RT Journal Article SR Electronic T1 Implementation of a Hearing Loss Screening Intervention in Primary Care JF The Annals of Family Medicine JO Ann Fam Med FD American Academy of Family Physicians SP 388 OP 395 DO 10.1370/afm.2695 VO 19 IS 5 A1 Melissa DeJonckheere A1 Michael M. McKee A1 Timothy C. Guetterman A1 Lauren S. Schleicher A1 Elie Mulhem A1 Kate Panzer A1 Kathleen Bradley A1 Melissa A. Plegue A1 Mary E. Rapai A1 Lee A. Green A1 Philip Zazove YR 2021 UL http://www.annfammed.org/content/19/5/388.abstract AB PURPOSE Hearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians.METHODS We collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies.RESULTS We interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes.CONCLUSION Integration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes.