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Table 4 Implementation support components

From: Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation

CAP step

Tasks for this step

Format of support

Specifics of implementation support strategy

Implementation strategy type, per ERIC categorization scheme [128]

Step 1. Create an “SDH team.”

Obtain leadership support (BBPC #1).

Identify, orient clinic champion/study contact.

Materials

For clinic leaders: benefits of SDH documentation/action; leaders’ role in supporting SDH process adoption

Recruit, designate, train for leadership; orientation materials

Clinician champion orientation, task summary materials

Project champion orientation, task \summary materials

Draft email from leadership to clinic staff alerting staff to SDH plan

Technical assistance

Office hours

Covering: (1) orienting champions; (2) goal setting

Identify/prepare champions; recruit, designate, train for leadership; orientation materials; peer-to-peer learning

Call

With implementation support team: orientation

Technical assistance

Step 2. Identify clinic goals.

Identify clinic’s goals for SDH screening, and which patients will be screened for which SDH measures.

Materials

Decision tools: why do you want to collect SDH data? What do you hope to accomplish? What do you plan to do with the SDH data? Which patients do you want to screen? How often? For which SDH?

Goal identification/implementation blueprint

Written recommendations/key considerations for selecting clinic goals

Goal identification; technical assistance

Summary of the clinic’s stated goals

Goal identification

Office hours

Covering: (1) goal setting; (2) learning the EHR tools

Goal identification/implementation blueprint; peer-to-peer learning

Call

With implementation support team: identify goals

Goal identification/implementation blueprint

Step 3. Create an “SDH plan.”

Create a workflow plan for SDH documentation, and (if desired) SDH data review and action (BBPC #3, 4).

Create a rollout plan.

Materials

Planning tools: SDH documentation workflow; SDH data review/action workflow; workflow implementation rollout

Technical assistance

Resource list (PRAPARE, HealthLeads, etc.)

Guides to using EHR’s SDH data tools: in workflows; in SDH documentation, on site or via patient portal; to review SDH; for SDH referral-making (with guidance on creating a social service resource list)

Written materials: pros and cons of different SDH documentation workflow options; key considerations based on other CHCs’ experience

Summary of the clinic’s stated workflow plan

Goal identification/implementation blueprint; technical assistance

Call

With implementation support team: workflow development, use of workflow planning tools, rollout plan

Technical assistance

Office hours

Covering: (1) workflow planning; (2) EHR tools within workflows

Peer-to-peer learning; technical assistance

Step 4. Train clinic staff in the “SDH plan.”

Orient staff: staff meeting.

If SDH plan changes, orient staff. Train new staff as needed.

Materials

Orientation webinar for clinic staff; review clinic’s goals and workflow plan; include staff discussion of potential barriers/how to address them.

Educational meeting/materials; goal identification

Written materials: how to orient clinic staff to SDH documentation and action, based on other CHCs’ experiences

Educational meeting

Template slides/handouts for updating staff and/or training new staff

Educational meeting; technical support

Call

With implementation support team: how to train staff

 

Office hours

Covering: (1) how to train staff; (2) how to create target population reports and adoption reports

Peer-to-peer learning; technical assistance

Step 5. Roll out the “SDH plan.”

Review adoption rates on a regular basis (BBPC #2).

Iterate/revise rollout, workflows as needed.

Materials

Guides: using SDH data tools to review SDH documentation/action data; using SDH documentation data to track progress; testing workflows

Audit and feedback

Call

With implementation support team: develop strategy for testing workflows, addressing barriers, rollout, review of adoption progress; how to track SDH adoption progress using data tools; how to revise workflows, rollout plan as needed

Audit and feedback; technical assistance; practice facilitation/small tests of change; tailor strategies

Tools

Provide monthly adoption reports

Audit and feedback; tools for quality monitoring

Office hours

Covering: how to iterate and refine workflows; other topics identified as needed by the clinics or the IST

Peer-to-peer learning; technical assistance; ongoing consultation

  1. Abbreviations: SDH social determinants of health; IST implementation support team; Q&A questions and answers; BBPC building blocks of primary care