Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Bartels, Christie M.; Ramly, Edmond; Johnson, Heather M.; Lauver, Diane; Panyard, Daniel J.; Li, Zhanhai; Sampene, Emmanuel; Lewicki, Kristin; McBride, Patrick E.

doi:10.1002/acr.23612

Cited by 14 publications

(36 citation statements)

References 39 publications

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“…Adoption was evidenced by improved rates of target behaviors at six months, and maintenance over 24 months, including checking risk factors (i.e., BP and tobacco) and connecting patients to CVD riskreduction follow-up. [24,26,27,34] Such positive ndings are consistent with the theories guiding our project. When SDT concepts have been addressed in behavior change interventions, participants have not only initiated new behaviors but also maintained these new behaviors.…”

Section: Discussionsupporting

confidence: 82%

“…We evaluated implementation outcomes associated with IPAF in the context of a broader pre-, post-, quasi-experimental evaluation of CVD risk-reduction interventions. [24] That evaluation followed a Hybrid Type 2 effectiveness-implementation design, [25] attending to both intervention and implementation outcomes, We reported elsewhere the intervention outcomes: a) timely patient follow-up in primary care after high BPs and b) referrals to the tobacco quit line after assessing readiness to quit. [24,26,27] In this paper, we evaluated the implementation outcomes of feasibility, acceptability, delity, and adoption, [9] focusing on measures relevant to IPAF.…”

Section: Designmentioning

confidence: 99%

“…[24] That evaluation followed a Hybrid Type 2 effectiveness-implementation design, [25] attending to both intervention and implementation outcomes, We reported elsewhere the intervention outcomes: a) timely patient follow-up in primary care after high BPs and b) referrals to the tobacco quit line after assessing readiness to quit. [24,26,27] In this paper, we evaluated the implementation outcomes of feasibility, acceptability, delity, and adoption, [9] focusing on measures relevant to IPAF. We delivered IPAF sessions to individuals synchronously (in-person or by phone) for six months after the beginning of implementation, and later asynchronously by email for over 24 months.…”

Section: Designmentioning

confidence: 99%

“…We evaluated IPAF in a total of eight implementations, representing two interventions (BP Connect and Quit Connect) [24,[27][28][29][30] in four separate rheumatology clinics in two US health systems. Clinics A, B, and C were in a large, suburban, academic, multi-specialty practice; clinic D was a community clinic.…”

Section: Setting and Samplementioning

confidence: 99%

“…This paper focuses on the development and evaluation of IPAF, the implementation component for providing feedback to staff. IPAF was used to improve staff's target behaviors with two CVD risk-reduction interventions: BP Connect for high BP [24,28] and Quit Connect for tobacco use. [27,29] With a Check-Advise-Connect structure for both interventions, the target behaviors were to Check for addressable risk factors, con rming high BPs or readiness to quit tobacco; Advise patients on CVD risk, and Connect patients to relevant resources.…”

Section: Contextmentioning

confidence: 99%

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Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

Ramly

Lauver

Gilmore‐Bykovskyi

et al. 2020

Preprint

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Background: Theory-based implementation strategies, such as audit and feedback (A&F), can improve adoption of evidence-based practices. However, few strategies have been developed and tested to meet the needs of specialty clinics. In particular, frontline staff can execute CVD risk-reduction protocols, but A&F strategies to support them have not been well examined. The objective of this paper is to develop a novel A&F strategy, Interactive Participatory A&F (IPAF), and evaluate as an implementation strategy to support specialty clinic staff. Methods: We developed IPAF by combining theories to inform staff goals (Self-Regulation Theory) and address their psychological needs for relatedness, autonomy, and confidence (Self-Determination Theory). We facilitated IPAF fidelity by developing a theory-based facilitation tool: a semi-structured worksheet to guide flexible discussion of target behaviors, perceived barriers, goals, and action plans. We evaluated IPAF in the context of eight quasi-experimental implementations in specialty clinics across two health systems. Following a Hybrid Type 2 effectiveness-implementation design, we reported intervention outcomes for CVD risk-reduction elsewhere. This paper reports implementation outcomes associated with IPAF, focusing on feasibility, acceptability, fidelity, and adoption. We evaluated implementation outcomes using mixed-methods data including Electronic Health Records (EHR) data, team records, IPAF worksheets, and staff questionnaire responses. Results: Eighteen staff participated in 99 monthly, individual, synchronous (face-to-face or by phone) IPAF sessions during the first six months of implementation. Subsequently, we provided over 375 monthly feedback emails. Feasibility data revealed high staff attendance (90-93%) and engagement in IPAF sessions. Staff rated questionnaire items about acceptability of IPAF highly. IPAF records and staff responses demonstrated fidelity of delivery and receipt of IPAF. Adoption of target behaviors increased significantly (all P-values < 0.05) and was maintained for over 24 months. Conclusions: We developed and evaluated an interactive participatory A&F strategy to improve implementation of evidence-based interventions. The IPAF toolkit combines two complementary theories: Self-Regulation Theory and Self-Determination Theory. Findings support feasibility, acceptability, and fidelity of IPAF, and staff adoption and maintenance of target behaviors. By evaluating multi-site implementation outcomes in specialty clinics with frontline staff, we have extended prior research on clinic protocols and A&F beyond primary care settings and providers.

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Section: Discussionsupporting

confidence: 82%

Section: Designmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Setting and Samplementioning

confidence: 99%

Section: Contextmentioning

confidence: 99%

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Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

Ramly

Lauver

Gilmore‐Bykovskyi

et al. 2020

Preprint

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Significant Gains in Rheumatoid Arthritis Quality Measures Among RISE Registry Practices

Izadi

Schmajuk

Gianfrancesco

et al. 2021

Arthritis Care & Research

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Objective Using the American College of Rheumatology Rheumatology Informatics System for Effectiveness (RISE) registry, our objective was to examine performance on rheumatoid arthritis (RA) quality measures and to assess the association between practice characteristics and changes in performance over time among participating practices. Methods We analyzed data from practices enrolled in RISE between January 1, 2015 and December 31, 2017. Eight quality measures in the areas of RA disease management, cardiovascular risk reduction, and patient safety were examined. Variability in performance was evaluated at the practice level. Multivariate linear models were used to predict change in measure performance by year and to determine the effect of practice characteristics on change in performance over time. Results Data from 59,986 patients from 54 practices were examined. The mean ± SD age was 62 ± 14 years, 77% were female, 69% were Caucasian, and most patients were seen in a single‐specialty group practice (46%). The average performance on measures related to RA treatments was consistently high (>90%) across the study period. Measures related to RA functional status and disease activity assessment had the greatest improvements over time (8.4% and 13.0% increase per year, respectively; P < 0.001). Single‐specialty group practices had the fastest rates of improvement over time across all measures. Conclusion Among practices participating in RISE between 2015 and 2017, performance on most RA quality measures improved. Single‐specialty group practices saw the fastest rates of improvement over time. Identification of workflow patterns leading to dramatic improvements in quality of care will help guide process redesign to address gaps in priority areas, such as tuberculosis screening and blood pressure control.

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Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

Bartels

Johnson

Ramly

et al. 2022

Arthritis Care & Research

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Objective Smoking increases cardiopulmonary and rheumatic disease risk, yet tobacco cessation intervention is rare in rheumatology clinics. This study aimed to implement a rheumatology staff‐driven protocol, Quit Connect, to increase the rate of electronic referrals (e‐referrals) to free, state‐run tobacco quit lines. Methods We conducted a quasi‐experimental cohort study of Quit Connect at 3 rheumatology clinics comparing tobacco quit line referrals from 4 baseline years to referrals during a 6‐month intervention period. Nurses and medical assistants were trained to use 2 standardized electronic health record (EHR) prompts to check readiness to quit smoking within 30 days, advise cessation, and connect patients using tobacco quit line e‐referral orders. Our objective was to use EHR data to examine the primary outcome of tobacco quit line referrals using pre/post design. Results Across 54,090 pre‐ and post‐protocol rheumatology clinic visits, 4,601 were with current smokers. We compared outcomes between 4,078 eligible pre‐implementation visits and 523 intervention period visits. Post‐implementation, the odds of tobacco quit line referral were 26‐fold higher compared to our pre‐implementation rate (unadjusted odds ratio [OR] 26 [95% confidence interval (95% CI) 6–106]). Adjusted odds of checking readiness to quit in the next 30 days increased over 100‐fold compared to pre‐implementation (adjusted OR 132 [95% CI 99–177]). Intervention led to e‐referrals for 71% of quit‐ready patients in <90 seconds; 24% of referred patients reported a quit attempt. Conclusion Implementing Quit Connect in rheumatology clinics was feasible and improved referrals to a state‐run tobacco quit line. Given the importance of smoking cessation to reduce cardiopulmonary and rheumatic disease risk, future studies should investigate disseminating cessation protocols like Quit Connect that leverage tobacco quit lines.

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Connecting Rheumatology Patients to Primary Care for High Blood Pressure: Specialty Clinic Protocol Improves Follow‐up and Population Blood Pressures

Cited by 14 publications

References 39 publications

Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

Interactive Participatory Audit and Feedback (IPAF): Theory-based development and multi-site implementation outcomes with specialty clinic staff

Significant Gains in Rheumatoid Arthritis Quality Measures Among RISE Registry Practices

Impact of a Rheumatology Clinic Protocol on Tobacco Cessation Quit Line Referrals

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