancelRx implementation there was an immediate (change = 77.7 percentage point) and significant (p Conclusions Overall, this study demonstrates the role that technology can play in promoting communication between clinics and pharmacies, especially when medications such as controlled substances are discontinued.

ObjectiveTo assess how controlled substance medication discontinuations were communicated over timeData SourcesSecondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation.Study DesignThe study utilized an interrupted time series analysis (ITSA) to capture the proportion of controlled substance medications that were cancelled in the clinic’s electronic health record and also cancelled in the pharmacy’s dispensing software. The ITSA plotted the proportion of successful cancellation messages over time, particularly after the health system’s implementation of CancelRx, a novel technology.Data Collection/ExtractionData were extracted from the EHR and pharmacy records for patients aged 18+ who had a controlled substance discontinued by a health system provider. Information collected included patient demographics, drug information (name, dose), and dates discontinued in the clinic and pharmacy records.Principal FindingsAfter CancelRx implementation there was a significant increase in the proportion of discontinued controlled substance medications that were communicated to the pharmacy.ConclusionsThis study demonstrates the role that technology can play in promoting controlled substance policy and medication safety.

Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff-driven protocol, Quit Connect, to increase the rate of electronic referrals (e-referrals) to free, state-run tobacco quit lines.We conducted a quasi-experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6-month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e-referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design.Across 54,090 pre- and post-protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre-implementation visits and 523 intervention period visits. Post-implementation, the odds of tobacco quit line referral were 26-fold higher compared to our pre-implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6-106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100-fold compared to pre-implementation (adjusted OR 132 [95% CI 99-177]). Intervention led to e-referrals for 71% of quit-ready patients in90 seconds; 24% of referred patients reported a quit attempt.Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state-run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.

Background: Theory-based implementation strategies, such as audit and feedback (A&F), can improve adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute CVD risk-reduction protocols, but A&F strategies to support them have not been well examined. Our objective was to develop and evaluate a novel A&F strategy, Interactive Participatory A&F (IPAF). Methods: We developed IPAF by combining theories to inform staff goals (Self-Regulation Theory) and address their psychological needs for relatedness, autonomy, and confidence (Self-Determination Theory). We facilitated IPAF fidelity by developing a theory-based facilitation tool: a semi-structured worksheet to guide flexible discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a Hybrid Type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk-reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including Electronic Health Records (EHR) data, team records, IPAF worksheets, and staff questionnaire responses. Results: Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or by phone) IPAF sessions during the first six months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90-93%) and engagement in IPAF sessions. Staff rated questionnaire items about acceptability of IPAF highly. IPAF records and staff responses demonstrated fidelity of delivery and receipt of IPAF. Adoption of target behaviors increased significantly (all P-values < 0.05) and was maintained for over 24 months. Conclusions: We developed and evaluated an interactive participatory A&F strategy with frontline staff in specialty clinics to improve implementation of evidence-based interventions. The IPAF toolkit combines two complementary theories: Self-Regulation Theory and Self-Determination Theory. Findings support feasibility, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes, we have extended prior research on clinic protocols and A&F beyond primary care settings and providers.

This paper assesses the conceptualizations and analytical uses of complexity. Throughout the paper, we carefully eschew ontological issues, and sort out the epistemology of complexity. We try to explain why the ontology of complexity makes no sense to us, much like significance is neither material nor ontological. Our tool of choice is levels of analysis. First, we analyze the conceptualization of complexity. Much discussion of complexity is confused because complexity is mistaken as a material issue. Complexity arises from the way the situation is addressed, and is not material in itself. Even so, complexity does seem to have material ramifications without being itself a straightforward material distinction. We use an illustrative parallel example where genetic dominance is shown not to be material while having material consequences, but only after a gene is asserted to be dominant on normative criteria. Secondly, the paper compares two analytical approaches based on complexity, namely Robert Rosen’s work and Joseph Tainter’s work. In Rosennean complexity a system is complex if not all its constituent models are simulable, if certainty is denied. In that sense, complexity cannot be defined. Rosen’s distinction is between simple and complex systems makes complexity an all or nothing proposition. Complexification is seen by Tainter as a device used by societies to solve their problems. This leads to complexity being a matter of degree in successive societal complexifications, perhaps from Neolithic hunter-gatherers to industrial societies.

As Human Factors and Ergonomics (HF/E) practice in health care expands, there is growing recognition of the need to consider and design for patient work. Over the past several years HF/E practitioners and researchers have begun to formalize the theoretical foundations of a patient work approach. Methodologically, patient work approaches have required adaptations of existing HF/E and social science approaches as well as the development of new approaches. This panel will focus on current approaches of engaging patients in designing interventions in the multiple settings in which patient work is performed. Each panelist will introduce their work by discussing the health care challenge and how existing methods were adapted or new methods created to engage patients in the design of systems. The panelists will then interact with audience members to solicit current health care challenges and to brainstorm ways in which methods could be adapted or innovated to engage patients in addressing these challenges.

Objectives Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, we analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs. Design Qualitative descriptive study using prospective field-based assessment of workflows. Setting Six NHs in Wisconsin (n = 3) and Pennsylvania (n = 3). Participants A total of 44 interviews with 68 NH professionals, including leadership, nurses, and prescribers. Measurements During a 1-day field visit in each NH, we conducted semistructured interviews with NH professionals, collected artifacts (policies, procedures, and documentation and communication tools), and observed clinical meetings. Study participants were interviewed (30-60 minutes) about antibiotic prescribing workflows in their facility. Information collected during site visits was used to create a representative workflow map of NH antibiotic prescribing. The workflow map guided thematic analysis to identify barriers corresponding to workflow steps across multiple NHs. Results The representative antibiotic preprescribing workflow map included 17 steps, beginning with resident change in condition and ending with the decision to prescribe an antibiotic. Thematic analysis identified common step-specific barriers to antibiotic stewardship centering on three themes: (A) information barriers, comprising (A1) inconsistent nurse assessment report and (A2) misalignment between the work and tools of information sharing within the facility, (B) communication barriers, comprising (B1) mismatched perception of prescriber information needs and (B2) difficulty reaching prescribers for direct interaction, and (C) professional barriers, comprising (C1) low prescriber confidence in nurse assessment report and (C2) nurse reluctance to express their professional opinions. Conclusion Strategies addressing workflow barriers are important targets for antibiotic stewardship. Such strategies include structured information tools, nurse and prescriber education, and organizational improvement. Future research can build on combinations of existing and new strategies to measure their effects in improving antibiotic prescribing. J Am Geriatr Soc 68:2222-2231, 2020.

OBJECTIVE Recognizing high blood pressure (BP) as the most prevalent cardiovascular risk factor in patients with rheumatic diseases and all adults, experts recommend clinic protocols to improve BP control. The aim of this study was to adapt and implement a specialty clinic protocol, "BP Connect," to improve timely primary care follow-up after high BP measurements in rheumatology clinics. METHODS We examined BP Connect in a 6-month preimplementation and postimplementation quasi-experimental design with 24-month follow-up in 3 academic rheumatology clinics. Medical assistants and nurses were trained to 1) check (re-measuring BPs ≥140/90 mm Hg), 2) advise (linking rheumatic and cardiovascular diseases), and 3) connect (timely [

Objective Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. After implementing a rheumatology clinic protocol that increased tobacco quitline referrals 20-fold, we undertook this study to examine patients' barriers and facilitators to smoking cessation based on prior rheumatology experiences, to solicit reactions to the new cessation protocol, and to identify patient-centered outcomes or signs of cessation progress following improved care. Methods We recruited 19 patients who smoke (12 with rheumatoid arthritis [RA] and 7 with systemic lupus erythematosus [SLE]) to participate in 1 of 3 semistructured focus groups. Transcripts of the focus group discussions were analyzed using thematic analysis to classify barriers, facilitators, and signs of cessation progress. Results Participant-reported barriers and facilitators to cessation involved psychological, health-related, and social and economic factors, as well as health care messaging and resources. Commonly discussed barriers included viewing smoking as a crutch amid rheumatic disease, rarely receiving cessation counseling in rheumatology clinics, and very limited awareness that smoking can worsen rheumatic diseases or reduce efficacy of some rheumatic disease medications. Participants endorsed our cessation protocol with rheumatology-specific education and accessible resources, such as a quitline. Beyond quitting, participants prioritized knowing why and how to quit as signs of progress outcomes. Conclusion Focus groups identified themes and categories of facilitators/barriers to smoking cessation at the levels of patient and health system. Two key outcomes of improving cessation care for patients with RA and SLE were knowing why and how to quit. Emphasizing rheumatologic health benefits and cessation resources is essential when designing and evaluating rheumatology smoking cessation interventions.

Purpose We present a case report detailing a challenge in health information technology (HIT) project implementations we term “stakeholder creep”: not thoroughly identifying which stakeholders need to be involved and why before starting a project, consequently not understanding the true effort, skill sets, social capital, and time required to complete the project. Methods A root cause analysis was performed post-implementation to understand what led to stakeholder creep. HIT project stakeholders were given a questionnaire to comment on these misconceptions and a proposed implementation tool to help mitigate stakeholder creep. Findings Stakeholder creep contributed to an unexpected increase in time (3-month delayed go-live) and effort (68% over expected HIT work hours). Four main clinician/researcher misconceptions were identified that contributed to the development of stakeholder creep: 1) that EHR IT is a single group; 2) that all EHR IT members know the entire EHR functionality; 3) that changes to an EHR need the input of just a single EHR IT member; and 4) that the technological complexity of a project mirrors the clinical complexity. HIT project stakeholders similarly perceived clinicians/researchers to hold these misconceptions. The proposed stakeholder planning tool was perceived to be feasible and helpful. Conclusions Stakeholder creep can negatively affect HIT project implementations. Projects may be susceptible to stakeholder creep when clinicians/researchers hold misconceptions related to HIT organization and processes. Implementation tools, such as the proposed stakeholder checklist, could be helpful in preempting and mitigating the effect of stakeholder creep.

Background Antibiotic utilization in skilled nursing facilities (SNFs) varies widely and the factors responsible for this variation remain poorly understood. Staff retention and leadership stability in SNFs has been associated with a number of important resident and facility outcomes but the relationship to antibiotic utilization has not been examined previously. Data collected as part of an ongoing study of an antibiotic stewardship intervention in SNFs in two states provided an opportunity to explore the relationship between these facility characteristics on baseline antibiotic utilization in SNFs participating in this study. Methods Twelve months of pre-intervention data on antibiotic use were abstracted from pharmacy records in nine SNFs in Wisconsin and Pennsylvania. Baseline SNF characteristics were collected. The analysis focused on four clinical nursing variables: (1) director of nursing stability (1 = tenure? 5 years); (2) RN and LPN retention (1 = retention ≥ median of 79.5); (3) CNA retention (1 = retention ≥ median of 77.3); and full-time infection control practitioner (1 = works 50% of time or more). Measures of overall antibiotic utilization, including antibiotic starts (AS) and days of therapy (ADT) per 1,000 resident days, were calculated for each SNF over a 12-month baseline period. A GLM repeated-measures analysis explored the differences for the dichotomous variables where 1 is a Yes response. Results GLM analysis results shown in the table below indicate that SNFs with a full time ICP had significantly fewer ADT and fewer AS with higher RN/LPN retention. Antibiotic Starts (AS) Antibiotic Days of Therapy (ADT) DON Leadership Stability (µ = 0.74, P = 0.37) (µ = 3.85, P = 0.66) RN/LPN retention (µ = −1.53, P = 0.04) (µ = −13.62, P = 0.11) CNA retention (µ = −0.55, P = 0.53) (µ = −11.44, P = 0.20) Full time ICP (µ = −1.44, P = 0.051) (µ = −15.75, P = 0.04). Conclusion Our study shows that RN/LPN staff retention and having a fulltime ICP are associated with lower rates of antibiotic use in SNFs. Future studies should examine how these attributes exert influence on provider antibiotic decision-making. Nevertheless, our results suggest that ongoing efforts to improve staff retention, if successful, will positively impact the quality of antibiotic prescribing in SNFs. Disclosures All authors: No reported disclosures.

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

In September, 2009, AHRQ and NSF convened a workshop in which experts in the fields of industrial and systems engineering (ISyE) and health care explored critical areas of research at the intersection of both fields. The objectives were to 1) articulate a vision for an ideal health care delivery system, 2) determine why current efforts to apply ISyE knowledge to health care have not resulted in meaningful change, and 3) propose a research and action agenda that should be pursued to enable the field of ISyE to substantially contribute to the realization of an ideal health care delivery system. This paper presents the vision of the ideal health care delivery system and elements of the research agenda that are salient to the field of human factors and ergonomics (HFE). The ideal health care delivery system was defined as one that is new, patient-centered, and engineered. The research agenda emphasized knowledge innovation related to systems monitoring, modeling, and modification, but also included items related to transfer of existing ISyE knowledge and integration and prioritization of knowledge in both fields. Recognizing that human factors and ergonomics is much larger than ISyE, this paper is also presented to the HFES community to identify which other perspectives may need to be included.

Background Hypertension (HTN) is the most prevalent cardiovascular disease (CVD) risk factor among adults with rheumatic conditions. However, we found that blood pressures were addressed in Objectives Our objective was to study the feasibility and impact of an intervention using a staff HTN protocol to facilitate timely ( Methods We conducted a pre-post study in three academic rheumatology clinics. All eligible adult (≥18 years-old) rheumatology visits with BP ≥140/90 mmHg (12/2014–5/2015) were compared to pre-intervention visits (2012–9/2014). Our multi-dimensional intervention included: (1) educating staff on HTN, rheumatologic diseases, and CVD risk, (2) electronic health record (EHR) alerts for staff to re-measure BPs if ≥140/90 and 3) cuing brief patient education and scheduling primary care follow-up if 2nd BP ≥140/90, and (4) monthly audit and feedback with staff about performance. We assessed timely primary care follow-up of high BPs among patients who received primary care in our system using EHR data. We performed multivariable logistic regression and compared the odds (OR, 95%CI) of timely primary care follow-up before and during intervention, while controlling for baseline socio-demographics, comorbidities, utilization, and clinic. Results We compared 689 intervention period visits to 4,683 pre-intervention visits with BPs ≥140/90. Patient groups were comparable before and during intervention. Staff initiated BP re-measurement in 80% of eligible visits during intervention months 4–6, compared to Conclusions Our intervention was feasible for usual rheumatology clinic staff and it doubled rates of timely BP follow-up. Future studies should examine this intervention in other rheumatology clinics, and its impact on HTN control to reduce CVD risk in rheumatology patients. Disclosure of Interest C. Bartels Grant/research support from: Independent Grants for Learning and Change (Pfizer), E. Ramly: None declared, H. Johnson: None declared, P. McBride: None declared, Z. Li: None declared, Y. Zhao: None declared, K. Lewicki: None declared, D. Lauver: None declared

Background Smoking increases the severity and cardiopulmonary complications of many rheumatologic conditions. Yet despite tobacco assessment in many rheumatology clinics, we reported that Objectives Our objective was to engage clinic staff in participatory work system redesign to develop and plan implementing an Ask-Advise-Connect tobacco protocol in rheumatology clinics. We report the results of this redesign study under the Systems Engineering In Patient Safety (SEIPS) model9s five work system domains: people, organization, technology, environment, and tasks. Methods Our multidisciplinary team facilitated participatory work system redesign with medical assistants (MA) and nurses (RN) from three US academic rheumatology clinics. Staff participated in one of two hour-long focus groups. Trained facilitators used semi-structured interview questions informed by the SEIPS domains to appraise pre-visit assessment workflows, educational needs, proposed protocols, brochures, electronic health record (EHR) tools, and implementation plans. Results Over 80% (9 MAs, 5 RNs) of clinic nursing staff participated in focus groups. SEIPS domain questions facilitated discussions on intervention design, implementation, and sustainability planning (Table 1). The work system redesign included training (people); a protocol and workflows adapted to specialty care (organization, tasks); customized EHR alerts for assessing tobacco status and an EHR order set for e-referral to quit line services (technology); and physical cues like a desktop patient brochure linking rheumatologic conditions, tobacco use, and cardiovascular risk (environment). Focus group participants reported routinely assessing tobacco use, but most had not asked about readiness to quit. A few had asked such questions, but noted low outcome expectancy and not knowing what to do next. One nurse said, “I9d ask, `Are you ready to quit?9 and they9d say `No9 and then I9d stop.” Staff groups identified that education about links between tobacco use and rheumatologic diseases and stepwise support from our Ask-Advise-Connect protocol would help them overcome barriers to tobacco cessation counselling. They requested specific best-practice language in the EHR tools and appreciated rheumatology-specific brochures with printed conversational prompts. Conclusions We engaged rheumatology clinic staff in participatory work system redesign to plan implementing a tobacco cessation protocol. The participatory redesign process resulted in a tailored implementation plan for a quasi-experimental trial of a tobacco cessation e-referral protocol in rheumatology clinics. Disclosure of Interest C. Bartels Grant/research support from: Independent Grants for Learning and Change (Pfizer), A. Gilmore: None declared, D. Panyard: None declared, C. Maxcy: None declared, R. Adsit: None declared, A. Skora: None declared, E. Ramly: None declared