Table 3 Barriers and facilitators of implementing procedures for documenting patient refusals of HPV vaccination during the practice facilitation of quality improvement projects
Barriers | Facilitators |
|---|---|
Negative perceptions of documentation approach | Positive perceptions of documentation approach |
Perceived low utility of extra effort to document patient refusals | Perceived value in having a way to document of patient refusals of specific vaccines |
High motivation to document HPV vaccine refusals | |
Workflow integration challenges | Workflow integration aids |
Challenging to integrate use of an unfamiliar, non-standard code into existing workflow | Detailed instructions for documenting patient refusals that were provided to practices |
Physicians forgetting to use the “dummy code” to document refusals | |
Lack of time and low prioritization | Adding manual reminders to document (e.g., laminated card) for physicians within the workflow |
Use of “dummy code” complicated the billing process for staff | |
Technical assistance challenges | Technical assistance value |
Multiple EHRs across study practices, requiring the software company to customize approaches for integrating documentation of patient refusals into assessment and feedback reports | Practices that requested support for documenting refusals received assistance from the software company in reviewing their process and refusal codes |
Ability to discuss with QI coach whether or not refusals were showing up in assessment and feedback reports |