Communicare Intervention Assessment

Internal Characteristics

What are the characteristics of your health center? (rural/urban; other demographic variables)?  

Our health centers are in both urban and rural areas. 70% of patients are 100% and below poverty line; 73% are insured by Medicaid/Medicare; 54% are Hispanic or Latinx; 18% of our patient base comprise of special populations (unhoused, agriculture workers & families, veterans).

What are the infrastructure characteristics of your health center (use of expanded care team, culture)?

How do interventions and/or workflows need to be adapted to ensure health equity?

41% of CCHC patients are best served in a language other than English so providing written education materials, videos in other languages are important. In pursuit of health equity, our DEI practices at CCHC focus on meeting each patient where they are so the interventions chosen are to ensure each patient’s understanding related to their specific data.

How complex are the patient interventions to implement (e.g., perceived difficulty of implementation, reflected by duration, scope, radicalness, disruptiveness, and number of steps required)?

Currently, all interventions are done in the exam room (videos) and the ASCVD calculator teaching tool is shown via provider’s iPhone or iPad with the patient.

What are key characteristics of the participating setting(s)?

All Davis providers have access to iPads

External Characteristics

What external or environmental supports or threats are there?

Intervention #2

Plan

Intervention #2

Actual

Describe Intervention
Chosen intervention: ASCVD Risk calculator
Plan for intervention: Continue using iPads to expand beyond the pilot team at DCC to all provider teams at DCC by Dec 2023. Starting Mar 2024, we will roll out risk calculator tool (using iPads) to all provider teams at the remaining CCHC sites.

Chosen Intervention:

Date when implemented: Not implemented yet, haven’t been able to build it in. Added risk calculator link to iPad to click on videos and clinician use it in internet.

Updates: In February 2024, iPads were received by all care teams at Davis. We will be targeting interventional education videos with all patients.

Updates: 03/11/24

Three other sites will receive loaded iPads and continue rolling out the risk calculator tool. Napa is shifting towards using QR codes and printed-out flyers/ handouts containing educational materials. Health center is using it as a conversation tool with patients related to side effects/for patients who are high risk/may not be adherent to medications, focus on patient and provider conversations for planning

Reach (#/% patients – or providers, for provider-facing interventions – who participated in intervention)

Reach of implementers/providers?

Planned: All sites, working on the estimated number, probably more than intervention. 2-4 providers.

Reach of implementers/providers?

Actual: 2-4 providers, who Davis Family site, will be rolling it out at other sites

Reach of patients?

Planned: 6 patients/day average per team

Reach of patients?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

number of patients exposed to the risk tool and their understanding, including conversations with provider, what their cardiovascular disease risk means and steps to manage.

Were you able to accurately measure how your intervention was working?

suggestion: did patient receive a statin, but also assess patient decision to go on a statin (video,

calculator or both - sample of patients)

number of conversations to create that change - how do prescribing patterns relate to this

What outcomes do you expect?

• regarding cardiovascular risk, we encourage patient autonomy by choosing their intervention from, (A) physical activity goal, (B) caloric intake goal (C) medication goal

What outcomes have you seen?

the patients have been able to play with the numbers in conjunction with the video, haven’t been able to

patients who are already on the statin affirm that they would like to see if they would like to see additional videos in the future.

Patients not on statin they play video then play with the calculator

How will you ensure your intervention will be effective for your target population?

we believe patient-driven choice/participation will be more motivating to reduce risk than provider-driven.

Did your intervention reach the target population? Yes, focus on patients who are eligible to be on a statin but weren’t

What unintended consequences or outcomes might there be?

we are hopeful the patient visit will be motivated to achieve positive change however the strategy chosen maybe something other than a statin.

What unintended outcomes did you experience? No unintended outcomes

Adoption (#/% and representativeness of staff and sites who implemented the intervention)

How did clinicians respond to interventions to intensify medication more rapidly/address therapeutic inertia?

Who will deliver the intervention (actually do the work)? Include staff and sites, if applicable.

Providers, medical assistants

Who delivered the intervention? Did they have the skills and time needed to complete the intervention?

Easier to have conversations with providers who have established panels, but want providers to have the same tools and for patients to have same information. Providers have the necessary skills, but could move to a health educator/clinical pharmacist (at Napa) in the future

How will you know if clinicians/care teams/sites used the intervention?

What proportion of the planned staff/sites implemented the intervention?

Were there any differences between care teams/sites who adopted the intervention best vs. others who did not (e.g., differences in staff types, capacity, etc.)?

Implementation Fidelity (How closely the staff/sites followed the intervention design, delivered it as intended – also called fidelity to the intervention)

How will you know what adaptations or modifications were made during the intervention?

How did you track modifications during the intervention? Using QR code, sharing statin patient education video in waiting room and now using in between MA rooming and provider coming in

What might be some of the possible obstacles to consistent implementation?

What were the barriers to consistent intervention implementation?

No existing lists tailored to providers

What costs and resources (including time and burden, not just money) need to be considered?

What costs and resources (including time and burden, not just money) need to be considered?

How closely did the staff/sites follow the intervention design and deliver as intended?

Check all that apply:

• Followed as designed
• Followed with minor modifications
• Followed somewhat as designed
• Not followed as design
• Delivered consistently/as intended
• Delivered somewhat consistently/somewhat as intended
• Delivered inconsistently/not as intended

Modifications made and other notes:

Maintenance (Extent to which intervention is part of routine practices and protocols)

What reinforcements will you put in place to sustain the intervention, if effective?

• Protocols
• Clinical decision support (alerts, order sets, templates, registries)
• Policies
• Regular training
• Regular reports
• Incentives
• Other:

Explain:

What reinforcements did you put into place to sustain the intervention?

• Protocols
• Clinical decision support (alerts, order sets, templates, registries)
• Policies
• Regular training
• Regular reports
• Incentives
• Other:

Explain:

How will you spread your intervention and lessons learned?

How will you spread your intervention and lessons learned?

What are likely modifications or adaptations that will need to be made to sustain the intervention over time (e.g., lower cost, different staff, reduced intensity, different settings)?