Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

by Purba Chatterjee -
  1. Considering the protocol you are developing: identify the process and outcome indicators associated with the program and briefly describe an approach to measuring each.

    My protocol is on treatment intensification for HTN control in GMC patients.

 

Formative Evaluation

-      Focus groups with GMC Attendings to adapt Kaiser HTN control protocol

-      Review of available medications in GMC formulary

-      Base-line GMC blood pressure rates and uncontrolled blood pressure rates

Process Indicators

Means of Verification

Conduct pre-clinic educational conferences for GMC attendings, residents, nurse practitioners, and nurses

Participant sign-in sheets completed

Ensure fixed dose combination pills are available in the formulary

List of formulary medications for hypertension control

Include HTN control order sets in eCW

Order sets developed and included in eCW

Post algorithm around clinic

Algorithm distributed to all GMC clinicians and posted in clinic

Include algorithm under Treatment and Referrals in the CHN website

Algorithm posted, easily accessible, and providers are accessing

 


2. Define one or more “intermediate” outcome measures (reflecting changes in environment, organizational culture, systems of care, patient or public behavior, and/or clinician behaviors) that can inform you about the mechanism by which your intervention achieves its downstream effect on health inform you about the acceptability of your intervention. Intermediate outcome measure could be “systems of care”.

Intermediate Outcome Measure  - This new protocol has a team based approach to HTN control with nurses playing a greater role in follow-up visits, education, titrating meds, and addressing adherence issues. So, one intermediate outcome measure could be whether follow-up nurse visits are being scheduled and if task shifting and team based approach to managing HTN control is happening in practice.

Outcome Measures

 

 

Outcome Indicators

Means of Verification

Are meds being titrated up?

Medication list from i2i

Are fixed dose combination pills being prescribed?

Medication list from i2i or pharmacy claims data

Reduction in blood pressure in GMC patients

Blood pressure rates in clinic

 

 

 

 

 

Re: Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

by Sarah Imershein -

Another outcome measure could be time in between intensification, time to maximal dose, or time to BP control.  One of the goals of such an initative is to shorten the time for titration, versus usual care taking months (or years!).

Re: Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

by Sarah Imershein -

Another outcome measure could be time in between intensification, time to maximal dose, or time to BP control.  One of the goals of such an initative is to shorten the time for titration, versus usual care taking months (or years!).

Re: Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

by Grace -

Wondering about the relevance of patient satisfaction levels with these practices. That might be a potential outcome measure. Are patient's more satisfied with this process and the level of care they are getting. I think this might be related to reduction in blood pressure.

Re: Assignment #7, Chatterjee, Program Evaluatio for implementation of HTN control protocol in GMC

by Ralph Gonzales -

Purba,

This is great.  Adding to your Means of Verification, you could think about the first steps in response to your intervention activity.  So for Order Sets, how often were they opened?  You could also consider a survey to ask providers how often they used/found the algorithm applicable to their HTN patients, and then also add some questions to assess how well these tools improved their knowledge, attitudes, skills and behavior.

 I like you intermediate outcome measure as a proxy for if the program is inducing the intended changes.  The KAB survey of providers I mentioned above could also serve this purpose.  Nice job!