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BACKGROUND: This is a study of 2 clinical feed forward systems (FFSs) situated in different contexts: in the United States, where the system was developed, and in Swedish clinical settings, where it was first adopted. Both systems were identified as clinically successful despite differing contexts, and the objective of this study is to understand what essential properties determined their success. METHODS: In our search for essential properties of the FFS, we used acceptance, use, and utility as indicators in questionnaires and interviews of patients and providers. Properties were identified as essential if they enabled reinforcing loops favorable for patients, providers, or both at clinical encounters. RESULTS: A total of 44 patients participated in each context, along with 13 providers from the United States and 6 providers from the Swedish clinics. In the patient questionnaire, a majority of patients rated their impression of the FFS as excellent to good (United States: 84%, Sweden: 96%, P < .001). Interviews with both patients and providers indicated that the FFS patient overview displaying structured data previous to the clinical encounter is favorable. These essential properties enabled patient involvement through engagement, education, and communication with the provider, who appreciated them as time-saving for managing data and as decision support. DISCUSSION: Despite distinctly different contexts and locally adapted content, essential properties that induced successful patient participation and provider support were identified as universal in the FFSs. Thus, further spread of the FFS may be enabled to accomplish patient-centered care and improved clinical information and quality management.
Hvitfeldt et al. (2009) studied this question.