Evara Intervention Assessment

Internal Characteristics

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

some urban and suburban areas served

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

Marcia and Alyssa are the two team members working on the project, clinical care team is not very involved, no care manager/health coach specific for cardiovascular work (focus on cancer screening)

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

Increased utilization of all resources, including telehealth services, ASCVD risk score calculator, statin Q&A tool, and pharmacy services to ensure 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)?

Complex due to research & development needed, time required- patients/providers/support staff

Multiple tools/steps/resources require additional education/training among providers and support staff

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

External Characteristics

What external or environmental supports or threats are there?

Support- grant funding
Threat- funding, Medicaid expansion in FL was declined

Plan

Actual

Describe Intervention

Chosen intervention:

• Looking at noncompliant patients to see why a patient is not compliant, finding patients who are not on a statin but should be, having team member reach out to schedule appointment, via telehealth or hybrid visit (with provider via telehealth but support staff visit patient’s home), provider would have a conversation with patient about a statin and prescribe at this visit.

Plan for intervention:

• use report of each high risk group in Epic, filter by pts who are not on a statin, use Epic tools to take action on this workable and updated patient list.

• 12/6 after breakthrough were able to move needle on statin uds measure

• patient confidence on taking the statin

Chosen Intervention:

• Review noncompliance list and take corrective action where appropriate

Date when implemented:

• Quarterly

Questions for Poster for Harvest Meeting:

• Strategy Name (e.g., outreach, clinical decision support, clinician education, data reports, etc.)

• Strategy Description 

• 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?

• 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:

• Family Practice Providers

Reach of implementers/providers?

Actual:

• Providers: 33 providers in Family Practice

Reach of patients?

• Group that is missing is the diabetic group, could be target patient population

• (num/denom could be goal of how many pts receive a statin this project year once decided)

• (HCN built out registries for all the health centers for each risk group)

Reach of patients?

Actual:

• Estimate reviewing 1500 charts, taking action on 2/3 of them

Efficacy (Impact of intervention on important outcomes)

How will you measure that your intervention is working?

• Want to see that the prescription has been ordered and that the patient picks it up, can see if a prescription has been accepted and picked up in Epic. Most prescriptions are ordered for a year.

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

• Challenging to determine if action was taken on blue sticky note, but closely monitoring statin UDS performance

What outcomes do you expect?

• Improvement in statin therapy UDS measure

• Reduction in LDL

What outcomes have you seen?

• Maintaining high statin therapy performance (80+%)

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

• Will ask open ended questions for why patients are unable to pick up prescriptions or why they are not taking medication (ex. cost, side effects)

Did your intervention reach the target population?

• Yes, reports used were Million Hearts specific to each high risk group OR statin therapy UDS specific.

What unintended consequences or outcomes might there be?

• Provider fatigue, not being able to attend to other issues

What unintended outcomes did you experience?

• Identifying gaps in provider knowledge/need for additional education

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.

Family Practice Providers (n=~23)

Who delivered the intervention? Did they have the skills and time needed to complete the intervention?

• Alyssa Benson & Marcia Gainer performed the chart reviews.

• They have the skills, made time to perform chart reviews once a week and other times as needed.

How will you know if clinicians/care teams/sites used the intervention?

Million Heart Reports and/or UDS reports

also were shown Epic reports on 2/23/24 that provider can pull up on their own

What proportion of the planned staff/sites implemented the intervention?

• Alyssa & Marcia supported 33 providers in Family Practice

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.)?

• Next step: compare provider scores in statin from last year to this year?

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?

• family practice meetings updates

How did you track modifications during the intervention?

• blue sticky note to communicate with providers (statin & medication compliance)

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

What were the barriers to consistent intervention implementation?

• time demand, Alyssa admin day is Tuesday

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?

• Alyssa admin day takes away from patient care

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: Alyssa admin day every Tuesday

Explain:

How will you spread your intervention and lessons learned?

provide info/training at our family practice staff meetings

How did you spread your intervention and lessons learned?

• provide info/training at family practice staff meetings

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)?

• Keep up with provider education, improve Alyssa Epic access to work with reports, making 1:1 time for provider education on statin therapy.

Intervention #2

Plan

Intervention #2

Actual

Chosen Intervention:

Date when implemented:

Updates:

12/6 after breakthrough were able to move needle on statin uds measure - tried last year so might try this again

patient confidence on taking the statin

Providing Statin therapy information at our provider departmental meetings to facilitate provider education about statin therapy

Chosen Intervention: Providing Statin therapy information at our provider departmental meetings to facilitate provider education about statin therapy

• Date when implemented: 2/7/2023

Updates:

• continue to provide providers with information regarding Statin therapy and Statin compliance.

• Provided info on statin exclusions

• informed about statin cohorts

• Epic tools: Statin Q& A and ASCVD risk calculator

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

Reach of implementers/providers?

Planned:

Reach of implementers/providers?

Actual:

• Providers: 33 providers in Family Practice

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):

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?

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

• Next step: compare provider scores in statin from last year to this year?

• Low use of statin tools:

  • 1 pt received 9/1/23 and statin rx same day

  • 1 pt received 11/7/23 and statin rx 1 month later

What outcomes do you expect?

What outcomes have you seen?

currently at 82% for statin therapy???

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.

Family Practice providers

Who delivered the intervention? Did they have the skills and time needed to complete the intervention?

Providers delivered the interventions.

Yes, the providers have the skill set to complete the intervention.

time is always a challenge, encouraged to chip away at each visit.

How will you know if clinicians/care teams/sites used the intervention?

What proportion of the planned staff/sites implemented the intervention?

• 33 providers in Family Practice

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?

QM report card data

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

What were the barriers to consistent intervention implementation?

Time, visits times are limited.

patient adherence/understating of Statin therapy

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?

different visit modalities- telehealth and in office

In office lab draws for LDL

pharmacy-home delivery

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?

continue to provider updates to maintain momentum.

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)?

Being consistent in identify target populations for Statin therapy and utilizing resources available.