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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