Discuss two implementation outcomes (adoption and reach) and explain why they are important for clinicians to measure and report, with application to own work Name sources of data that are accessible to clinicians in health care settings, with consideration of own setting. Describe a range of dissemination strategies used to create impact, including new ideas for dissemination of own work

George, Deepu

Highsmith, McKenzie

Lusenhop, William

Polaha, Jodi

Sandoval, Adrian

English

East Tennessee State University

East Tennessee State University Digital Commons @ East Tennessee State University ETSU Faculty Works Faculty Works 10-1-2019 Clinical Evaluators Take Your Mark Jodi Polaha East Tennessee State University, polaha@etsu.edu McKenzie Highsmith East Tennessee State University, highsmithm@etsu.edu William Lusenhop University of New Hampshire Deepu George The University of Texas Rio Grande Valley Adrian Sandoval The University of Texas Rio Grande Valley Follow this and additional works at: https://dc.etsu.edu/etsu-works  Part of the Family Medicine Commons, and the Pharmacy and Pharmaceutical Sciences Commons Citation Information Polaha, Jodi; Highsmith, McKenzie; Lusenhop, William; George, Deepu; and Sandoval, Adrian. 2019. Clinical Evaluators Take Your Mark. Collaborative Family Healthcare Association Annual Meeting, Denver, CO. https://www.integratedcareconference.com/workshops/clinician-evaluators-take-your-mark/ This Presentation is brought to you for free and open access by the Faculty Works at Digital Commons @ East Tennessee State University. It has been accepted for inclusion in ETSU Faculty Works by an authorized administrator of Digital Commons @ East Tennessee State University. For more information, please contact digilib@etsu.edu. Clinical Evaluators Take Your Mark Copyright Statement Authors are permitted to submit their presentation materials to repositories. The document was originally provided by Collaborative Family Healthcare Association Annual Conference. This presentation is available at Digital Commons @ East Tennessee State University: https://dc.etsu.edu/etsu-works/6881 10/19/191CLINICIAN EVALUATORS: TAKE YOUR MARK!Jodi Polaha & McKenzie HighsmithEast Tennessee State UniversityWill LusenhopUniversity of New HampshireDeepu George & Adrian SandovalUniversity of Texas Rio Grande Valley1Faculty DisclosureThe presenters of this session have NOT had any relevant financial relationships during the past 12 months.  2Conference ResourcesSlides and handouts shared by our conference presenters are available on the CFHA website at https://www.cfha.net/page/Resources_2019and on the conference mobile app.3OBJECTIVESDiscuss two implementation outcomes and why they are important for clinicians to measure and report.Name sources of data that are accessible to clinicians in healthcare settings.Describe a range of dissemination activities that can have impact.4BRIDGE EXERCISE5EXAMPLE 1610/19/192EXAMPLE 1ADOPTION OF PHYSICIAN REFERRAL PROCESSProblem: Complex patients represent patient population often with the most problems, least resources and highest cost of care.Action: Complex patient clinic developed to move towards a patient-centered approach to caring for complex patients. During implementation, various methods of enrollment in complex patient clinic utilized. Physicians have been trained on criteria that qualify a good candidate for complex patient clinic. Question: Do risk assessment screening tools vs. a physician referral process result in better treatment reach?Adopt: Do physicians adopt the referral method?Reach: % of patients who receive low (just the assessment), medium (assessment plus some services) and high “dose” (completion/graduation) of team care intervention7THE BRIDGEData:• Electronic Health Record• Physician feedback• Appointment data• Payer-provided information8EXAMPLE 29HOW FAR TO REACH: IDENTIFYING UNDERSERVED STUDENTS FOR A PCBH MASTER’S TRAINING PROGRAMGoalRecruit students of Color and lower income students for PCBH Master’s Level Training Program (2nd Yr. MSW/MSOT)Questions• How far to REACH? • Do students receive information about the training program?• What factors affect the choice of training options?• Of those REACHED, what percentage enroll in the program?10DATA ---------------------------BRIDGEData Sources / Issues Business OfficeIncomplete DataSelf-ReportIssue: Response Rate11HOW FAR TO REACH: IDENTIFYING UNDERSERVED STUDENTS FOR A PCBH MASTER’S TRAINING PROGRAMAll First Year SW and OT Students All Jnr/Snr Undergraduate SW and OT All Current Undergraduate Students All Potential Students in NHAll Potential Students in New EnglandAll Students in the U.S.Not FeasibleInternal Department ListsSelf-Report SurveysInternal Department ListsSelf-Report Surveys1210/19/193Reach AND Ongoing Evaluation R =Received MarketingEnrolled Value to This Approach ● Baseline enrollment data● Can test marketing strategies by year and across programs, i.e. F2F, OL, Hybrid13EXAMPLE 314EXAMPLE 3: ADOPTION AND REACH – MEDICATION REFILL PROTOCOLADRIAN SANDOVAL, PHARM.D. , BCPS, BCACPASSISTANT PROFESSORDIVISION CHIEF OF RESEARCH, DEPARTMENT OF FAMILY MEDICINEUNIVERSITY OF TEXAS RIO GRANDE VALLEY SCHOOL OF MEDICINE 15TIMELINEA shared burden: A recognized need to improve efficiency for medication refills Patients Medical Assistants Residents and Faculty Current problem: Not patient centered Extra burden on patient Extra burden on providers Phase I of solution: Pharm.D. requested to create a protocol Established a stakeholder committee Physicians Medical AssistantsResidents Administrators Protocol development: A week to prepare the protocol 6-8 weeks for approval Implement into Cerner (EHR) after that16Data sources: ADOPTION Number is # of pts for whom MAs used protocol / Denominator is # pts for whom the protocol was relevant REACH Numerator is # of refill requests (via Cerner) / Denominator is # of total calls OTHERPatient satisfaction with new refill Resident satisfaction, attending satisfaction and workloadMedical Assistant satisfaction Implementation and scaling: Second site added and a third site on board Would like to assess ease of adoptability of new protocol based on clinic location and history (# of patients calling in to use the new protocol)17EXAMPLE 41810/19/194INCREASING BEHAVIORAL HEALTH INTEGRATION: CHANGING USE OF BEHAVIORAL HEALTH CONSULTANTS 19MEASURE OF REACH: USING DATA AS FEEDBACK TO IMPROVE AWARENESS Behavioral health integration systematically improves a healthcare team’s capacity address whole person care Use of Behavioral Health Consultants: Conceptual buy-in; low frequency of referrals Low frequency and diversity in referrals: BHCS are called mostly for mental health referral Low frequency and diversity in referrals: systematically reduces opportunities for whole-person care20SCRUBBING THE SCHEDULE: MISSED OPPORTUNITIES • AM Clinic • 3 Residents in Clinic • 21 scheduled patients (excluding walk-ins)• 14 possible BHC consults September 20, 2019: • Collect data for 4 weeks • Daily missed opportunities Missed BHC opportunities as a feedback and training opportunity: 21Date Total number of scheduled patients Year and Name of resident Possible number of consults per resident Total possible number of consults scrubbed Total number of consults completed Sep 30 14Scrubbing the schedule: Training residents to scrub the schedule Systematize the process: inclusion / exclusion criteria, new patients and walk-ins. Calculating reach: Total number of completed BHC visits /Total number of possible BHC visits x 100 = reach Total number of BHC visits / Total number of patients seen = population health penetration 22AUDIENCE DISCUSSIONName one study you could so evaluating adoption and/or reach in your settingDescribe sources of data you might use to evaluate this23DISSEMINATION OF SCIENTIFIC FINDINGS:A TALE OF TWO WORLDSResearchers1. Journal articles2. Face to face meetings3. Media interviews4. Press releasesPractitioners1. Professional associations2. Seminars/workshops3. Email alerts4. Journal articlesSource: R Brownson/TIDIRH2410/19/195DISSEMINATIONGoals of disseminationYour Clinic: how are we doing? what changes do we need to make?Clinical/Policy Community: what innovations might help us with this problem?Scientific Community: how can we study this better?  25DISSEMINATIONYour Clinic: Clinical/Policy Community: Scientific Community:261. Proctor, E. K., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G. A., Bunger, A., . . . Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76. doi:10.1007/s10488-010-0319-7.2. Peek, C.J., Cohen, D.J.,& DeGruy, F.J. (2014). Research and evaluation in the transformation of primary care. American Psychological Association, 69(4), 430 – 4423. Polaha, J., & Sunderji, N. (2018). A vision for the future of Families, Systems, & Health: Focusing on science at the point of care delivery. Families, Systems, & Health, 36(4), 423-426.4. Funderburk, J. & Polaha, J. (2017). To clinician innovators: A special invitation. Families, Systems, and Health, 35(2), 105-109.5. Polaha, J. & Click, I. (2017). Conducting research in primary care settings. In. R. T. Codd, III (Ed.).Practice-Based Research: A Guide for Clinicians. Routledge.6. Polaha, J. & Nolan (2014).  Dissemination and implementation science: research for the real world medical family therapist. In J. Hodgson, T. Mendenhall, & A. Lamson (Eds). Medical Family Therapy. Switzerland: Springer International.Bibliography / Reference27Learning Assessment• A learning assessment is required for CE credit.• A question and answer period will be conducted at the end of this presentation.28Session SurveyUse the CFHA mobile app to complete the survey/evaluation for this session.29Join us next year in Philadelphia, Pennsylvania! Thank you!30

Clinical Evaluators Take Your Mark

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Clinical Evaluators Take Your Mark

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