• CEDI research has the potential to improve health inequities. • QuitSMART Utah used a multi-component community engagement process. • The partnership had shared goals, resources, data, and mutual respect of expertise.

Our objective was to develop an evaluation framework for electronic health record (EHR)-integrated innovations to support evaluation activities at each of four information technology (IT) life cycle phases: planning, development, implementation, and operation. The evaluation framework was developed based on a review of existing evaluation frameworks from health informatics and other domains (human factors engineering, software engineering, and social sciences); expert consensus; and real-world testing in multiple EHR-integrated innovation studies. The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers four IT life cycle phases and three measure levels (society, user, and IT). The ELICIT framework recommends 12 evaluation steps: 1) business case assessment; 2) stakeholder requirements gathering; 3) technical requirements gathering; 4) technical acceptability assessment; 5) user acceptability assessment; 6) social acceptability assessment; 7) social implementation assessment; 8) initial user satisfaction assessment; 9) technical implementation assessment; 10) technical portability assessment; 11) long-term user satisfaction assessment; and 12) social outcomes assessment. Effective evaluation requires a shared understanding and collaboration across disciplines throughout the entire IT life cycle. In contrast with previous evaluation frameworks, the ELICIT framework focuses on all phases of the IT life cycle across the society, user, and IT levels. Institutions seeking to establish evaluation programs for EHR-integrated innovations could use our framework to create such shared understanding and justify the need to invest in evaluation. As health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated. The ELICIT framework can facilitate these evaluations.

Background: Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. Methods: This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. Discussion: This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. Trial registration: This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.

This study examined moderate-to-vigorous physical activity (MVPA) levels in youth during flag football practice and compared youth MVPA in practices led by trained or untrained, and by experienced or inexperienced, coaches. Boys (n = 111, mean age = 7.9 ± 1.2 years) from 14 recreation-level flag football teams wore an accelerometer during two practices. Each team’s volunteer head coach reported prior training and coaching experience. Mixed-model team-adjusted means showed the proportion of practice time spent in sedentary (13 ± 1%), MVPA (34 ± 2%) and vigorous (12 ± 1%) activity. Practice contributed ~20 min of MVPA towards public health guidelines. There was no significant difference in percentage time spent in MVPA between teams with trained (mean = 33.3%, 95% CI = 29.4%, 37.2%) and untrained coaches (mean = 35.9%, 95% CI = 25.5%, 42.4%) or between experienced (mean = 34.1%, 95% CI = 30.2%, 38.0%) and inexperienced coaches (mean = 33.8, 95% CI = 27.9%, 39.7%). Although sport provides a setting for youth to accrue MVPA, two-thirds of practice was spent sedentarily or in light activity. Participation in a coach training programme was not associated with higher MVPA. Further research is needed to inform volunteer coach training programmes that provide coaches with skills necessary to increase the percentage of practice time spent in MVPA.