Page Comparison

Internal Characteristics

What are the characteristics of your health center? (rural/urban; other demographic variables, use of expanded care team, culture)?  

Urban FQHC that serves over 40,000 patients annually. Last year 56% of pts were black/AA and 28% reported being Hispanic.

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

Use expanded care team. Our organization engages in ongoing QI work to ensure quality, safety, and value for our patients, and we have an organizational commitment to QI capacity.

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

For the purposes of this project, we continue to utilize the patient details list to determine / drive how we are implementing and delivering our interventions. This is to ensure that we are targeting our AA patient population and improving health equity in our health centers.

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)?

The interventions we have selected are:

• to continue to use the patient detail list to target (no therapy, active patients, uncontrolled HTN) to message utilizing our WELL bidirectional software to encourage patients to see their PCP and/or the clinical pharmacy team (data-driven patient outreach)

• we are continuing to assist patients with obtaining validated, automated home BP measurement devices with appropriately-sized upper arm cuffs to improve patient engagement

The interventions are not super complex because we are able to use the patient detail list as well as some in-house data to drive these interventions. Additionally, we have already established the protocols for ordering a BP cuff for our patients directly through the pharmacy. So the amount of steps and disruptiveness for these interventions is reduced.

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

Urban FQHC that serves over 40,000 patients annually. Last year 56% of pts were black/AA and 28% reported being Hispanic. Use expanded care team. Our organization engages in ongoing QI work to ensure quality, safety, and value for our patients, and we have an organizational commitment to QI capacity.

External Characteristics

What external or environmental supports or threats are there?

Some of the identified external or environmental threats are difficulties experienced with our patients in regards to transportation & ability to pay.