Table 2 Discrete strategies and specifications identified by stakeholders across interviews and workshops
Strategy category | Discrete strategy | Actor(s) | Action(s) | Temporality | Dosage |
|---|---|---|---|---|---|
Training | Asynchronous training of MA/nurses | Trainers: video (School of Medicine, available materials with pediatric standardized patient) Trainees: MAs/nurses | • Training in BP measurement techniques and context (refreshers) • Training in EHR strategies for EBP | • New hires • Transfers/inter-departmental changes to pediatrics (within 1 week of starting) | • 20–30 min |
Synchronous training of MA/nurses | Trainers: BP champion(s), MA trainer or lead MA Trainees: MAs/nurses | • In vivo BP measurement technique and context training • Training in EHR strategies for EBP • BP measurement spot-checks | • Immediately following asynchronous training (above) • Spot-checks: ongoing | • 15–20 min (total) • Spot-checks: quarterly, 5–10 min | |
Training of MA/nurses in manual BP reading | Trainers: BP champion(s), Video (School of Medicine, available materials with pediatric standardized patient) Trainees: MAs/nurses | • Training in manual BP measurement techniques • Manual BP measurement spot-checks | • New hires • Transfers/inter-departmental changes to pediatrics (within 1 week of starting) • Spot-checks: ongoing | • 20–30 min | |
Asynchronous training of pediatric clinicians | Trainer: video Trainees: pediatric clinicians | • Training in BP measurement techniques and context (particularly for pediatric practices) • How to address EBP, etc. • Training in EHR strategies | • Annually | • One training for diagnosis • One training for treatment/management (~15 min each) | |
Synchronous training of pediatric clinicians | Trainer: specialist (e.g., pediatric nephrologist) Trainees: pediatric clinicians | • Psychoeducation (grand rounds, in-service, counseling strategies, case presentations) | • Annually | • 50–60 min | |
Audit and feedback | Feedback reports | • Data team • Alliance-generated report • Targets: pediatric clinicians, (support staff) | • Dashboard report • Practice-level comparisons, • Individual clinician performance (combined with annual review) | • Report generation and review: as needed (recommended: monthly to quarterly, combined with other data reports/reviews) • To providers: 6 months (combined with incentive structure) | • ~10 min per meeting |
Workflow changes | Workflow changes | Operations director (to MAs) | • Specification and dissemination of new workflow | • Within 1 month of implementation launch | • 1–2 h |
Staffing changes | Develop new position | • Operations director/practice manager • Residency/intern manager | • Describe the position and hire; develop a business plan to justify position | • Within 1 month of implementation launch | • 6–8 h |
Shift tasks among existing positions | • Operations director/practice manager • Residency/intern manager | • Specify new expectations (population health tool) • Relieve other duties and reassign as needed | • Within 1 month of the launch of the population health tool | • 1–2 h | |
Visual reminders/materials (non-digital) | Visual reminders for staff | • Operations director/practice manager • Marketing team | • Make materials available and accessible | • Within 1 month of implementation launch • Refresh as needed | • 2–5 min per patient, as needed (to use materials) • May require time to create materials |
Materials for patients/families | • Operations director (for workflow change) • MAs (sending messages) | • Send email or snail mail to indicated patients/families | • Within 1 month of implementation launch • Refresh as needed | • 1–2 h/week | |
HIT solutions/features | EHR reminders and features | • Alliance, individual health center’s EHR department • Target: pediatric clinicians, support staff | • Programming EHR (order sets, clinical decision tree quick-link) | • Within 1 month of implementation launch, use with every patient as necessary | • 1–2 min/patient |
Population builder (population health tool) | Identify at-risk patients/populations | • BP champion(s) • Trainees • Data team • Case managers | • Run population queries and review • Flag at-risk patients (scheduled or need follow-up) | • Weekly to monthly | • 5–20 min/week (highly variable) |
Patient care huddles | • Care team (pediatric clinicians and support staff, case managers) | • Meeting to review results of population health tool query | • Daily | • 5–10 min, 1–2 times/day | |
Leadership support | Engaging leadership | • Pediatric clinicians • Quality Improvement team • External actors from relevant interest groups (AAP, AllianceChicago) | • Meetings • Materials to make the case • Prioritization within strategic plan/quality improvement plan | • Highly variable per CHC (more effort up front, with ongoing time commitment) | • Variable, dependent on the current stage of change |
Financial support | Provider incentives | • Leadership: COO, CEO, CFO • HRSA, • UDS measures • Insurance companies | • Integrate within existing pediatric provider incentive structure plan and financial model | • 6 months (performance review schedule) | • Requires 2–3 h up front, minimal time once integrated |
Accessing funding (positions, equipment) | • Leadership: COO, CEO, CFO | • Add/integrate into yearly budget • Clinic space: work with facilities | • Ongoing (e.g., replace broken equipment, as needs arise) | • 30–60 min for budget planning |