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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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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: First Nurse run HTN clinic started in June 2023 with nurse Carlo and Dr Menezes in BACH North on Tuesdays 10am – 12pm and extended it with PA Parikh. Nurse Iana and Camille started another HTN clinic with Dr Dickey in August on Tuesdays 1- 3pm In BACH south, Nurse Daisy started HTN clinic in January with PA Busante on Wednesdays 1 to 3pm and with Dr Rashmi on Thursdays 1 to 3pm 2/28/2024: Expected more providers but nurses are training now and not available. |
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: 5 providers started HTN clinics, i.e Dr Menezes, PA Parikh, Dr Dickey. PA Busante and Dr Rashmi with four nurses ,i.e Carlo , Daisy , Iana and Camille. 2/28/2024: Over 6 months implementation now; up to 6 providers. |
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: 64 patients came in HTN clinics (all uncontrolled HTN pts) |
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? 12/20/24 - nurses are working on Excel sheet - still in progress 2/26/24 - 4 nurses have been keeping excel sheet to track progress of HTN clinic. |
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? We have seen improvement in BP of the patients that do get engage in HTN clinics and get connected with the nurses. We have also observed that patients who do not come back for their follow up appointments still have uncontrolled BP when they come for their other appointments. |
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? As we are still working on starting new HTN clinics with more providers, our progress is slow but we have managed to reach the intended population, i.e patients with uncontrolled HTN. |
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? We had intentions of bringing Million hearts HTN patients in these clinics but we have noticed their involvement in these clinics have been very low since they prefer to keep following up with their PCPs and sometimes, they are not open to new antihypertensive therapy medications such as combo pills. |
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? BACH providers including clinic director along with care team and wellness nurses delivered 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? Adaptions can be discussed during internal meetings and clinician huddles | How did you track modifications during the intervention? Nurses created excel sheets to track progress |
What might be some of the possible obstacles to consistent implementation? Staffing challenges that may arise; ensuring consistent documentation of BP and second reading data (Dr. Ramchandani and Dr. Menezes are notified of documentation issues); finding a day(s) of the week that consistently works for providers for the clinic at each location; ensuring sustainable behavior change as it relates to prescribing habits; blocking provider schedules – training MAs to know not to schedule over these slots | What were the barriers to consistent intervention implementation? Main barrier is the availability of staff and scheduling conflicts between providers. Space hss always been the issue as well. |
What costs and resources (including time and burden, not just money) need to be considered? Upfront time investment to train providers and staff on workflows for HTN clinic; finding a physically large enough space at certain locations to host the clinic | What costs and resources (including time and burden, not just money) need to be considered? Time spent by nurses for chart prepping and calling for appointment reminders. Wellness nurses have their own panel of HTN/DM patients that need to be called as well , so devoting set time for HTN clinics and tracking the progress has been challenging. |
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: Also sending weekly reminders to clinicians about the MH project and provide information on what medications are covered by BACH |
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: 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 with 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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