Elaine Ellis Intervention Assessment

Internal Characteristics

What are the characteristics of your health center? (rural/urban; other demographic variables, use of expanded care team, culture)?  

Elaine Ellis Center is a ambulatory FQHC located in Ward 7 in the Kenilworth Community in Northeast Washington D.C. The mission of this healthcare center is to provide affordable, quality healthcare to the underserved community which includes the Kenilworth Court public housing community and its surrounding areas regardless of their ability to pay.

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

Interventions and workflows need to be inclusive and adaptable to reflect the complexities and challenges that the patient population face to achieve positive outcomes to health equity. Access, communication and resources are the most important characteristics to achieve 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)?

Patient interventions can be complex are the patient interventions to implement due to an number of factors. This can range from patient engagement, staffing structures of the clinical care team and/or standing order policies. Patient interventions should be simple in the number of steps so everyone on the care team can follow.

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

Elaine Ellis is a small but growing organization. The care team contributes in providing care to the patients is adaptable (especially in sharing duties), diverse, responsive and motivated to provide quality healthcare to the community of patients. Other Challenges patients face range from transportation for access, medication affordability, health literacy and resources for care.

External Characteristics

What external or environmental supports or threats are there?

One of the benefits of Elaine Ellis is that it is located in a high traffic area which serves as a thoroughfare. it is accessible by Metro bus and provides free parking to the patients. It also allows a good environment to provide a good location and base for community outreach for the patients and residents in the surrounding area.

Treatment Intensification (Combination Therapy)

Plan

Treatment Intensification (Combination Therapy)

Actual

Describe Intervention Patient engagement and health literacy on importance of lower BP numbers

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

Chosen intervention: Improve patient engagement. Apply shared decision making at initiation of treatment plan and throughout therapy. Use collaborative communication skills in conversations.

Plan for intervention: During the visit, discuss with the patient the plan to lower blood pressure rates by having an inclusion strategy process with the patient on communicating different ways on medication therapy, small lifestyle adjustments and set up follow-up appointments before they leave the site.

Chosen Intervention: Improve patient engagement.

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned: The goal is to reach eighteen (18) of the African American patients that has high blood pressure that requires treatment protocol.

Reach of implementers/providers?

Actual:

Reach of patients (# of patients receiving treatment intensification)? The goal is to reach fifteen (15) of the African American patients that has high blood pressure that requires treatment protocol.

Planned:

• # AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023): 23

• # AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023): 4

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?

Continue to pull HTN data from EMR and chart reviews to see if the number/percentage of patients lowers due to more patient engagement and education.

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

What outcomes do you expect?

The expectation of this protocol is that the follow-up appointment will become more routine in care and establish an importance in the patient/provider relationship. With more trust in the relationship, this will promote lower high blood pressure rates with African-American patients.

What outcomes have you seen?

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

This will be completed by chart audits on those patients, monitor their appointments and work with the clinical team (including the Case worker) on negating challenges in their care and lower their hypertension rates.

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

Non-compliance from the patients is the largest hurdle.

What unintended outcomes did you experience?

Adoption (#/% and representativeness of staff and sites who implemented the intervention) Three primary care providers at location.

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.

The intervention will be delivered by the clinical staff, first by the provider discussing the BP reading taken by the medical assistant. Once the patient/provider discuss more in depth about medication therapy regimen and other care education items, they will set up the follow-up appointment and/or refer to LCSW to coordinate for more resource assistance.

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? Periodic chart reviews from data pull from the EMR on HTN patients.

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? Periodic chart reviews from data pull from the EMR on HTN patients. Deeper dive from the patient’s previous visit and conduct an audit to see any differences, trends and improvements.

How did you track modifications during the intervention?

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

Patient cultural attitudes towards care which includes no-show for their appointments, other SDOH which can prevent access in health equity.

What were the barriers to consistent intervention implementation?

What costs and resources (including time and burden, not just money) need to be considered? The amount of time needed to spend with each patient for their engagement which could impact patient flow in the center. In addition, since EECH does not have nurses on site, may need more involvement from both NP’s and clinical MA’s to work with patients.

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?

There will be periodic meetings with the team to share data. This time will also be used to brainstorm ideas from the clinical team to possibly put into practice.

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 Improve Medication Adherence

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

Chosen intervention: Expand care team encounters to include medication education and adherence coaching.

Plan for intervention: Set up a series of follow-up appointments to monitor High HTN numbers and during the follow-up appointment provide more coaching and education.

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned: There are three(3) primary providers. Monitor and work with them to make sure that there are follow-up appointments set for those patients with high HTN numbers especially those that had a intensification to their therapy regime.

Reach of implementers/providers?

Actual:

Reach of patients (# of patients receiving treatment intensification)? The goal is to reach 50 patients that are African American patients that has high blood pressure that requires treatment protocol.

Planned:

• # AA pts. w/uncontrolled HTN on no therapy (as of 6/30/2023): 45

• # AA pts. w/uncontrolled HTN on monotherapy (as of 6/30/2023):8

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?

Continue to pull HTN data from EMR and chart reviews to see if the number/percentage of patients lowers due to more patient engagement and education.

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

What outcomes do you expect? The expectation of this protocol is that the follow-up appointment will become more routine in care and establish an importance in the patient/provider relationship. With more trust in the relationship, this will promote lower high blood pressure rates with African-American patients.

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.

The intervention will be delivered by the clinical staff, first by the provider discussing the BP reading taken by the medical assistant. Once the patient/provider discuss more in depth about medication therapy regimen and other care education items, they will set up the follow-up appointment and/or refer to LCSW to coordinate for additional resource assistance.

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? Chart pull review audits for hypertension patients to see if the number/percentage of patients are lowered.

How did you track modifications during the intervention?

What might be some of the possible obstacles to consistent implementation? No-Show rates continue to be an issue for the site.

What were the barriers to consistent intervention implementation?

What costs and resources (including time and burden, not just money) need to be considered? The amount of time needed to spend with each patient for their engagement which could impact patient flow in the center. In addition, since EECH does not have nurses or a patient navigator on site, may need more involvement from both NP’s and clinical MA’s to work with patients.

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? Periodic meetings to inform protocol progress.

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)?