First Choice Intervention Assessment

Internal Characteristics

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

First Choice Health Centers serves over 22,000 patients across central Connecticut with 11 locations in East Hartford, Manchester, and Vernon. We are proud to provide integrated care and break down social and economic barriers to wellness and healthy living.

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

Our services include Primary Care, Pediatrics, Women’s Health, Dental, Behavioral Health, Chiropractic, Nutrition, LGBTQ+, Optometry, Podiatry, Medication Assisted Treatment, Pharmacy, and more.

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

We need to ensure all patients are being targeted. This includes patients coming in for appointments in addition to outreach to patients who have been lost to follow up. We need a team that can speak both English and Spanish and be able to use interpreter services for other languages. We need to have defined workflows and resources for patients who have socioeconomic barriers to any gap in care.

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)?

Our project interventions range from easy to complex. An example of an easy intervention to implement is sending out a broadcast message to hundreds of patients at once, perhaps those who are due for screening. This only takes a few minutes to set up and send. We may also have a team member add reminders to patient visits to highlight a gap in care to the provider. We try to maximize these “easy” interventions with all of our projects and implement more complex strategies if staffing and expected reward/benefit allows. This project’s main intervention is a good example of this.

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

Most often at a Primary Care clinic.

External Characteristics

What external or environmental supports or threats are there?

External – being able to access pharmacy records and/or outside specialist records is improving, though we still struggle with proper documentation especially with ASCVD history. We also have the support of telehealth in the event the patient has a barrier and can’t physically come to the clinic.

Plan

Actual

Describe Intervention

Chosen intervention:

Clinical Pharmacist and students will chart review patients non-compliant for statin metric.

Plan for intervention:

List will be provided to this team to outreach, focusing on LDL >190.

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

3 (1 Clinical Pharmacist + 2 students)

Reach of implementers/providers?

Actual:

Reach of patients?

Planned:

80

Reach of patients?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

# patients of our planned reach that we actually reached. Of those, # patients switched to the compliant category.

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

What outcomes do you expect?

We expect to identify patients who have refused statins in the past and will likely always remain “non-compliant”, but we will find more patients who are eligible for statins and we will be able to intervene.

What outcomes have you seen?

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

Measure outcome of # patients moved to compliant category and ideally, track therapeutic goals.

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

Expert Consensus still not published as guidelines yet, so it remains unclear which direction we should counsel providers in.

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.

Clinical Pharmacist and students followed by Providers implementing the decisions of statin Rx.

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?

Tracking lists of 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?

Patient list/tracking

How did you track modifications during the intervention?

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

Frequent chart review and education to providers

What were the barriers to consistent intervention implementation?

What costs and resources (including time and burden, not just money) need to be considered?

Time is the biggest one. Time to chart review, send messages with recommendations to providers, time to outreach to patients, etc.

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?

Review of the chart reviewed data overall with teams

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:

Review quality metrics, including statin therapy, with each Care Team one-on-one

Plan for intervention:

Block dedicated time for site visits with each Care Team

Chosen Intervention:

Date when implemented:

Updates:

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

Reach of implementers/providers?

Planned:

12 providers

Reach of implementers/providers?

Actual:

Reach of patients?

Planned:

N/A

Reach of patients?

Actual:

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

Quarterly review to continue tracking trend

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

What outcomes do you expect?

More awareness of quality performance and workflow changes from Care Teams

What outcomes have you seen?

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

Live meetings vs. emailed data

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

Providers not available for the meeting. Turnover.

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.

Director of PI + PI Associate

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?

Attendance at the meeting

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?

Tracking performance of the metric by provider

How did you track modifications during the intervention?

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

Turnover

What were the barriers to consistent intervention implementation?

What costs and resources (including time and burden, not just money) need to be considered?

Time to run reports and block schedules for the providers to have dedicated time to meet.

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?

General debrief at provider meetings.

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)?