Adaptation of a Quality Improvement Approach to Implement eSceening in VHA Healthcare Settings

Posted on May 7, 2021May 18, 2021 by coprhcon

BACKGROUND

The Veterans Health Administration (VHA) developed a comprehensive mobile screening technology (eScreening) that provides customized and automated self-report health screening via mobile tablet for veterans seen in VHA settings. There is agreement about the value of health technology, but limited knowledge of how best to broadly implement and scale up health technologies. Quality improvement (QI) methods may offer solutions to overcome barriers related to broad scale implementation of technology in health systems. We aimed to develop a process guide for eScreening implementation in VHA clinics to automate self-report screening of mental health symptoms and psychosocial challenges.

METHODS

This was a two-phase, mixed methods implementation project building on an adapted quality improvement method. In phase one, we adapted and conducted a Rapid Process Improvement Workshop (RPIW) to develop a generalizable process guide for eScreening implementation (eScreening Playbook). In phase two, we integrated the eScreening Playbook and RPIW with additional strategies of training and facilitation to create a multicomponent implementation strategy (MCIS) for eScreening.

We then piloted the MCIS in two VHA sites. Quantitative eScreening pre-implementation survey data and qualitative implementation process “mini interviews” were collected from individuals at each of the two sites who participated in the implementation process. Survey data were characterized using descriptive statistics, and interview data were independently coded using a rapid qualitative analytic approach.

RESULTS

Pilot data showed overall satisfaction and usefulness of our MCIS approach and identified some challenges, solutions, and potential adaptations across sites. Both sites used the components of the MCIS, but site 2 elected not to include the RPIW. Survey data revealed positive responses related to eScreening from staff at both sites. Interview data exposed implementation challenges related to the technology, support, and education at both sites. Workflow and staffing resource challenges were only reported by site 2.

CONCLUSIONS

A RPIW can be an important factor in the adoption of health technology, but organizational factors also need to be addressed. Through our experience implementing eScreening, we have found that successful adoption of health technology needs to be flexible and contain multiple components. Overall, our use of RPIW and other QI methods to both develop a playbook and an implementation strategy for eScreening has created a testable implementation process to employ automated, patient-facing assessment. The efficient collection and communication of patient information has the potential to greatly improve access to and quality of healthcare.

Using IM-Adapt to Implement CREST in Spanish-speaking Rural Communities for Hoarding Disorder

Posted on May 7, 2021May 18, 2021 by coprhcon

BACKGROUND

Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and community consequences. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter accumulates and fills active living areas, preventing the normal use of space resulting in distress and disability. The accumulation of clutter places individuals at risks of falls, fires, infestation, food contamination, medication mismanagement, social isolation, and nutritional deprivation. HD starts early in life and progresses in severity with age and does not remit if left untreated. Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) provides training in compensatory cognitive strategies to address the executive dysfunction typical of individuals with HD, then uses exposure therapy to reduce the distress associated with discarding items. CREST improves hoarding symptoms and functioning in older adults with HD, but there has been little focus on the implementation and dissemination of evidence-based treatment for hoarding in community settings.

METHODS

To address the lack of evidence-based interventions for HD in the rural heavily Spanish speaking East San Diego and Imperial Counties, we plan to use the IM-Adapt (Intervention Mapping – Analyze, Discover, Adapt, Practice, Test) model to tailor an implementation strategy. The tailored implementation strategy will be used to scale-out CREST to these communities, focused on Spanish-speaking adults with HD. This project will work with a diverse group of stakeholders to analyze the needs and goals of these regions via focus groups and interviews to provide evidence-based services to residents with HD, adapt a strategy, and develop a practice plan for implementing CREST in these communities.

Pre-Implementation to Guide the Development of the MedSafe Clinical Decision Support System

Posted on May 7, 2021May 21, 2021 by coprhcon

BACKGROUND

The US Department of Veterans Affairs (VA) VISN 21 Pharmacy Benefits Program Service has developed the Clinical Dashboard for Patient Aligned Care Team (PACT) performance measures, which includes patient data showing whether the clinical care meets performance measures tracked by the VA. Embedded within the Clinical Dashboard is a decision support tool being developed by the Medication Safety (MedSafe) QUERI Program, the MedSafe Clinical Decision Support (CDS) system. It provides recommendations for the care of select patients who are not meeting VA performance measures.

We conducted a pre-implementation assessment of potential interest among PACT members in use of the MedSafe CDS system. We also examined barriers and facilitators to guide its implementation.

RESULTS

Six participants (28.6%) expressed varied interest in using the CDS system to inform other PACT members about issues like medication adherence and goal attainment. PACT member role was important as a PACT-nurse said: “We really rely on the pharmacists to do more of the medication management and so nurses don’t typically focus on medication…” According to a pharmacist, the CDS system: “…keeps you up to date with the different formulary issues, with different drugs that doctors may not all be familiar with…all of those things are constantly changing so it can be overwhelming keeping up with it.”

Barriers to use included doubts about CDS recommendation alignment with their own/provider recommendations, time constraints, understaffing and potential technical difficulties. To implement the CDS system, significance of support from the members of the PACT was reflected as: “…just not having a proper PACT team set up and getting buy-in for everybody to still use it.” However, one PACT-nurse said: “I don’t really see any barriers to using it.”

Participants expected the recommendations from the CDS system would improve efficiency during patient visits. It could be used for panel management as a PCP stated: “…usually I would like to have a pre-visit planning done for my patients before my patient’s appointment…this is an ideal tool to figure out what can be done as a PACT team.” For population management purposes: “I think this really makes population management much more manageable being able to go in and have this information at your fingertips.”