Whitney M. Young Intervention Assessment

Internal Characteristics

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

Urban

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

WMY is focusing on all populations for HTN/ Statin needs

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)?

WMY has re-pivoted frequently with workflows related to this initiative (primarily related to staffing challenges). Goal is to “meet patients where they are at.” (both statin and HTN project).

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

Clinic real-time patient facing, phone outreach. We feel the clinic real-time patient facing is most effective to patient engagement for both statin and HTN projects.

External Characteristics

What external or environmental supports or threats are there?

Unite Us Referral Platform is used to meet any SDOH needs based on positive screens. For example: patient ability to afford medications, or need for health insurance.

Plan

Actual

Describe Intervention:

Statin Therapy and HTN:  needs identified by looking at “whole patient” diagnosis such as DM, HTN, elevated LDL > 190 or hypocholesteremia, ASCVD are the focus. Triage Nurse, clinical pharmacist and Care Manager following patient will review chart to ensure patient is identified as qualifying for statin treatment (missed opportunity). The team ensures patient has a follow up apt. in place. Triage nurse will refer patients to clinical pharmacist to make recommendations to provider for statin therapy. Health Equity focus: All populations with HTN/Statin Therapy.

Chosen intervention:

Identify patients with diagnosis of HTN and DM not on statin therapy who are being followed for HTN and or any triage patient calls the triage nurse is consulted for (triage nurse refers patient to clinical pharm.).

Plan for intervention:

Triage nurse, clinical pharm. and Care Manager will inform provider of patients need for statin therapy. Team meets twice per month to discuss patients being followed for HTN/Statin therapy. Challenges to patient outreach, patient engagement, patient engaged plan of care discussed and consider workflow changes to challenges identified. Banners and buttons created for patient awareness to HTN/Statin/DM.

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

7-8 providers

Reach of implementers/providers?

Actual:

Reach of patients?

Planned:

Triage nurse following 30 patients for both statin and HTN. Care Managers identifying transition of care patients (HTN/Statin) approx. 20 patients per week. 7-8 providers, 4-5 providers the nursing staff conduct pre-visit planning to identify missed opportunities.

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:

Clinical Pharm. Pulling data reports for ASVD cohorts, LDL > 190, and out reaching 10-15 patients per week across all three clinic locations. Care Manager is also looking at transition of care patients and adding the statin need to the chart prep for provider to weigh in on (missed opportunity). Clinical Pharm. will also provide recommendation for patient who are having side effects and not compliant with statin therapy as a result.

Plan for intervention:

Clinical Pharm. will provide recommendations for provider to consider if a patient is identifying side effects from a statin. Clinical pharmacist to outreach 10-15 patient per week. Clinical pharm. also looking at the provider scheduled patient visits for week to perform a chart review for patients dx. With HTN, DM, LDL > than 190, ASCVD and identify missed opportunities.

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

7-8 providers

Reach of implementers/providers?

Actual:

Reach of patients?

Planned:

10-15 patient per week

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)?