Berks Intervention Assessment

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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)?	Smaller urban health center Predominantly Hispanic population Low-income community High risk for cardiac events
What are the infrastructure characteristics of your health center (use of expanded care team, culture)?	Expanded care team but Short-staffed concerns
How do interventions and/or workflows need to be adapted to ensure health equity?	Ensuring no language barriers in health communication Addressing cultural influences Addressing social drivers of health that affect access (lack of insurance, lack of device/connectivity, etc)
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?	High crime rate

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: Adopt and activate a hypertension management algorithm based on participation in SMBP

Plan for intervention:

-Review algorithm examples

-Present algorithm to providers

-Revise algorithm as needed

-Activate algorithm

inc

Chosen Intervention:

Date when implemented:

Updates: 12/19 in the last month have just received Azara data and in the process of validation -making sure SMBP data is flowing into Azara properly, other BP data is already validated. Dr Joy will review algorithms in the next month

Updates as of 2/6: Dr. Joy has HTN 80-90% of the algorithm complete and needs to send info over to CMO (Dr.Wang) then the algorithm can be rolled out.

Education for staff on proper techniques for taking BP (MA’s and nurses) is scheduled for later this month. As of 2/6 Adopting a competency piece (ex: MA BP competency checks performed for Feb )

as of 2/13 almost done with algorithm - will be working with staff on the BP measurement and will review

to see how works with SMBP

planning provider education for March including reviewing guidelines will officially roll out then.

incorporate peer review. have done survey with providers on Tx. Once algorithm done will be open to all providers

Diane - as nurse be able to titrate medications on her own

04/27 updates: Dr. Joy observation: this is not an assignment/task that could be done in a short time period. During this process, we recognized, that this is a longitudinal project that requires devoted time, analysis, review and repair.

In preparation for algorithm creation, review and roll-out, we needed to assess the current practices/attitudes/understanding of the providers. An informal survey monkey questionnaire was sent out to providers. This showed that providers had different BP values that they diagnosed HTN as well as their treatment goals. Based on this, we decided to do an education session and chart review.

February 16: Provider education on HTN updates - good discussion, several commented that they learned new info; providers given lists of their pts that were uncontrolled; opportunity for intervention by provider team

February 23: Provider Peer Review completed; overall theme: avoid beta blockers unless indicated, consider SPC more; consider using lower BP (130/80) for diagnosis and goal to treat; planning on doing this again in the Fall

Proposed algorithm shared with two providers; feedback received and algorithm being revised; providers did not like the limitations of choices; clinical pharmacist hired, to start week of May 6; will get her feedback also

SMBP on hold for new pts due to unavailability of BP monitors, still seeing established pts

Azara data verification in progress

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:

20% of providers

Reach of implementers/providers?

Actual: TBD upon implementation

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

Planned:

# AA pts. w/uncontrolled HTN on no therapy: 30%
# AA pts. w/uncontrolled HTN on monotherapy: 30%

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?

will start with a list of patients in i2i using patient search feature and also look at pts w/ uncontrolled htn on 1 medication

List of patients meeting the criteria will be distributed
Patients submitting BP for SMBP
Whether RN has had an encounter with patients enrolled in SMBP
Treatment intensification has been communicated to provider
Treatment intensification has been activated.

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

TBD upon implementation

will be using Azara to assess, Diane will be checking regularly, will also be checking weekly

for all providers. Very eager to get to patients on no Tx. after working in Azara. Survey monkey -

50% are treating stage 2 with two or more medications - there is some work to do - combo in the algorithm

Megs suggestion - able to do study groups in Azara to see which providers are prescribing SPCT and if patients are responding

also are encouraging providers to use SMBP program

What outcomes do you expect?

Need to reactivate SMBP patient participation
5-10% of patients will be unreachable
Some providers will not buy in

What outcomes have you seen?

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

Consistent participation with HFP to brainstorm
Consistent education and communication with providers and patients
Ongoing review of the algorithm
Data to demonstrate progress at the provider level
Review progress with Medical director and other center leadership

Did your intervention reach the target population?

What unintended consequences or outcomes might there be?

Staffing challenges
Pharmacy benefit challenges

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.

Dr. Joy, Diane, Rafaela, and providers at sites.

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?

Increased # of referrals for SMBP
Who is referring patients to smbp
Review of medications and # of intensifications

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?

Having ongoing check-ins with implementing staff for feedback

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?

Proposed algorithm shared with two providers; feedback received and algorithm being revised; providers did not like the limitations of choices;

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

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

Chosen intervention: already are working on registries due to Azara implementation - may be looking at this down the road after Azara implementation (note about large number of patients (no n yet) who have been graduated by Diane from SMBP

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 (# of patients receiving treatment intensification)?

Planned:

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