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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedPowell KR, Winkler AE, Liu J
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
The objective of this study was to investigate the implementation of telehealth in nursing homes during the COVID-19 pandemic. Researchers conducted a secondary analysis of data from a national survey of nursing home administrative leaders using six survey questions and semi-structured interviews. Their conclusions indicate that training, restructuring teams and tasks, and adaptation of work processes to support communication could improve usability and sustainability of telehealth in nursing homes.
AHRQ-funded; HS02249.
Citation: Powell KR, Winkler AE, Liu J .
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
J Am Geriatr Soc 2022 Dec;70(12):3493-502. doi: 10.1111/jgs.18020..
Keywords: COVID-19, Elderly, Telehealth, Health Information Technology (HIT), Nursing Homes, Implementation
Lewis CC, Klasnja P, Lyon AR
The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms.
The purpose of this project is to identify strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The study reports that once strategy-mechanism linkages are identified, implementation scientists can utilize the resulting searchable database to create customized implementation strategies and generate stronger evidence about which strategies work best in which situations. Additionally, providers will be able to choose implementation strategies that best address their specific implementation challenges. The researchers concluded that new possibilities in implementation strategy development, optimization, evaluation, and deployment are anticipated to be more achievable as a result of this research, which can lead to improved implementation of evidence-based interventions and related improvements in patient outcomes.
AHRQ-funded; HS025632.
Citation: Lewis CC, Klasnja P, Lyon AR .
The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms.
Implement Sci Commun 2022 Oct 22;3(1):114. doi: 10.1186/s43058-022-00358-3..
Keywords: Implementation
Pestka DL, Paterson NL, Brummel AR
Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation.
The objective of this study was to identify barriers and facilitators when integrating pharmacist-provided comprehensive medication management (CMM) services into a health system's team-based primary care transformation (PCT) using the Consolidated Framework for Implementation Research. Findings showed that identifying and addressing implementation barriers and facilitators early during PCT rollout was critical to the success of team-based services such as CMM and becoming a learning health system. Further, clinical pharmacists providing CMM represented a valuable interdisciplinary care team member who can help to improve healthcare quality and access to primary care.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Brummel AR .
Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation.
Am J Health Syst Pharm 2022 Jul 22;79(15):1255-65. doi: 10.1093/ajhp/zxac104..
Keywords: Medication, Provider: Pharmacist, Primary Care, Implementation, Practice Improvement
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Decision Making
Wyse JJ, Mackey K, Lovejoy TI
Expanding access to medications for opioid use disorder through locally-initiated implementation.
The purpose of this study was to identify and describe locally- and internally-developed approaches to improve patient access to medication treatment for opioid use disorder (MOUD). The researchers utilized the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews and ethnographic observations to examine the planning, design, and implementation of a locally-initiated process to expand access to MOUD. The study found that a self-appointed local team successfully developed and implemented a Primary Care-based Buprenorphine Clinic and E-Consult Service to expand access to MOUD to patients across the health care system, including national and local policy changes, identifying appropriate and widely supported models of care delivery and consultation, and increasing staff investment in the efforts by including them in collaborative planning and problem-solving. The study concluded that a local team can plan, develop and build new processes of care that are customized to meet local needs and contribute to long-term sustainability in the community.
AHRQ-funded; HS026370.
Citation: Wyse JJ, Mackey K, Lovejoy TI .
Expanding access to medications for opioid use disorder through locally-initiated implementation.
Addict Sci Clin Pract 2022 Jun 20;17(1):32. doi: 10.1186/s13722-022-00312-7..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Access to Care, Practice Patterns, Implementation
Petragallo R, Bardach N, Ramirez E
Barriers and facilitators to clinical implementation of radiotherapy treatment planning automation: a survey study of medical dosimetrists.
Researchers examined the barriers and facilitators to adoption of commercially available automated planning tools into the clinical workflow using a survey of medical dosimetrists. Through surveys, three categories of barriers to use of automation were identified. This investigation highlighted several concrete approaches that could potentially increase the translation of automation into the clinic, along with areas of needed research.
AHRQ-funded; HS026486.
Citation: Petragallo R, Bardach N, Ramirez E .
Barriers and facilitators to clinical implementation of radiotherapy treatment planning automation: a survey study of medical dosimetrists.
J Appl Clin Med Phys 2022 May;23(5):e13568. doi: 10.1002/acm2.13568..
Keywords: Treatments, Implementation
Cope EL, Johnson M, Khan M
AHRQ Author: Mistry KB
Contextual factors affecting implementation of pediatric quality improvement programs.
Researchers assessed the role of contextual factors in influencing the efforts of 5 diverse quality improvement projects as part of the Pediatric Quality Measure Program (PQMP) directed by AHRQ. In a mixed methods study, they conducted semistructured interviews, followed by structured worksheets, of 5 PQMP grantees. They found that using a determinant framework, such as the Tailored Implementation for Chronic Diseases, is valuable in facilitating comparisons across heterogeneous projects, allowing identification of key contextual factors influencing the implementation of pediatric quality measures across a diverse range of clinical topics and settings.
AHRQ-authored.
Citation: Cope EL, Johnson M, Khan M .
Contextual factors affecting implementation of pediatric quality improvement programs.
Acad Pediatr 2022 Apr;22(3S):S81-S91. doi: 10.1016/j.acap.2021.08.016..
Keywords: Children/Adolescents, Quality Measures, Quality Improvement, Quality of Care, Implementation
Mistry KB, Sagatov RDF, Schur C
AHRQ Author: Mistry KB, Sagatov RDF
Design and implementation of the Pediatric Quality Measures Program 2.0.
This AHRQ-authored research discusses the design and implementation of the Pediatric Quality Measures Program (PQMP) 2.0. The PQMP was established in response to the Children’s Health Insurance Program Reauthorization Act of 2009. AHRQ and CMS awarded 6 grants to Centers of Excellence (COEs) and a contract to facilitate collaboration and learning across the COEs. The COEs partnered with stakeholders from multiple levels to field test real-world implementation and refinement of pediatric quality measures and quality improvement initiatives. A PQMP Learning Collaborative (PQMP-LC) consisting of AHRQ, CMS, the 6 COEs, and L&M Policy Research, LLC was created to complete literature reviews, conduct key informant interviews, and collect data to develop reports to address the Research Foci. It also aided with development of measure implementation and quality improvement toolkits; conceptualized an implementation science framework, analysis, and roadmap; and facilitated dissemination of learnings and products. The various products created are intended to support the uptake of PQMP measures and inform future pediatric measurement and improvement work.
AHRQ-authored.
Citation: Mistry KB, Sagatov RDF, Schur C .
Design and implementation of the Pediatric Quality Measures Program 2.0.
Acad Pediatr 2022 Apr;22(3s):S59-S64. doi: 10.1016/j.acap.2021.12.021..
Keywords: Children/Adolescents, Medicaid, Children's Health Insurance Program (CHIP), Quality Measures, Quality Improvement, Quality of Care, Implementation
Schnipper JL, Reyes Nieva H, Mallouk M
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
This study was a follow-up of the first Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS1) that demonstrated mentored implementation of a medication reconciliation best practices toolkit. The toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The toolkit has been refined with lessons learned and retooled as MARQUIS2. The tool was implemented at 18 North American hospitals or hospital systems from 2016 to 2018, offering 17 system-level and 6-patient-level interventions. One of eight physicians coached each site remotely via monthly calls and one or two site visits. A total of 4947 patients were sampled, with 1229 preimplementation and 3718 postimplementation. A steady decline in medication discrepancy rates were experienced from 2.85 discrepancies per patient down to 0.98 discrepancies. An interrupted time series analysis of the 17 sites showed the intervention was associated with a 5% relative decrease in discrepancies per month.
AHRQ-funded; HS025486; HS023757.
Citation: Schnipper JL, Reyes Nieva H, Mallouk M .
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
BMJ Qual Saf 2022 Apr;31(4):278-86. doi: 10.1136/bmjqs-2020-012709..
Keywords: Medication, Evidence-Based Practice, Tools & Toolkits, Implementation, Quality Improvement, Quality of Care, Medication: Safety, Patient Safety
Forrest CB, Simpson L, Mistry KB
AHRQ Author: Mistry KB
PQMP Phase 2: implementation and dissemination.
The authors provide an overview of the articles in this supplement concerning the Children’s Health Insurance Program Reauthorization Act Pediatric Quality Measures Program (PQMP). The articles examine the opportunities and challenges associated with the PQMP 2.0 work of the Centers for Excellence and how findings may advance the science for pediatric quality measurement and improvement, and, ultimately, child health outcomes.
AHRQ-authored.
Citation: Forrest CB, Simpson L, Mistry KB .
PQMP Phase 2: implementation and dissemination.
Acad Pediatr 2022 Apr;22(3s):S55-S58. doi: 10.1016/j.acap.2022.01.012..
Keywords: Children/Adolescents, Medicaid, Children's Health Insurance Program (CHIP), Quality Measures, Quality Improvement, Quality of Care, Implementation
Schur C, Johnson M, Doherty J
AHRQ Author: Mistry KB
Real-world considerations for implementing pediatric quality measures: insights from key stakeholders.
This AHRQ-authored paper describes key stakeholder insights focused on measure implementation and increasing the uptake of Pediatric Quality Measures (PQM). The PQMP Learning Collaborative conducted semistructured interviews with 9 key informants (KIs) presenting states, health plans, and other potential end users. The interviews focused on obtaining KIs’ perspectives on 6 research questions focused on assessing the feasibility and usability of PQM and strengthening the connection between measurement and improvement. The KIs uniformly acknowledged the complexity of the issues raised and pinpointed multiple unresolved issues.
AHRQ-authored; AHRQ-funded; 290201400003I.
Citation: Schur C, Johnson M, Doherty J .
Real-world considerations for implementing pediatric quality measures: insights from key stakeholders.
Acad Pediatr 2022 Apr;22(3S):S76-S80. doi: 10.1016/j.acap.2021.04.007..
Keywords: Children/Adolescents, Medicaid, Children's Health Insurance Program (CHIP), Quality Measures, Quality Improvement, Quality of Care, Implementation
Kukhareva PV, Weir C, Del Fiol G
Evaluation in Life Cycle of Information Technology (ELICIT) framework: supporting the innovation life cycle from business case assessment to summative evaluation.
The authors developed an evaluation framework for electronic health record-integrated innovations to support activities at four information technology (IT) life cycle phases: planning, development, implementation, and operation. The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers these four phases and three measure levels: society, user, and IT. The ELICIT framework recommends 12 evaluation steps. The authors concluded that, as health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated, and their framework can facilitate such evaluations.
AHRQ-funded; HS026198.
Citation: Kukhareva PV, Weir C, Del Fiol G .
Evaluation in Life Cycle of Information Technology (ELICIT) framework: supporting the innovation life cycle from business case assessment to summative evaluation.
J Biomed Inform 2022 Mar; 127:104014. doi: 10.1016/j.jbi.2022.104014..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Implementation
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Barnes GD, Sippola E, Ranusch A
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
This study examined the implementation of electronic dashboards and the key barriers that were found. Semi-structured interviews were conducted at the national Veterans Health Affairs (VA) following implementation of a population health tool, and in Michigan for the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2) dashboard tool designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians. A total of 45 stakeholders were interviewed, 32 at the VA, and 13 at MAQI(2). Five key determinants of implementation success were identified: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about IT support and prioritization within MAQI(2) prior to implementation but not VHA after implementation and also concerns about authority and autonomy.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Ranusch A .
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
Implement Sci Commun 2022 Feb 2;3(1):10. doi: 10.1186/s43058-022-00262-w..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Blood Thinners, Medication, Implementation
Katz MJ, Tamma PD, Cosgrove SE
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
The purpose of this study was to determine if AHRQ’s Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use in long-term care (LTC) facilities in the US. Findings showed that participation in the AHRQ safety program was associated with the development of antibiotic stewardship programs (ASPs) that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in days of antibiotic therapy and starts, which was more pronounced in more engaged facilities, indicated that implementation of this multifaceted program may support successful ASPs in LTC settings.
AHRQ-funded; 233201500020I.
Citation: Katz MJ, Tamma PD, Cosgrove SE .
Implementation of an antibiotic stewardship program in long-term care facilities across the US.
JAMA Netw Open 2022 Feb;5(2):e220181. doi: 10.1001/jamanetworkopen.2022.0181..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Long-Term Care, Medication, Implementation, Patient Safety
Chyr LC, DeGroot L, Waldfogel JM
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
The purpose of this study was to assess the implementation of models for integrating palliative care into ambulatory care for adults with noncancer serious chronic illness. Between January 2000 to May 2020, the researchers reviewed 3 electronic databases and included qualitative, mixed methods studies, and randomized and nonrandomized controlled trial studies. Quantitative analysis included 14 studies of 2,934 US adult patients. The study found that when compared to usual care the models assessed were not more effective for improving patient health-related quality of life (HRQOL) or for patient depressive symptom scores. Qualitative analysis included 5 studies of 146 patients. There was variance in patient preferences for appropriate timing of palliative care; barriers to implementation included costs, additional visits, and travel. The researchers concluded that models were not more effective than usual care for improving HRQOL or depressive symptom scores and may have little to no effect on decreasing overall symptom burden but were more effective for increasing AD documentation.
AHRQ-funded; 2902015000061
Citation: Chyr LC, DeGroot L, Waldfogel JM .
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
Ann Fam Med 2022 Jan-Feb;20(1):77-83. doi: 10.1370/afm.2754..
Keywords: Chronic Conditions, Palliative Care, Implementation, Patient-Centered Healthcare, Quality of Life
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Nease DE .
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords: Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Rangachari P
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
In this paper, Rangachari (1) reviewed the theoretical literatures on technology use & implementation, and identified a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outlined a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identified strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
J Hosp Adm 2014 Dec;3(6):66-78. doi: 10.5430/jha.v3n6p66.
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Keywords: Health Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Implementation
Mold JW, Aspy CB, Smith PD
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
This study was conducted to determine whether practice-based research networks (PBRNs) could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices. After the intervention, the initial four PBRNs increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices, which also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency. The researchers concluded that, with some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices.
AHRQ-funded; HS019945.
Citation: Mold JW, Aspy CB, Smith PD .
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
Implement Sci 2014 Nov 23;9:169. doi: 10.1186/s13012-014-0169-x.
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Keywords: Practice-Based Research Network (PBRN), Primary Care, Kidney Disease and Health, Chronic Conditions, Guidelines, Implementation
Werner JJ, Stange KC
Praxis-based research networks: an emerging paradigm for research that is rigorous, relevant, and inclusive.
The authors argue that praxis-based research networks (PBRNs) are dynamically evolving to meet the needs of communities by partnering to generate new knowledge that can benefit community and population health. Furthermore, the praxis-based research network model facilitates adaptive partnering and provides a learning mechanism that enables the formation of new collaborations while remaining true to the core values of PBRNs.
AHRQ-funded; HS021648.
Citation: Werner JJ, Stange KC .
Praxis-based research networks: an emerging paradigm for research that is rigorous, relevant, and inclusive.
J Am Board Fam Med 2014 Nov-Dec;27(6):730-5. doi: 10.3122/jabfm.2014.06.140034..
Keywords: Practice-Based Research Network (PBRN), Implementation, Community Partnerships
Holzer JK, Ellis L, Merritt MW
Why we need community engagement in medical research.
The aim of this article was to illustrate how community engagement can help to remedy shortfalls of community trust, participant enrollment, and uptake of research findings. After briefly describing these shortfalls, the authors considered 3 case examples that demonstrate the potential of community engagement to address each. They also discussed the ethical importance and implications of demonstrating respect for the community.
AHRQ-funded; HS017589.
Citation: Holzer JK, Ellis L, Merritt MW .
Why we need community engagement in medical research.
J Investig Med 2014 Aug;62(6):851-5. doi: 10.1097/jim.0000000000000097..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Research Methodologies, Implementation
Weng C, Payne PR, Velez M
Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.
This vision paper discusses the value and feasibility of supporting symbiosis in text-based knowledge acquisition (KA) and knowledge representation (KR). It concludes that KA for KR should be made explicit, scalable, elastic, iterative, and “just expressive enough” to allow NLP-assisted knowledge engineering and increase the facility by which clinical practice guidelines are translated from research into practice.
AHRQ-funded; HS022961.
Citation: Weng C, Payne PR, Velez M .
Towards symbiosis in knowledge representation and natural language processing for structuring clinical practice guidelines.
Stud Health Technol Inform 2014;201:461-9..
Keywords: Evidence-Based Practice, Guidelines, Implementation, Health Information Technology (HIT)