West Oakland Health Center Intervention Assessment

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Important Health Center Context Fill out this section during your planning process
Internal Characteristics
What are the characteristics of your health center? (rural/urban; other demographic variables, use of expanded care team, culture)?	most pts are Black/AA or Hispanic; @ WOH site primarily AA; East Oakland primarily Hispanic (most HTN between these two groups); high # of homeless pop - challenging to keep in outreach; community health dept handles outreach - hired health coach to utilize as educator (more focused on outreach and engagement than in clinic work)
How do interventions and/or workflows need to be adapted to ensure health equity?	lean on community health dept a lot to incorporate equity - help to identify barriers for pts - work with underprivileged communities so find ways to help pts prio health (e.g., need healthy food, provide gift cards, education, transportation)
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)?	main barrier is understaffing which makes all workflows much harder to implement - saw the impact of this on most of their measures; provider schedules also adds to perceived difficulty - pts feel appts are so far away that they end up not wanting to come in; BP clinic is helping to relieve that wait time and can address some of these concerns with a fully staffed community health dept and new providers currently onboarding
What are key characteristics of the participating setting(s)?	having an in-house pharmacy at WOH has been an enabler for medication-related interventions as it relates to HTN; BP clinic set up is also unique to WOH and can help with BP compliance
External Characteristics
What external or environmental supports or threats are there?

Treatment Intensification (Combination Therapy)

Plan

Treatment Intensification (Combination Therapy)

Actual

Describe Intervention

(Select ONE; use BPAA Project Roadmap for ideas on evidence-based strategies)

Chosen intervention: Having a provider champion train clinicians on guideline-supported treatment algorithms

Plan for intervention: Provider champion (Dr. Vanessa Grubbs) will help train and educate new providers on treatment algorithms to speed up the onboarding process and will refresh knowledge sharing efforts for existing provider group; the plan is to have her help new clinicians become aware of existing workflows and get them quickly up to speed; she will essentially be in communication with providers to help bridge the information gap; cadence and structure of training will be determined, but she will begin joining internal meetings to discuss HTN workflows and any needed workflows changes

Chosen Intervention: provider champion for clinician training on guideline-supported treatment algorithms

Date when implemented: August 2023

Updates: TBD

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

Reach of implementers/providers?

Planned:

Reach of implementers/providers?

Actual:

Reach of patients (# of patients receiving treatment intensification)?

Planned:

# AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023):
# AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023):

Reach of patients (# of patients receiving treatment intensification)?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

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

What outcomes do you expect?

What outcomes have you seen?

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

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

What unintended outcomes did you experience?

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.

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

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?

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

What were the barriers to consistent intervention implementation?

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)?

Intervention #2

Plan

Intervention #2

Actual

Describe Intervention

(Select ONE; use BPAA Project Roadmap for ideas on evidence-based strategies)

Chosen intervention: implementing joint visits (nurse-provider) to involve provider in HTN education and treatment planning

Plan for intervention: The intervention will add providers to educational visits for HTN pts (the WOH team is deciding if this will be a telephone call with the pt and a nurse/virtual, or whether the provider will be in the exam room in person); instead of a referral from BP clinic → provider, the provider would join the educational visit and treatment plans can be finalized at the point of care; WOH is still looking to leverage their in-house pharmacy for this partnership as part of their HTN workflows (e.g., if a provider is unavailable and the pt needs a medication adjustment)

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

Reach of implementers/providers?

Actual:

Reach of patients (# of patients receiving treatment intensification)?

Planned:

# AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023):
# AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023):