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Treatment Intensification (Combination Therapy) Plan | Treatment Intensification (Combination Therapy) Actual |
Describe Intervention (Select ONE; useBPAA Project Roadmap for ideas on evidence-based strategies) Chosen intervention: Expandednurse-run hypertension clinics with provider involvement Plan for intervention: Plan is to have one nurse on Tuesday seeing all HTN pts and 3-4 providers working on that day will be educated on HTN workflows; nurse will bring in one provider to review, change, or continue meds for pts; nurse will also prompt/nudge provider by having a covered formulary list (recently developed) and providing any necessary education on meds to streamline care; nurse will continue to offer training on guideline-supported treatment algorithms and will have regular 3-6 month follow up with providers to assess pt compliance | Chosen Intervention: nurse-run hypertension clinics with provider involvement Date when implemented: planned for mid-October 2023 Updates: |
Reach (#/% patients – or providers, for provider-facing interventions – who participated in intervention) | |
Reach of implementers/providers? Planned: 9 providers involved in HTN clinics (North locations) | Reach of implementers/providers? Actual: |
Reach of patients # of patients receiving treatment intensification)? starting with 4 to 6 patients per clinic (2 to start with) and re-evaluate when started, will look at patients below Planned: # of pts in panel per provider for hypertensive patients
| 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? track the number of patients who came into the clinic and who has BP improvement (1-3 months after visit); can also track the number of patients who were intensified after clinic visit; nurse team plans to use an Excel for tracking pt list(s) and can add a note “meds were intensified” and run reporting use dot phrases; | Were you able to accurately measure how your intervention was working? |
What outcomes do you expect? would expect to see an increase in med intensification for target population based on increased provider education and involvement in med management/treatment planning; would also anticipate decrease in monotherapy prescribing as nurses continue to train on guideline-supported treatment algorithms as part of these “joint visits” | What outcomes have you seen? |
How will you ensure your intervention will be effective for your target population? combination of looking at the data being tracked and qualitative/narrative data with patients and implementers on how intervention is going/progressing tracking by provider | Did your intervention reach the target population? |
What unintended consequences or outcomes might there be? outcomes could be other health maintenance metrics (mammos, paps, vaccines) could be addressed - nurses will be addressing this in Epic during HTN visits | 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. providers and care team nurses (HTN clinic nurses) at North locations | 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? tracking how many patients came in for HTN visits and how many were intensified internal meetings/huddles to discuss clinics and progress being made; discuss issues or patient cases with Dr. Menezes (clinical champion) | 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? | 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:
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?
Explain: | What reinforcements did you put into place to sustain the intervention?
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; useBPAA Project Roadmap for ideas on evidence-based strategies) Chosen intervention: [intervention subject to change] piloting Best Practice Advisory (BPA) popup for MAs Plan for intervention: Plan is to alert MAs that they need to re-check BP and enter this data into the EMR; working with IS team to put pop ups in place in the North location; Dr. Menezes is pilot sponsor will be a pop up if BP is above limit - have to retake BP - a couple of weeks away from implementation. El Rio - two part BPA - one to recheck, 2nd bpa if 2nd one still elevated script to MA to reschedule 2 to 4 weeks - BACH interested in this suggestion. in scheduling column added DBP and SBP so can see who is out of range can see if need to address - at end of the day can see who left with out of range BP and think if did anything on this. | 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:
| 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? | 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:
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?
Explain: | What reinforcements did you put into place to sustain the intervention?
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)? | |
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