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Instructions: Use the pencil icon in the top right to edit the form below. ↗️ Remember to push PUBLISH when you are done to save your work. |
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Important Health Center Context Fill out this section during your planning process | |
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Internal Characteristics | |
What are the characteristics of your health center? (rural/urban; other demographic variables, use of expanded care team, culture)? | Diverse population (including homeless). Some patients qualify under a special program called Care Neighborhood. Some patients utilize specialty clinics (like HIV). Needed to adjust to reach/expand to these patients. |
What are the infrastructure characteristics of your health center (use of expanded care team, culture)? | Used expanded care teams to address MH patients with special conditions (BP cuffs, nutrition, HTN clinics). |
How do interventions and/or workflows need to be adapted to ensure health equity? | Same workflows implemented for all patients (BP cuffs were made available to all patients regardless of insurance). Made sure as many patients as possible had access to BP devices. Have a food pharmacy to help with nutritional needs. Gave advice to different ethnic groups on how they can improve their nutrition (recipe ideas, reducing sodium intake). Some MH patients also offered Recipe4Health (food farmacy + health coaching). Access to these programs were made available to all MH patients |
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)? | Hard to convince providers to use combo therapy over monotherapy. Many difficult discussions/debates about effectiveness of combo therapy; also hard to bring providers together to huddle. Difficult to coordinate a time that works for the entire staff. |
What are key characteristics of the participating setting(s)? | To be answered for October submission |
External Characteristics | |
What external or environmental supports or threats are there? | |
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Intervention #2 Plan | Intervention #2 Actual |
Describe Intervention (Select ONE; useBPAA Project Roadmap for ideas on evidence-based strategies) Chosen intervention: 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: 12/20 have started the clinics and put a pop up alert to take 2nd BP (MAs) started additional providers in early December and the pop up started mid December |
Reach (#/% patients – or providers, for provider-facing interventions – who participated in intervention) | |
Reach of implementers/providers? Planned: Roughly # of MAs? Liberty: 10 - 14 providers → 1.5 MAs (anywhere from 50-60 MAs); leads will let them know that they need to address the BPA when it pops up; training on viewing the BPA | 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? Of MH patient list, track # of patients who came in during the month and had a second BP documented in EMR; if using MA script, can look at # of patients rescheduled 2 to 4 weeks out and then visit rate (who showed up for scheduled appt after MA outreach) | Were you able to accurately measure how your intervention was working? 12/20 for tracking purposes and to assess - IS department - how many popups show up and how many 2nd BPS are taken |
What outcomes do you expect? With MA outreach after elevated second BP reading, we’d expect to see an increase in pt engagement for those who have elevated BP, and potentially an increase in # of AA adults who received medication intensification at follow up visit | What outcomes have you seen? |
How will you ensure your intervention will be effective for your target population? Maybe adding a race/ethnicity field to see whether pt is part of MH | Did your intervention reach the target population? |
What unintended consequences or outcomes might there be? Opportunity cost of having MAs spend additional time on second BP check and outreach for pts with elevated BP; positively, training MAs to acknowledge and act on BPAs can help with implementation of other clinical decision support tools on the horizon for 2024 (e.g., SmartDx for HTN). | 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. MA staff at all North location; if provider notices elevated BP they will outreach to schedule f/u; if it’s gap in care just try to get the pt in as quickly as possible | 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? Education and onboarding of MAs; and re-educating current MAs; possible IS reporting (# of BPAs that pop up) | 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? MA teams with supervisors meet regularly to discuss implementation and make any needed adjustments; modifications will be discussed during team meetings and training sessions | How did you track modifications during the intervention? |
What might be some of the possible obstacles to consistent implementation? Consistent staffing; MAs may be pulled into other tasks, which impacts their ability to follow the workflow for BPA popup and recheck BP | What were the barriers to consistent intervention implementation? |
What costs and resources (including time and burden, not just money) need to be considered? Up front training time; IS time needed to set up BPA and help with reporting; re-educating of current MAs on a new process will take time | 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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