Page Comparison

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:EMBED ALGORITHM INTO CARE PROCESSES.

Plan for intervention: Engage clinicians across the organization in the development of a treatment protocol for hypertensive patients and pilot implementation of the protocol.

Chosen Intervention: EMBED ALGORITHM INTO CARE PROCESSES.

Date when implemented: October, 2023

Updates: 1/18 - to implement algorithm into care processes followed by pilot-providers.

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

Reach of implementers/providers?

Planned: 12 Providers

1. Taylor IM - 3 Providers

2. Lincoln Park IM - 3 Providers

3. Inkster IM - 5 Providers

4. Dearborn IM - 1 Provider

Reach of implementers/providers?

Data Update: (2/27/2024)

1. Taylor IM - 3 providers

2. Lincoln Park IM - 3 Providers

3. Inkster IM - 5 Providers

4. Dearborn IM - 1 Provider

Actual:

Taylor and Inkster sites are implementing interventions to pilot the algorithm.

Data Update: (3/11/2024)

Informed providers, MA’s, and CHW’s (all sites) of PVP reports being sent every week to establish care for HTN Med. Intensification - by specific cohorts. Ex. AMA MAP HTN Med. Intensification, WW Million Hearts AA Uncontrolled HTN

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

1. 5% of patients from HTN no therapy to guideline therapy.

Goal: 24 patients with uncontrolled HTN on no therapy to monotherapy or combination therapy.

2. 5% patients from HTN on monotherapy to guideline recommended therapy.

Goal: 26 Patients with uncontrolled HTN on monotherapy to combination therapy.

Baseline Data (as of 6/30/2023):

• # AA pts. w/uncontrolled HTN on no therapy: 82/502 - 16.33%

• # AA pts. w/uncontrolled HTN on monotherapy: 141/502 - 20.08%

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

Actual:

Data Update: (2/27/2024)

• # AA pts. w/uncontrolled HTN on no therapy: 63/497 - 12.67% | We had a 3.66% decrease in this measure, showing a positive trend. That is about 18 patients who are now receiving mono/combination therapy since our baseline date:(06/30/2023).

• # AA pts. w/uncontrolled HTN on monotherapy: 127/497 - 25.55% | We had a 5.47% increase in this measure, showing a positive trend. That is about 28 patients who are now receiving mono-therapy since our baseline date:(06/30/2023).

Data Update: (3/27/2024)

• # AA pts. w/uncontrolled HTN on no therapy:70/519 - 13.5% | We had a 0.83% increase in this measure, showing a negative trend. This is possibly due to the increase of our denominator.

• # AA pts. w/uncontrolled HTN on monotherapy:128/519 - 24.66% | We had a 0.89% decrease in this measure, showing a negative trend. This is possibly due to the increase of our denominator.

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

Assess Providers barriers and successes through surveys and discussions during Provider meetings; Monitor Dr. Malcom’s patients during the pilot.

NOTE: NACHC glad to assist with survey methodology

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

Data Update: (2/27/2024)

Currently monitoring Uncontrolled HTN on No Anti-HTN Medications and AMA MAP BP™ - HTN-Medication Intensification scorecards.

Monitor Excel sheets with patient gaps - check charts to see if visits are fulfilled.

Refection of data unto the Azara scorecards on a monthly basis. Shared data at provider meetings (Dr. Malcolm and NP Gertz) for updates.

Data Update: (3/11/2024)

We are targeting patients on a weekly basis from each site utilizing the above scorecards by rendering location and individual provider. Conducting a monthly audit for progress check in according measures. Reach and Efficacy tabs to be updated by end of month.

Data Update: (4/02/2024)

What outcomes do you expect?

Standardized protocol for all Providers throughout Western Wayne.

Improvement on Uncontrolled HTN on No Anti-HTN Medications reduced by 5%. Goal: 10%.

Improvement on AMA MAP BP™ - HTN-Medication Intensification increased by 15%. Goal: 30%.

What outcomes have you seen?

Data Update: (2/27/2024)

For HTN Medication Intensification, we have been able to move our percentage rate from 1% from 15% - 16% for AMA MAP BP™ - HTN-Medication Intensification for WWFHC.

We have been able to move our percentage rate from a 1% decrease from 13% - 12% for Uncontrolled HTN on No Anti-HTN Medications for WWFHC (inverse measure).

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

Monitor process and outcome data within the Million Hearts Scorecard in Azara, as well as individual Provider scorecards.

Did your intervention reach the target population?

Data Update: (2/27/2024)

We have been able to reach our target population as a result of point-of-contact through PVP Azara cohort alerts.

What unintended consequences or outcomes might there be?

1. Provider apprehension

What unintended outcomes did you experience?

Data Update: (2/27/2024)

We are moving slower pace due to patient availability for scheduled appointments. Provider schedules are at times booked beyond a one-month period.

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.

PRIMARY LOCATION: Inkster - Dr. Latisha Malcom (MD), Medical Assistants (MA), Community Health Workers (CHW), Clinical Supervisors.

PRIMARY PILOT LOCATION: Lincoln Park - Dr. Sanjoy Mukerjee (MD), Medical Assistants (MA), Community Health Workers (CHW), Clinical Supervisors.

SECONDARY PILOT LOCATION: Taylor - Danielle Gertz (NP), Medical Assistants (MA), Community Health Workers (CHW), Clinical Supervisors.

SECONDARY PILOT LOCATION: Dearborn - Dr. Mazraani (MD), Medical Assistants (MA), Community Health Workers (CHW), Clinical Supervisors.

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

Data Update: (2/27/2024)

Introduction of algorithm took place in a provider meeting where all providers were present.

Data Update: (3/11/2024)

Informed providers, MA’s, and CHW’s of PVP reports being sent every week to establish care for HTN Med. Intensification - by specific cohorts. Ex. AMA MAP HTN Med. Intensification.

Data Update: (4/02/2024)

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

Review the change in the measure, AMA MAP BP™ - HTN-Medication Intensification, from baseline provider meeting. Establish touch-base through provider meetings.

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

Data Update: (2/27/2024)

1/4 (25% of our providers) are implementing this intervention through WWFHC.

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?

Data Update: (2/27/2024)

Meetings were arranged prioritizing change management, now we are moving back to project implementation. Currently have provider buy-in.

Data Update: (3/11/2024)

Specific outreach to each provider with list of upcoming patients to have established care for HTN intensified treatment.

Data Update: (4/2/2024)

Each week, emails regarding patients scheduled for the week that qualify for HTN Med. Intensification are sent to 9 Internal Med. providers and their Medical Assistants.

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:

•  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: Presenting Million Hearts metrics quarterly at our Inter Quality Improvement Committee (IQIC) meetings to our clinical staff.

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: Million Hearts progress metrics presented during our X Date IQIC meeting and were well received by our clinical team.

How will you spread your intervention and lessons learned?

We will share updates on the progress of Million Hearts metrics quarterly at our provider meetings.

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)?

Need to have a standardized and continuous system of patient outreach. Perhaps investing in a tech solution that automates this.