...
Intervention #2 Plan | Intervention #2 Actual |
Describe Intervention Chosen intervention: Patient outreach (2) weekly, utilizing Relevant report. Focus on patients with LDL >= 190 who are not on statin. Plan for intervention: Case Manager to outreach via report weekly | Chosen Intervention: Date when implemented: Updates: Set-up an excel spreadsheet on 2/2/24. Will start the week on 2/5/24 outreaching patients. Began reviewing patient charts on 2/5/2024 and will continue on a weekly basis. Relevant report contains a list of patients with Diabetes and who have an LDL >= 190. |
Reach (#/% patients – or providers, for provider-facing interventions – who participated in intervention) | |
Reach of implementers/providers? Planned: N/A | Reach of implementers/providers? Actual: |
Reach of patients? Planned: 40 patients | Reach of patients? Actual: 7 patients as of 2/20/2024. Out of the 7, 1 patient who had an elevated LDL wants to try lifestyle modifications prior to starting a statin. 14 41 patients as of 3/19/2024. 18 patients as of 4/2/2024. 21 patients as of 4/16/2024by end of June 2024 reached. |
Efficacy (Impact of intervention on important outcomes) | |
How will you measure that your intervention is working? Via monthly data pull of patients with LDL greater than or equal to 190 who are on prescription. | Were you able to accurately measure how your intervention was working? Track quarterly. Review monthly data with HealthEfficient. |
What outcomes do you expect? We would expect that number of patients who have LDL greater than 190 who are actively on prescription would increase. | What outcomes have you seen? Increase noted in prescriptions provided to patients with LDL >= 190 from July 2023 (11.8%) to February 2024 (20.5%). Since the last learning lab, asking patients how are you taking your medications and how often, rather than asking if they’ve filled their Rxs. Implementing this method allows staff to get more information from the patient regarding if they’re taking their Rxs. |
How will you ensure your intervention will be effective for your target population? This will tie back to reports and monthly data. | Did your intervention reach the target population? Targeted outreach via Relevant reports on the LDL>= 190 and Diabetes cohorts. |
What unintended consequences or outcomes might there be? Patient refusal to take statin, refusal to engage in care, inability to contact patient, inability to afford medication. | What unintended outcomes did you experience? 1 patient wanted to try lifestyle modifications prior to starting statin prescription. 1 patient refusing to take statin medication. 1 patient last LDL in 2022, refused to have blood drawn for updated lab: will continue to outreach patient. |
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. Case Managers in conjunction with the Manager of Case Management. | Who delivered the intervention? Did they have the skills and time needed to complete the intervention? Case Managers in conjunction with the Manager of Case Management. Diabetic educator also encouraged to check for LDL labs, patient names forwarded to Manager of Case Management for f/u. |
How will you know if clinicians/care teams/sites used the intervention? Supervision of spreadsheet by the Manager of Case Management. | What proportion of the planned staff/sites implemented the intervention? Have a shared spreadsheet for both locations. 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.)? Amsterdam providers are performing lower overall than Schenectady providers according to the statin therapy report in Relevant database. OB provider’s patients are at a lower percentage than other providers. |
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? Documentation via spreadsheet. | How did you track modifications during the intervention? Documentation is being maintained regarding patient outreach on spreadsheets. |
What might be some of the possible obstacles to consistent implementation? Decreased staffing in Case Management Department, competing priorities. | What were the barriers to consistent intervention implementation? Time and resources continue to be a barrier to implementation. Also, delay in CLIA certificate for POC cholesterol testing is a barrier. Difficulties contacting some patients: unable to leave voicemails, changing phone numbers, etc. |
What costs and resources (including time and burden, not just money) need to be considered? Time with being short-staffed 2 Case Manager’s. | What costs and resources (including time and burden, not just money) need to be considered? Time and staffing resources continue to be a barrier. As of 3/19/2024 the case management department is fully staffed. |
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: Pulling monthly data, reporting out to CM staff on updates | What reinforcements did you put into place to sustain the intervention?
Explain: Discussion with CMO regarding policy/procedure on how often cholesterol screenings should be performed/follow-up visits should be scheduled after medication changes. Had 1:1 meeting with CMO and discussed items noted above. Will validate if this language is within the policy. |
How will you spread your intervention and lessons learned? Discuss at Interdepartmental/Quality Meetings, Statin (Diabetics) Quality Dashboard inclusion. | How will you spread your intervention and lessons learned? Qualitymeeting scheduled for May. Will discuss at interdepartmental meetings (April meeting cancelled, will plan for May). Intervention has also been applied to the Diabetes education program. Cholesterol testing & lipid lowering therapy included on PVP reports, which is provided daily to care teams. |
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)? Will likely discuss as a topic at case manager meetings regularly. Case manager meetings occurring weekly. Intervention has also been applied to the Diabetes education program. Staffing capacity and time. | |
...