FPCN Intervention Assessment

Internal Characteristics

What are the characteristics of your health center? (rural/urban; other demographic variables)?  

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

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

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)?

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

External Characteristics

What external or environmental supports or threats are there?

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: Activate SMBP at Abbotsford

Plan for intervention:

• Meet with the Director of PC and site director to discuss smbp plan

• Develop a staffing plan

• Root cause analysis of patients on no therapy or monotherapy

Chosen Intervention: Reactivating the SMBP program at Abbottsford Falls

Date when implemented:

SMBP educational presentation presented to all NP’s at Abbotsford on Dec 8th

SMBP training with RN’s performed onsite on Jan 16th

SMBP was implemented on 1/17 at abbotsford

Updates:

Implementation Strategy for One Intervention (4/30)

Strategy Name (e.g., outreach, clinical decision support, clinician education, data reports, etc.)

Strategy description (including who is the focus/target of the intervention)

Who enacts the strategy (e.g., QI staff, clinicians, health center leadership, patients/consumers, etc.)?

What specific actions, steps, or processes need to be enacted before the intervention can be implemented (e.g., enacting a new policy, developing a workflow, building a new report)?

When is the strategy used (e.g., during each patient visit, during monthly QI meetings)?

What is the dose of the strategy (e.g., one 3-hour training)?

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

Reach of implementers/providers?

Planned:

• 10 providers

• 2 RN’s

Reach of implementers/providers?

Actual:

2 RN’s

2/20 update - RNs enrolling patients, working with NPs to ensure they are aware of the program to direct

to RNs for enrollment, starting to move forward despite being a work in progress

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

We will reach 30 patients for treatment intensification

Planned:

• # AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023):30/ 210

• # AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023) 30/:377

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

Actual:

10 patients on no therapy have moved to therapy

2/20 update - 9 patients have been enrolled in SMBP - will look into how BP has changed since then

for monotherapy trying to resolve - whether it is identifying patients who have htn or just have a Rx for medication

troubleshooting and working way backwards - one challenge is those using FPCN as PCP vs specific services

one example is patients who might be seeing for dental, podiatry etc

Need to review data discrepancy for monotherapy

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

• Patient submitting BP

• Patients attending scheduled encounters

• Medication review/ intensification when patient is uncontrolled

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

2/20 - will update these

What outcomes do you expect?

• Higher patient engagement

• Higher # of patients enrolled in SMBP

• Improved blood pressure (lower avg systolic)

• Improved provider/patient satisfaction

What outcomes have you seen?

Process for Refills- (patients who have not had BP taken in the office but still receiving
refills)

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

• Provide adequate training to staff

• Staying engaged with the providers/staff about program

• Adequate staffing

Did your intervention reach the target population?

Yes,

What unintended consequences or outcomes might there be?

• Patients with other chronic conditions may be more involved in health

What unintended outcomes did you experience?

• There may be some patients considered hypertensive that are truly not. (e.g white coat
  hypertension)

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.

Rn’s and providers at Abbs will deliver the intervention

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

1: Training on the SMBP program was administered to Abbottsford Falls staff by the
Health Federation. Additional support on using the Bluetooth cuffs and on the patient enrollment
process has come from the Health Federation and from the FPCN IT department.

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

• Monitoring enrollments

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?

• Ongoing meeting with implementing staff to discuss successes and challenges.

How did you track modifications during the intervention?

2/20 - do have a workflow so staff can see visually what should be happening

one goal is to have SMBP enrollment process embedded in provider training

Modifications have been documented during our regular Million Hearts check-ins,
as well as during site staff meetings.

What might be some of the possible obstacles to consistent implementation?

What were the barriers to consistent intervention implementation?

Staff comfort with new workflow, training on SMBP devices and enrollment,
ensuring that patients come in for visits/enrollment.

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?

Ongoing cost of purchasing SMBP devices; time for refresher training for existing
staff, and initial training for new staff during onboarding process.

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:

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:

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; use BPAA Project Roadmap for ideas on evidence-based strategies)

Chosen intervention: Use clinical data to demonstrate the efficacy of smbp and treatment intensification

Plan for intervention:

-To present the concept to Director of PC and providers

-Get provider buy in

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

10 providers

Reach of implementers/providers?

Actual:

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

30

Planned:

• # AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023): 30/210

• # AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023): 30/377

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

Actual:

2: Challenges with implementing the updated forms in Athena have made it difficult
to effectively measure treatment intensification without reviewing patient charts.

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

-The # of uncontrolled patients will decrease

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

What outcomes do you expect?

What outcomes have you seen?

Pending…

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

• Enrollment # 's and control rates will increase.

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

-Sensitivity from providers if performance is not up to par

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.

Marlon-Quality Manager

-Delivery will be done at site level provider meeting monthly

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?

N/a

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?

How did you track modifications during the intervention?

Changes related to documentation in the EHR are tracked via the tickets
submitted to IT.

What might be some of the possible obstacles to consistent implementation?

What were the barriers to consistent intervention implementation?

Technical challenges indicated above.

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?

Time needed to instruct staff on new forms in EHR; ensuring that staff use the
correct forms in the EHR to document medication modifications.

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:

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:

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)?