Table 4 Findings in EQUIP and resulting adjustments made in EQUIP-2
EQUIP Finding | EQUIP-2 Adjustment: Intervention |
|---|---|
Clinical interventions | |
Care targets were equally applied at all sites. | Sites choose their preferred care targets based on local needs and resources. |
Delivery system interventions | |
Providers made limited use of symptom assessments performed by highly trained nurse assessors, and questioned the accuracy of the assessments. | Patients complete self-assessments, which are given to relevant providers. |
Providers at the clinics had high levels of depersonalization, high levels of exhaustion, and a low sense of personal accomplishment (burn-out). | One clinic staff member included in project calls and meetings in order to modify the care model to local needs and organization. Staff provided with more feedback throughout implementation, including material and other reinforcements for high achievers. |
The Quality Report was distributed quarterly by the nurse to each individual psychiatrist, with only modest discussion. | The Quality Report is distributed at monthly staff meetings by the product champion. Quality of care outliers (good and bad) and clinic-wide problems are discussed among the team. |
The PopUp included links to summaries of treatment guidelines, but psychiatrists did not use these links. | Treatment recommendations will be "pushed" to psychiatrists in the context of specific patients, and computers will provide patients with education about guideline-concordant treatments. |
Adoption/implementation tools | |
A non-systematic approach to site inception may have affected buy-in and enthusiasm. | A project "kick-off" is highlighted with participation of all sites. |
Engagement was primarily with clinic-level personnel. | Engagement occurs with clinic-level personnel, medical center personnel, and regional policy-makers. |
Case managers were important, but were available only at one site and entered the project late. | Case managers are involved from the beginning. |
Product champions were appointed by medical center administration late, and were less intensively involved than desired. | Product champions self-identify prior to implementation and are more fully utilized. |