Evolving Patient Stakeholder Engagement in Invested in Diabetes

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
RAMONA KORENI
University of Colorado Anschutz Medical Campus
BACKGROUND
Patient engagement in healthcare research may be beneficial to enhancing research studies in enhancing research feasibility, acceptability, rigor and relevance. The active collaboration between patients and researchers can inform the full spectrum of research activities (planning study design, selecting relevant outcomes, tailoring interventions to meet patient needs and preferences, enhancing patient study enrollment, study implementation/conduct, analyses review, and dissemination). Specifically, actively engaged patient participation in these various research activities throughout the research project lifecycle can produce interventions that align more with patient needs and are more acceptable by patients thus leading to greater patient uptake and engagement and potentially greater improvement in intervention outcomes.
 
The Invested in Diabetes project, a comparative effectiveness cluster-randomized pragmatic trial comparing two methods of implementing diabetes shared medical appointments, engaged patient partners from conception through implementation and continues to engage patients as findings begin to be disseminated. This presentation will describe the experience of the patient-researcher partnership and how engagement evolved throughout the course of the project.
SETTING/POPULATION
The study takes place in primary care practices in Colorado and Kansas. The views represent Colorado-based patient stakeholders and University of Colorado researchers.
METHODS
Five stakeholders and four researchers responded to questions around their perception of patient stakeholder involvement. Project notes and deliverables were looked at to examine the change in engagement over time.
RESULTS
Stakeholders entered the project at different times and had different motivations for participation. Engagement and expectations changed significantly for stakeholders as the project went from concept to implementation, with stakeholders moving from an advisory role to assisting in project deliverables and otherwise becoming part of the study team as patient partners. Stakeholders responsibilities included finalizing study outcomes of interest, developing training and onboarding materials for peer mentors, co-leading peer mentor learning collaborative calls, and reviewing patient-facing materials for practices. Changes in interaction between the stakeholders and researchers naturally occurred as well, as will be discussed.
CONCLUSIONS
Patient stakeholders played a critical role in the Invested in Diabetes project. The prolonged engagement resulted in a stakeholder advisory role that transformed in response to the changing needs of the project over time. Projects utilizing patient stakeholders should consider how to best engage them based on their project needs,and should expect to re-evaluate the relationship over time.
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Evaluating the Need for a New Clinical Decision Support Tool in Knee Arthroplasty Rehabilitation

Join us as this presenter discusses this poster live on May 25, 2021 | Track A at 1:00 PM Mountain

PRESENTER
JEREMY GRABER, PT, DPT
University of Colorado Anschutz Medical Campus
BACKGROUND
Physical therapists (PTs) use range of motion (ROM) and functional measures like the Timed Up and Go (TUG) to monitor patient recovery after total knee arthroplasty (TKA).1 We recently developed a clinical decision support tool which precisely predicts ROM and TUG recovery post-TKA; we believe this may augment PTs’ ability to monitor patient recovery. The purpose of this project was to assess PTs’ confidence and accuracy in monitoring post-TKA recovery prior to implementing our clinical decision support tool into practice.
SETTING/POPULATION
This project is part of a quality improvement collaboration between ATI Physical Therapy and the University of Colorado. All data collection occurred at two outpatient clinics in Greenville, SC.
METHODS
Eight PTs rated their confidence level in predicting ROM and TUG measurement in TKA rehabilitation; the survey was scored on a Likert scale ranging from 0 (not at all confident) to 3 (very confident). During standard rehabilitation, PTs regularly collected ROM, TUG, and other outcomes; these data were entered into a quality improvement database for all patients with TKA. At the first postoperative visit, PTs also estimated patients’ discharge knee flexion ROM and TUG values. We examined correlation (Pearson’s r) and agreement (Bland-Altman plots) between predicted and observed values for ROM and TUG.2 Observations recorded within 21 days of patients’ discharge date were eligible for inclusion. Patient records with an episode duration < 1 month were excluded to remove data associated with premature self-discharge.
RESULTS
Overall, PTs felt confident in their ability to predict patient outcomes. PTs reported feeling “confident” or “very confident” for both measures, except for two PTs who chose “somewhat confident” for TUG prediction. A total of 477 patient records were screened for inclusion in the accuracy assessment; only 25 were eligible for ROM assessment and 22 for TUG. The correlation between predicted and observed was moderate for ROM (r = 0.65) and weak for TUG (r = 0.29).3 The Bland-Altman limits of agreement were 0.8 + 16.3 degrees for knee flexion ROM and 0.3 + 4.2 seconds for TUG.
CONCLUSIONS
Although PTs rated themselves as confident in their ability to predict post-TKA ROM and TUG recovery, their accuracy suggests there is room for improvement. The Bland-Altman limits of agreement exceeded the minimal detectable change for both knee flexion ROM (6.4 – 7.1 degrees4) and TUG (2.49 seconds5). The observed correlations indicate PTs may benefit most from assistance monitoring TUG recovery. These results suggest our clinical decision support tool may provide PTs with a relative advantage-a key feature for disseminating innovations6-compared to standard practice. Our next steps will be to integrate the tool into the participating clinics to assess its effectiveness and implementation potential in outpatient TKA rehabilitation.
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Planning for Sustainability of Medication for Opioid Use Disorders Services in Rural Colorado

Join us as this presenter discusses this poster live on May 26, 2021 | Track B at 12:15 PM Mountain

PRESENTER
CLAUDIA R. AMURA, PhD, MPH
University of Colorado Anschutz Medical Campus
INTRODUCTION
Opioid use disorders (OUD) have become a national crisis and a huge burden for people with problematic opioid use, their families, and their communities. Colorado rural counties show the highest rates of opioid overdose deaths, and present unique risks such as isolation, low access to treatment or opportunities for overdose reversal. In July 2019, the Colorado Senate approved expansion of the Medication for (MOUD) pilot program to increase access to care in rural areas. Here we focus on lessons learned and plans for sustainability.
SETTING/POPULATION
Under SB19-001, 8 clinical service organizations received funding to bring MOUD into 20 rural Colorado counties in a Hub and Spoke system that expanded to 47 sites in 20 rural counties. In collaboration with the Center for Prescription Drug Abuse Prevention, the CU College of Nursing provided clinical expertise, oversight, and evaluation of the program.
METHODS
Informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance and Practical Robust Implementation and Sustainability Model (RE-AIM/PRISM) frameworks, and using a stakeholder-involved approach, we conducted team-based Strengths, Weaknesses, Opportunities and Threats (SWOT) analyses with each “Hub” to understand needs and plan for MOUD clinical service sustainability.
RESULTS
Since January 2020, the Hub and Spoke system doubled the health provider capacity to serve 979 new MOUD patients across the rural areas covered. The COVID-19 pandemic deeply impacted patient retention, requiring sharp adaptations to service provision and outreach activities in order to adhere to social distancing requirements. Despite these challenges, sites developed a network of treatment expertise and referral for patients in under-served, geographically isolated rural areas. Adaptive capabilities included the development of case management and care coordination systems, new partnerships between clinical sites, judicial systems, and community organizations, and utilization of peer-support specialists for patient tracking and connection to resources. Analyses of barriers and successes also helped academic and community partners define opportunities and plans for sustainability. These include leveraging existing community and local relationships, solidifying care coordination systems built during this time, and seeking additional funding for ongoing clinical services, case management and peer support specialists.
CONCLUSIONS
Working in multidisciplinary teams and focusing on local needs helped overcame numerous barriers encountered while implementing OUD treatment and behavioral health interventions in primary care rural settings. Lessons learned from this effort should result in program implementation improvement and stronger care coordination systems. This state-sponsored MOUD program has the potential to enhance outcomes and generate sustainable solutions for addressing the opioid crisis in Colorado.
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