Table 1 Summary of ALL initiative when implemented in KP and as adapted for CHCs
At KP | As adapted for and implemented in the study CHCs | |
|---|---|---|
Overarching strategies | Make it easier for providers to: (1) identify patients with diabetes who are indicated for an ALL medication(s), but have no active prescription for an indicated medication, and (2) prescribe these medications | |
Target population | ||
Population “indicated” for ACE/ARBs and/or statins | Patients with diabetes at high risk of CVD (55-75, or comorbid CVD) | Any adult patients with diabetes (18-75) |
Intervention components: Tools to expedite identifying patients indicated for but not prescribed ALL medication(s) | ||
Automated EHR point-of-care alerts “fire” at patient encounters if ALL medications indicated but not prescribed | Alerts added to existing, internally built “Patient Support Tool” which identifies myriad “care gaps” based on EHR data1;2 | Alerts in the form of “Best Practice Alert” built into existing EHR functions; no other care gaps identified by this alert |
Data registries enable searching provider/clinic panel for patients for whom ALL medications indicated but not prescribed | Integrated into existing panel tool; used to identify patients (i) on the day of a clinic visit, at the team “huddle,” and (ii) in targeted outreach efforts, in addition to other care gaps | Built as stand-alone ALL-specific rosters; provide similar functions as at KP (daily intake review; outreach) |
Intervention components: Tools to expedite prescribing | ||
Order sets in EHR to make prescribing easier | Pre-programmed to expedite “one-click” prescribing for any indicated ALL medications (SmartSets) | Pre-programmed to facilitate prescribing by listing commonly prescribed dosages/medications |
Intervention components: Tools to enhance patient adherence | ||
Patient education materials | EHR shortcuts that expedite providers’ ability to generate informational text about the medications in after-visit summaries | Similar EHR shortcuts; exam room poster about the ALL medications in English, Spanish, Russian; handouts to enhance adherence to prescribed medications in English, Spanish, Russian |
Outreach to patients missing a prescription | Nurse, pharmacy case managers call patients to set up appointment to get prescription | At clinic discretion, used ALL registries to facilitate outreach to diabetic patients overdue for a visit |
Compliance tracking | Nurse, pharmacy case managers call patients to remind them to refill their prescriptions | Not part of the CHCs’ intervention due to limited outreach capacity |
Intervention components: Strategies to encourage provider uptake | ||
Communicate expectations related to intervention uptake | Top-down practice change directives | Presented as recommendations; staff input/feedback solicited |
Orient staff to the evidence underlying the intervention | Champions presented at department meetings | Practice facilitators and/or clinician champions presented at clinic or team meetings (varied by organization) |
Ongoing implementation support | Regional clinician champions responsible for multiple QI initiatives, including ALL | ALL-specific practice facilitators (clinic employees) provide on-the-ground support; clinician champions at each organization; research staff provides additional support |
Performance tracking—providers | Monthly performance reports, posted publicly and tied to staff incentives | Monthly reports made available; emphasis, timing, and method of distribution varied by organization |