Implementation Training

Training Advanced Practice Nurses (APRN) to Implement CER in Primary Care Settings

Patient-Centered Outcomes Research Institute

December 2020 – November 2022

Overall Goal:

The overall goal of the project is to advance the use of CER findings in the primary care setting by building capacity for disseminating and training APRNs, specifically targeting FNPs practicing in underserved and rural communities where they are increasingly filling the gap due to shortage of primary care physicians.

This project has a three-fold purpose: 1) dissemination of PCORI-funded CER findings to APRNs providing care in underserved and rural communities, 2) training of APRNs and other important clinical stakeholders on implementation methods, and 3) support for uptake of the findings in clinical practice. The third part, support for implementation, is critical to facilitate action among APRNs when they return to their patient care settings. Through these efforts, CER evidence will reach health disparities populations, improving outcomes.

Objectives/Activities:

1. Recruit a multi-stakeholder advisory team for program development, including APRNs, organizational leaders, and patients.
2. Use qualitative methods to identify CER findings of interest and the facilitators and barriers to implementation of CER findings in primary care settings to inform program development.
3. Develop a stakeholder-guided implementation training program model that is sustainable post-funding and meets the needs of APRNs working with underserved and rural populations.
4. Disseminate select PCORI-funded CER findings and deliver intensive implementation training to 15 APRNs annually.
5. Develop a support program to aid the implementation and evaluation of CER findings at the clinic level, which includes an implementation resource guide/toolkit for APRNs, based on PCORI’s D & I Toolkit.
6. Evaluate program impact on knowledge, self-efficacy, and intent to use findings (short-term) and assess actual use (long-term)

Long-term objective:

The long-term objective is to continue the APRN dissemination and implementation training program, using the infrastructure established in the proposed project, to increase knowledge of CER findings and implementation methods, which, in return, will contribute to these findings reaching patients in underserved and rural communities.

Because of their increasing presence and evolving role as independent practitioners, APRNs are an important stakeholder group to target for implementation of research findings in the health care setting. APRNs are close to the health problems of patients and the issues they face with treatments. Nurse practitioners are trained with a focus on providing evidence-based care and patient engagement is a core principle of nursing practice. However, APRNs, like other practitioners, are unfamiliar with CER, patient-centered outcomes research (PCOR), and the findings that have been generated through these methods. Targeting this important stakeholder group can potentially result in widespread dissemination and implementation of CER findings. In particular, targeting FNPs providing care in underserved and rural communities, where patient outcomes are worse compared to the general population, for dissemination and implementation of CER findings has the potential to contribute to decreasing health disparities. It is well known that individuals in medically underserved areas (MUA), and rural communities, have poorer health and health outcomes. Some of the challenges that contribute to poor patient outcomes in rural and MUAs are cultural and language barriers, lack of medical specialists, transportation issues, and lack of culturally sensitive providers. Many of these MUAs are considered medical deserts with limited hospitals, urgent care centers, and primary care providers. The most prominent issue is lack of access to quality care. It is clear that lack of health care access, coupled with inconsistencies in delivery of evidence-based care, contribute to the health disparities observed in these communities. Health disparities populations stand to gain the most from patient-engaged implementation of CER findings.