Skip to end of metadata
Go to start of metadata

You are viewing an old version of this page. View the current version.

Compare with Current View Page History

« Previous Version 2 Next »

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.


Important Health Center Context

Fill out this section during your planning process

Internal Characteristics

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

Plan

Actual

Describe Intervention

Chosen intervention:

Plan for intervention:

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

Reach of implementers/providers?

Actual:

Reach of patients?

Reach of patients?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

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

What outcomes do you expect?

What outcomes have you seen?

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

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

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.

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?

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?

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:

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

Chosen intervention:

Plan for intervention:

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

Reach of implementers/providers?

Actual:

Reach of patients?

Reach of patients?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

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

What outcomes do you expect?

What outcomes have you seen?

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

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

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.

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?

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?

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:

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)?



Version Date Comment
Current Version (v. 2) Oct 13, 2023 18:39 Lauren Becker
v. 25 May 06, 2024 14:04 Antoinette Anwar
v. 24 Apr 23, 2024 17:56 Chris Espersen
v. 23 Apr 23, 2024 14:24 Antoinette Anwar
v. 22 Apr 18, 2024 14:37 Antoinette Anwar
v. 21 Apr 17, 2024 15:42 Antoinette Anwar
v. 20 Apr 10, 2024 20:45 Antoinette Anwar
v. 19 Apr 10, 2024 20:36 Antoinette Anwar
v. 18 Apr 10, 2024 20:28 Antoinette Anwar
v. 17 Apr 10, 2024 20:24 Antoinette Anwar
v. 16 Apr 09, 2024 13:11 Antoinette Anwar
v. 15 Feb 27, 2024 18:39 Chris Espersen
v. 14 Feb 08, 2024 16:39 Antoinette Anwar
v. 13 Feb 08, 2024 16:09 Antoinette Anwar
v. 12 Jan 26, 2024 14:25 PAAnderson (Unlicensed)
v. 11 Jan 24, 2024 14:38 PAAnderson (Unlicensed)
v. 10 Jan 05, 2024 18:37 Lauren Becker
v. 9 Dec 28, 2023 14:43 PAAnderson (Unlicensed)
v. 8 Dec 28, 2023 13:22 PAAnderson (Unlicensed)
Reverted from v. 6
v. 7 Dec 27, 2023 17:55 PAAnderson (Unlicensed)
v. 6 Dec 06, 2023 18:28 Chris Espersen
v. 5 Dec 06, 2023 14:30 Antoinette Anwar
v. 4 Nov 02, 2023 18:14 Antoinette Anwar
v. 3 Nov 02, 2023 17:39 Antoinette Anwar
v. 2 Oct 13, 2023 18:39 Lauren Becker
v. 1 Sept 18, 2023 20:30 Lauren Becker
  • No labels

0 Comments

You are not logged in. Any changes you make will be marked as anonymous. You may want to Log In if you already have an account.