2.8.21 Operational: Implementation of PRAPARE

Discussion:

• Are you currently using PRAPARE? Y/N
  • 54% using PRAPARE 
  • 24% not using PRAPARE 
  • 22% did not respond 

• What tips, tricks, or successes have you had implementing PRAPARE?

  • Staffing resources available to follow-up on results in a robust way (I.e. documentation of community referrals in EHR)

  • Incentivizing staff with a contest between our medical and dental centers, doing a presentation at a staff meeting on the importance of addressing SDOH, starting a food pharmacy, more community partnerships

  • We are screening everyone using the short Picture form.    It has been added to our kiosk check-in also.

  • The health center that participated in NACHC Round 2 PRAPARE Train the Trainer program have been extremely successful with screening and referral

  • We have had the questionnaire in our EHR, but no one was using it.  We had a nursing meeting this month and reviewed how and why we are using this.  We are now asking those questions at each appointment quarterly.

  • We started small.  With just our OB department screening new OB work ups.  And as the comfort level grew we started to expand

  • Adding Otech tablets so patients can answer questions with some privacy have increased completion rates

  • We just started last week. We are starting slow with a smaller population of pts. Starting with our Medicaid Health Home patients & having the patient navigators complete PRAPARE & then sending any positives to  Case Manager for an appt for resources

  • Using learning cohorts to train clinics in the implementation and analysis of the data has increased clinics success in implementing

  • Integrating it into the workflow of different roles. Having it as a smart form in the EHR.

  • Have staff that are working directly with patients to complete PRAPARE in program design and workflows
  • Putting my name on forms that are created for patients to reschedule with the providers. When the providers write down when the patient should return, they see my name and try to get the patients to me for a screening.
  • Automating the push of the tool to patients' discussing concerns with patient advisory group to understand concerns
  • Using PRAPARE during telehealth visits
  • Imbed PRAPARE questions into daily workflow; keep workflows easy; use tools that promote patient to enter information directly like iPads - would love a text/SMS option; Communicate, communicate, communicate to raise staff and provider engagement
  • One of my health centers had great success using PRAPARE during no show follow-up

• What challenges or barriers have you had implementing PRAPARE?

  • Patients that are receiving Medication Assisted Treatment for OUD

  • Sometimes it depends on funding sources. One of my health center had a SDOH grant that focused on Medicaid patient populations. It was their SDOH pilot.

  • SDOH information for all members of care team.

  • Communication is poor at times between staff. This makes it harder to know when it is time to work PRAPARE into the workflow

• Please identify specific populations that are being screened using PRAPARE?

  • Patients 13+ in person. Remotely we are piloting it among those with a high risk score

  • All patients 18 and older

  • Started with Homeless patients, now we screen everyone.

  • Patients coming in for their Annual Wellness Visits-Medicare
  • Medicaid recipients that are enrolled in the Medicaid Health Home program.
  • Patient that are in care coordination, such as Ryan White Patients- HIV + pts,  MyHealth (Medicaid pts with high risk)

  • Patients with Medicaid

  • For adolescent populations it was noted that health centers tailored/modified the PRAPARE questions. See example: 

• How are you implementing PRAPARE during COVID?

  • We are Piloting a remote solution using the CareMessage platform to send the link to complete PRAPARE. The CareMessage also pushes them SDOH resources via text over a 4 week period.

  • Call in patients one at a time to do the screening

  • Doing the in-person visits.

  • After doing the PRAPARE questions via phone then offering patients the option to meet in person or via telehealth for their Case Management appt.

  • We use care coordinators and they administer it during their care management calls over the phone

  • Using with patients that have tested positive to see what type of resources needed to support patient

  • Unfortunately, our workflow has the nursing staff completing the PRAPARE during their intake. Nurses are not completing intakes for telephonic/video visits

  • It is helpful to have access to technology to be able to do PRAPARE screenings by phone, video, etc. However, it is harder to connect with patients as most do not answer calls or do not keep video appointments.

• What questions do you have?
  • If organizations are using Azara DRVS, how are  you using the SDoH dashboards?
    • It was noted that a future meeting to invite an Azara rep. to speak at the meeting to better understand barriers etc. 
  • How often would you recommend doing the screening? Once a year, every visit, etc.?
    
    • Organizations can decide on the frequency of re-administering PRAPARE, although we recommend at least annually. For example, race and ethnicity might be answered once and then revalidated annually. Or a health center might determine that a material security question is needed to be asked at each visit due to the local economic condition.