Provider Champions Research Articles

"It's What Would Work for Her": An Analysis of Adaptations to the Individualized Positive Psychosocial Interaction Program in U.S. Nursing Homes.

The Individualized Positive Psychosocial Interaction (IPPI) program is an adaptable, evidence-based intervention. IPPI trains nursing home care partners to engage residents living with moderate to severe dementia in preference-based, one-to-one interactions using emotion-focused communication. We sought to understand provider-driven adaptations made to the IPPI program and whether the adaptations made were fidelity-consistent. Data were collected from n = 78 interviews with n = 23 nursing home provider champions who led a quality improvement project to implement the IPPI programwith 3-5 residents per care community. Using content analysis, we report quantitative data on the adaptation characteristics according to the Framework for Reporting Adaptations and Modifications-Expanded core modules and participant quotes to illustrate adaptations. Champions reported 34 adaptations, with an average of 2.6 adaptations per nursing home. The majority of IPPI adaptations pertained to implementation (65%; n = 22), whereas 17% (n = 6) were content and 17% (n = 6) were context. Some adaptations were motivated by the organization (e.g., time constraints), while others were motivated by the recipient (e.g., cognitive capacity). Most adaptations made to the IPPI protocol by care partners were fidelity-consistent (92%; n = 33). Care partners' adaptations to the IPPI made the intervention more resident-centric. Future healthcare intervention providers must consider the user perspective and encourage adaptations that further tailor to the user, as long as the adaptations are fidelity-consistent.

Management of peripheral arterial disease in the context of a multidisciplinary limb program.

Peripheral artery disease (PAD) continues to increase in prevalence worldwide due to risk factors such as advanced age, diabetes mellitus, and obesity. Critical limb ischemia (CLTI) is the advanced form of PAD that can result in a lack of healing and limb loss as the most devastating consequence. Patients with PAD, especially CLTI, benefit from multidisciplinary care to optimize outcomes by reducing cardiovascular morbidity and mortality and preventing lower extremity amputation. Collaboration between various specialties allows a focus on problems involved in treating the patient with PAD including prevention, screening, medical care, wound care, infection, and revascularization when needed. Although there is no clear definition or consensus on the structure of the PAD team, certain guidelines are applicable to most clinical scenarios emphasizing "provider champions" in leading a clinical program. A vascular specialist (vascular surgery, interventional radiology, interventional cardiology) and a soft tissue specialist (podiatry, plastic surgery) are the typical "champions," often involving orthopedics, general surgery, vascular medicine, diabetology/endocrinology, infectious disease, nephrology, and rehabilitation medicine. The team should also include wound nurses, nutritionists, occupational therapists, orthotists, pharmacists, physical therapists, prosthetists, and social workers. This paper presents a brief overview of the structure of the multidisciplinary team with key components and functions of such a team to optimize treatment outcomes for PAD and CLTI.

Perception of nudge interventions to mitigate medication errors risk in healthcare service delivery

BackgroundConventional cognitive interventions to reduce medication errors have been found to be less effective as behavioural change does not always follow intention change. Nudge interventions, which subtly steer one’s choices, have recently been introduced.MethodsConducted from February to May 2023, this study aimed to determine the relationships between perceived effectiveness and perceived ease of implementation of six nudge interventions to reduce medication errors, i.e., provider champion, provider’s commitment, peer comparison, provider education, patient education and departmental feedback, and the moderating effects of seniority of job positions and clinical experience on nudge acceptability. Partial Least Square Structural Equation Modelling was used for data analysis.Results and discussionAll six nudge strategies had significant positive relationships between perceived effectiveness and acceptability. In three out of six interventions, perceived ease of implementation was shown to have positive relationships with perceived acceptability. Only seniority of job position had a significant moderating effect on perceived ease of implementation in peer comparison intervention. Interventions that personally involve senior doctors appeared to have higher predictive accuracy than those that do not, indicating that high power-distance culture influence intervention acceptability.ConclusionFor successful nudge implementations, both intrinsic properties of the interventions and the broader sociocultural context is necessary.

Applying the R = MC2 implementation science heuristic to assess the impact of readiness on reach and implementation of a population-wide genomic screening program.

Population-wide genomic screening for genes that have high penetrance and clinical actionability enhances the opportunity to identify individuals at risk for developing hereditary conditions. Organizational readiness has been shown to influence the likelihood of successful implementation of complex initiatives such as the integration of population-wide genomic screening in clinical settings. We use the organizational readiness heuristic R = MC2 to better understand three factors that influence readiness for implementation of In Our DNA SC, a population-wide genomic screening program: motivation to implement, general capacity of an organization, and innovation-specific capacities. We then assessed the influence of these readiness factors on implementation outcomes of reach (measured through enrollment rate) and implementation (measured through the number of DNA samples collected). Data were collected pre-implementation and captured during the three-month pilot phase of the In Our DNA SC program. We collected administrative data from the electronic health record and quantitatively captured elements of readiness through surveys distributed to provider champions and clinical administrative champions at the 10 sites implementing the population-wide genomic screening program. We facilitated innovation-specific capacity through training offered at each site, as well as technical assistance through weekly meetings with other implementing sites, and resources available to all staff. Forty percent of provider champions attended training and 80% of administrative champions attended training. An average of 3.7 additional staff were trained at each implementing site. Satisfaction with training positively influenced reach (β = 0.0121, p = 0.0271) but did not impact implementation. Provider engagement (innovation capabilities) was associated with reach (β = 0.0020, p = 0.0251) and clinical administrator engagement was associated with sample collection rate (β = 0.2599, β = 0.038). Readiness to change is considered one of the most important factors in understanding the potential opportunity for implementation. We found that motivation to adopt a population-wide genomic screening program positively impacted the program's reach. The type of champion influenced discrete outcomes, with provider champions positively impacting reach and administrative champions influencing implementation (assessed through sample collection rate). As genomics continues to be integrated into clinical practice, it will be important to understand the contextual factors that influence readiness for implementation and design support throughout the life-course of implementation to ensure the success of large-scale, complex initiatives.

A Cost Analysis of Rethink the Strip: De-implementing a Low-value Practice in Primary Care.

Routine self-monitoring of blood glucose is a low-value practice that provides limited benefit for patients with non-insulin-treated type 2 diabetes mellitus. We estimated the costs of Rethink the Strip (RTS), a multistrategy approach to the de-implementation of self-monitoring of blood glucose in primary care. RTS was conducted among 20 primary care clinics in North Carolina. We estimated the non-site-based and site-based costs of the 5 RTS strategies (practice facilitation, audit and feedback, provider champions, educational meetings, and educational materials) from the analytic perspective of an integrated health care system for 12 and 27-month time horizons. Material costs were tracked through project records, and personnel costs were assessed using activity-based costing. We used nationally based wage estimates. Total RTS costs equaled $68,941 for 12 months. Specifically, non-site-based costs comprised $16,560. Most non-site-based costs ($11,822) were from the foundational programming and coding updates to the electronic health record data to develop the audit and feedback reports. The non-site-based costs of educational meetings, practice facilitation, and educational materials were substantially lower, ranging between ~$400 and $1000. Total 12-month site-based costs equaled $2569 for a single clinic (or $52,381 for 20 clinics). Educational meetings were the most expensive strategy, averaging $1401 per clinic. The site-based costs for the 4 other implementation strategies were markedly lower, ranging between $51 for educational materials and $555 for practice facilitation per clinic. This study provides detailed cost information for implementation strategies used to support evidence-based programs in primary care clinics.

UNDERSTANDING PROCESSES NEEDED TO SUCCESSFULLY IMPLEMENT PAL CARDS IN NURSING HOMES

Abstract Background The CFIR Process domain can be used to evaluate practices that are associated with successful or unsuccessful implementation. The purpose of this study was to understand the processes that led to successful implementation of the PAL Card QIP during the height of the pandemic from the provider champion’s perspective. Methods Qualitative interviews with n=11 champions who completed the PAL Card QIP were audio recorded, transcribed verbatim, and coded using the CFIR Process Domain. Results Major themes regarding the process of implementation included engaging (e.g., staff and family), executing (adapting to different situations), planning (e.g., having a clear plan of implementation), and reflecting and evaluating (e.g., taking time to evaluate the project). Discussion: Providers articulated strategies that contributed to successful implementation during a global pandemic, which can help inform future quality improvement projects. Implications for practice and policy will be discussed.

THAT'S JUST MY SUPERPOWER: THE ROLE OF NURSING HOME PROVIDER CHAMPIONS IN IMPLEMENTING A PERSON-CENTERED PROJECT

Abstract Champions are crucial to successful intervention implementation; however, as an area of research champions have only recently begun to gain empirical focus. The purpose of this study was to identify the barriers and facilitators regarding champion qualities using the domain “Characteristics of the Individual” from CFIR. Qualitative interviews were conducted with nursing home provider champions (n=16) who led efforts to create PAL Cards for 15-20 residents and participated in a total of n=50 monthly interviews that were audio-recorded and transcribed verbatim. The following themes regarding characteristics of the individual emerged: champions’ investment in their community, capacity and existing workload, and willingness to ask for help. While some champions saw the value of the PAL Cards, they lacked the bandwidth necessary to widely implement the intervention in their community. Champions who recruited a supportive team and valued person-centered care exhibited success in implementing PAL Cards.

IT’S A COOL LITTLE TOOL: PROVIDER PERSPECTIVES ON IMPLEMENTING PAL CARDS DURING COVID-19

Abstract This symposium describes the implementation of a person-centered care (PCC) communication tool in nursing homes. PCC is a philosophy that recognizes “knowing the person” and honoring individual preferences. The communication tool is based on an assessment of NH resident likes and dislikes via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. The Preferences for Activity and Leisure (PAL) Card was developed to communicate important resident preferences across care team members. From July 2020 to July 2021 we lead a Quality Improvement Project (QIP) approved by the Ohio Department of Aging providing virtual coaching to providers who created 15-20 PAL Cards for their residents. Our first presentation describes the QIP where n=16 started implementation and n=11 communities completed the project during the height of the pandemic. Providers were non-profit (50%) with an average star rating of 3.29 (SD 1.33). Feedback from n=68 direct care staff on PAL Card usage are reported. The next four presentations describe implementation of PAL Cards from the perspective of the provider champions who contributed to n=66 monthly interviews. Interviews were recorded, transcribed verbatim, and coded in Dedoose using the Consolidated Framework for Implementation Research as an a priori coding scheme. We present barriers and facilitators related to the domains of Inner Setting, Characteristics of the Individual, Characteristics of the Intervention, and Process. The Discussant, Dr. Natalie Douglas will discuss the implications of initiatives to address the quality of resident care.

THE INFLUENCE OF NURSING HOME CHAMPIONS ON THE IMPLEMENTATION OF A PERSON-CENTERED QUALITY IMPROVEMENT PROJECT

Abstract Preferences for Activity and Leisure (PAL) Cards are a communication tool designed to alert nursing home staff to important resident preferences. This study explored the role of nursing home provider champions implementing (PAL) Cards in their community. Champions (n=35) created PAL Cards for 15-20 residents. A total of 88 monthly interviews were audio-recorded, transcribed, checked for accuracy, and coded using the domain “Characteristics of the Individual” from the Consolidated Framework for Implementation Research. Each construct was assigned a general valence rating based on consensus. Four constructs received the highest positive valence ratings and were identified as important facilitators to implementation success, and one construct received a neutral valence. Champions who anticipated the benefits of PAL Cards for their community and recruited a supportive team exhibited high implementation success. Additionally, the champion’s perception of help from staff seemed to increase their own self-efficacy to achieve their goals.

Positive Healthcare Encounters for Children With Autism Spectrum Disorder: Accommodations During Surgical Procedures

Children with autism spectrum disorder have unique needs during medical procedures involving anesthesia. However, with early patient identification, provider champions can adapt their practice to better serve this population, thereby improving patient satisfaction and outcomes. This article describes a novel protocol developed by an anesthesia resource center to modify care for children with autism spectrum disorder and their families. This information serves as a template for perianesthesia nurses and advanced care providers to implement practice accommodations. Two case examples, based on parent interviews and chart review, are presented to exemplify this protocol.

A qualitative study of effective collaboration among nurse home visitors, healthcare providers and community support services in the United States.

Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse-Family Partnership® (NFP) home visiting program as context, this qualitative study aimed to describe effective collaboration among nurse home visitors, healthcare providers and community support services to serve families experiencing social and economic adversities. We used grounded theory to characterise collaboration with six purposively sampled NFP sites in the United States through in-depth interviews. We interviewed 73 participants between 2017 and 2019: 50 NFP staff, 18 healthcare providers and 5 other service providers. Interviews were recorded, transcribed, validated and analysed in NVivo 11. Validation steps included inter-coder consistency checks and expert review. Thematic memos were synthesised across sites. Most participants perceived collaboration to be important when serving families with complex needs, but substantial variation existed in the degree to which NFP nurses collaborate with providers dependent on provider type and community context. Factors that contributed to effective collaboration were relational in nature, including leadership commitment and provider champions, shared perceptions of trust, respect and value, and referral partnerships and outreach; organisational in terms of mission congruence between providers; and structural such as policy and system integration that facilitated data sharing and communication channels. These findings provide greater insights into effective cross-sector collaboration and care coordination for families experiencing adversities. Collaboration across sectors to promote health among families experiencing adversities requires intentional efforts by all inter-professional providers and continued commitment among all levels of leadership to coordinate services.

Increasing Access to Contraception in the United States: Assessing Achievement and Sustainability.

Background: During October 2016 through May 2018, a learning community was convened to focus on policies and programs to increase access to the full range of contraceptive options for women of reproductive age. The Increasing Access to Contraception (IAC) Learning Community included 27 jurisdictions, with teams from each jurisdiction consisting of state health department leaders, program staff, and provider champions. At the kick-off meeting, teams from each jurisdiction created action plans that outlined their goals. Methods: We contacted jurisdictions during May-June 2019, 1 year after the learning community ended, and invited them to complete a post-assessment of goal achievement and sustainment through semi-structured interviews over the telephone or via email. Results: Follow-up information was collected from 26 jurisdictions (96%) that participated in the learning community. The teams from these jurisdictions had created 79 total goals. At the time of the learning community closing meeting in May 2018, 35 goals (44%) had been achieved. Three jurisdictions achieved all their goals by the close of the learning community. At the time of the post-assessment 1 year later, jurisdictions were sustaining efforts for 69 (87%) of the total goals. In every jurisdiction, work on at least one goal that originated in the learning community was sustained. Conclusions: The jurisdictions that participated in the IAC Learning Community continued the work of their action plan goals 1 year after the formal closure of the learning community, indicating sustainability of the learning community activities, beyond what jurisdictions accomplished during formal participation.

An Analysis of the Sustainability of a Collaborative Care Program Used to Deliver Integrated Mental Health Care Within a Micronesian Island State.

Adequate access to mental health care is a global problem, including in the Federated States of Micronesia (FSM). The Collaborative Care Model (CoCM) offers an opportunity to deliver improved access to mental health services in primary care centers, and key factors to program sustainability have been investigated in high-income country settings. This study's objective was to evaluate how well factors associated with sustainability have been incorporated into a CoCM in Kosrae, Federated States of Micronesia. The Kosraean CoCM's strengths included its supportive leadership, team member training, and having a strong care manager and engaged primary care provider champion. Opportunities for growth included further development of its financial viability, information technology systems, change readiness, and operational procedures. Our program found that having a stable and invested staff and leveraging its current strengths were important to its viability. In an international partnership, it is also critical to develop strong relationships among team members and to have stable internet connectivity to facilitate regular communication. These lessons learned can be applicable to other integrated care programs in similar Pacific Island countries.

136. Don’t Sweat the Small Stuff: Solutions for Large-Scale Stewardship Obstacles

BackgroundIn an effort to support stewardship endeavors, the MITIGATE (a Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adult and Children in Emergency Department and Urgent Care Settings) Toolkit was published in 2018, aiming to reduce unnecessary antibiotics for viral respiratory tract infections (RTIs). At the University of Washington, we have incorporated strategies from this toolkit at our urgent care clinics. This study aims to address solutions to some of the challenges we experienced.Challenges and Solutions MethodsThis was a retrospective observational study conducted at Valley Medical Center (Sept 2019-Mar 2020) and the University of Washington (Jan 2019-Feb 2020) urgent care clinics. Patients were identified through ICD-10 diagnosis codes included in the MITIGATE toolkit. The primary outcome was identifying challenges and solutions developed during this process.ResultsWe encountered five challenges during our roll-out of MITIGATE. First, using both ICD-9 and ICD-10 codes can lead to inaccurate data collection. Second, technical support for coding a complex data set is essential and should be accounted for prior to beginning stewardship interventions of this scale. Third, unintentional incorrect diagnosis selection was common and may require reeducation of prescribers on proper selection. Fourth, focusing on singular issues rather than multiple outcomes is more feasible and can offer several opportunities for stewardship interventions. Lastly, changing prescribing behavior can cause unintended tension during implementation. Modifying benchmarks measured, allowing for bi-directional feedback, and identifying provider champions can help maintain open communication.ConclusionResources such as the MITIGATE toolkit are helpful to implement standardized data driven stewardship interventions. We have experienced some challenges including a complex data build, errors with diagnostic coding, providing constructive feedback while maintaining positive stewardship relationships, and choosing feasible outcomes to measure. We present solutions to these challenges with the aim to provide guidance to those who are considering using this toolkit for outpatient stewardship interventions.Disclosures All Authors: No reported disclosures

Implementing electronic health record-based National Diabetes Prevention Program referrals in a rural county.

Since 2016, public health professionals in a rural, Midwest county have collaborated with competing health care organizations to establish electronic health record (EHR)-based systems for identifying patients with prediabetes and referring them to National Diabetes Prevention Program (NDPP) classes. The purpose of this program evaluation was to identify barriers and best practices learned from implementation in two rural health care organizations. A purposively selected program coordinator from each organization and a primary care provider and information technology administrator from one of the organizations provided perspectives on initiating the referral process. Data were collected using open-ended questions in electronic survey format. Content analysis was used to identify themes. Two barrier themes were identified: Timely, clear communication is challenging; and More education is needed for both patients and providers. Best practice themes included Start small with one provider champion; Create a referral process that doesn't exceed resources; and Providers should be actively involved in referral discussions and decisions. Retrospective queries are a feasible way to initially establish EHR-based referral programs in rural areas. PHNs can facilitate this system change among competing health care organizations by leading partnerships, identifying common goals and timelines, and providing space for sharing challenges and best practices.

Nursing Home Responses to Performance-based Accountability: Results of a National Survey.

The Centers for Medicare & Medicaid Services (CMS) Nursing Home Quality Initiative aims to improve quality through performance measurement. We describe quality improvement (QI) changes that skilled nursing facilities (SNFs) reported making in response to CMS performance measurements and whether reported QI changes were associated with better performance on CMS performance measures. Nationally representative survey. A total of 15,475 SNFs that reported quality performance on Nursing Home Compare in 2016. A total of 1,182 SNFs (58% of random sample of 2,045 SNFs). Adoption of 22 possible QI changes, grouped into seven categories (organizational culture, health information technology, care process redesign, provider incentives, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance); performance on the CMS Nursing Home Compare Five-Star Quality Rating System's quality measure rating. SNFs reported making an average of 13 QI changes (interquartile range = 11-16 changes). SNFs mostly commonly reported becoming a learning organization (87%) and providing training to staff on QI strategies (87%). After controlling for patient and facility characteristics, larger SNFs were more likely to obtain assistance on measure reporting from QI organizations and use provider champions than smaller SNFs by 14 and 11 percentage points, respectively. Rural SNFs and SNFs with higher proportions of disabled, black, or Hispanic residents adopted QI changes at similar rates as other SNFs. Of the 22 QI changes, 20 were considered at least somewhat helpful by more than 80% of adopting SNFs. Implementation of all 22 QI changes (vs no changes) was associated with a .48-star higher quality measure rating (95% confidence interval = .003-.98 stars; P = .05). In response to CMS measurement programs, SNFs reported making substantial QI investments that were associated with better performance on CMS quality measures. To guide future SNF investments in QI, work is needed to identify the QI changes that yield the greatest performance improvements.

Launching a Medication-Assisted Treatment in an Outpatient Office-Based Practice.

Background: Opioid use and overdose are escalating in the United States. Primary care providers are in a strategic position to assess patients for medication-assisted treatment (MAT). Objectives: To describe the implementation of MAT in an integrated primary care residency clinic and assess provider comfort levels with evaluating patients for high-risk opioid use, conduct crucial conversations about MAT treatment options and referral to MAT for evaluation and treatment. Methods: As part of a Primary Care Training and Enhancement grant through Health Resources and Services Administration, we used an implementation process to allow for optimal clinic flow. The process included assessment of patient populations, identifying a provider champion, organizing multidisciplinary team, engaging a practice facilitator, designing clinic model and infrastructure, creating the electronic health record order sets along with provider and staff training. Providers responded to brief questions to evaluate comfort levels in 3 domains: identifying high-risk opioid use, conducting crucial conversations about treatment options and referral to MAT for evaluation and treatment. Discussion: Incorporating MAT within an integrated primary care clinic and residency program with waiver training for residents was a successful and innovative program. The availability of MAT provided a solution for patients that could benefit from this type of treatment. MAT presence gave providers the opportunity to refer these patients for treatment that had not previously been as accessible. Conclusion: An integrated primary care practice with an embedded MAT can be successful with an organized structure to optimize clinic flow.

Key Considerations for Implementing Group Prenatal Care: Lessons from 60 Practices.

Group prenatal care combines clinical care with peer support and education. Research has indicated neutral or positive results for group care when compared with traditional individual prenatal visits. A national initiative, Strong Start II, was implemented to determine if specific prenatal care interventions such as group prenatal care can reduce the rate of preterm birth, improve health outcomes, and lower costs. This study explored barriers to implementation and sustainability and strategies for overcoming barriers and sustaining the model. Results from prenatal care provider-level qualitative case studies for the independent evaluation of Strong Start were examined. Case studies for sites implementing group prenatal care were based on a total of 313 interviews with 441 Strong Start key informants (eg, prenatal care providers, project staff, and health administrators involved in group care) and 53 focus groups with 428 Strong Start participants from 2013 to 2016. Supplemental interviews with 25 additional stakeholders were also conducted. Case study data were queried using content analysis followed by a grounded theory-based analysis of these findings. Barriers to implementation existed at patient, provider, administrator, system, and funding levels and included inflexible appointment times, lack of childcare, lack of appropriate meeting space, new scheduling and training needs, meeting requirements of graduate medical education programs, prenatal care provider and administrator reluctance to adopt new practices, and Medicaid payment policies. Sites newly implementing group prenatal care had varying degrees of success sustaining their programs. Both new and established sites identified provider champions and opt-out enrollment approaches as critical for maintaining buy-in. Successful implementation of group prenatal care depends on systematic strategies at the practice, payer, provider, patient, and policy levels to implement, reimburse for, and sustain the model. Strategies for overcoming barriers can assist practices in offering this transformative approach, including practices with graduate medical education programs or those serving women with clinical, demographic, or psychosocial risk factors for preterm birth.

Facilitators and Barriers to the Implementation of the HPV VACs (Vaccinate Adolescents Against Cancers) Program: A Consolidated Framework for Implementation Research Analysis.

Purpose and ObjectivesThe human papillomavirus (HPV) vaccine is an effective but underused method for preventing multiple cancers, particularly cervical cancer. Although interventions have successfully targeted barriers to HPV vaccine uptake in various clinical settings, few studies have explored their implementation. Our study examines the delivery of the HPV VACs (Vaccinate Adolescents Against Cancer) Program and elicits information on barriers and facilitators to implementation.Intervention ApproachThe VACs Program pilot was a multilevel, evidence-based intervention conducted by the American Cancer Society in 30 federally qualified health centers (FQHCs) in the United States.Evaluation MethodsWe conducted in-depth interviews (N = 32) by telephone with representatives of 9 FQHC partners. We structured the interview guides on Consolidated Framework for Implementation Research (CFIR) domains. We asked about project start-up activities, implementation strategy selection, policy- and practice-level changes, staffing structure, challenges, and key factors leading to project success. At least 2 researchers coded each interview transcript verbatim.ResultsParticipants most frequently identified the electronic health record system, training and education, concrete tools and resources, and provider champions as facilitators to implementing HPV VACs. Limited staff resources, challenges of electronic health records, issues with state immunization registries, patient misinformation about vaccines and vaccine stigma, cultural/language barriers, competing priorities, levels of funding, staff buy-in, training needs, and low health literacy were identified as barriers.Implications for Public HealthProviding appropriate training for FQHC staff members and providers along with technical assistance and facilitation tools were critical for increasing provider confidence in recommending HPV vaccine. Addressing capacity-building and implementation barriers in FQHCs can increase effective implementation of evidence-based interventions to increase HPV vaccination uptake and reduce the burden of future cancers.

The stroke navigator: meaningful use of the electronic health record to efficiently report inpatient stroke care quality

To facilitate high-quality inpatient care for stroke patients, we built a system within our electronic health record (EHR) to identify stroke patients while they are in the hospital; capture necessary data in the EHR to minimize the burden of manual abstraction for stroke performance measures, decreasing daily time requirement from 2 hours to 15 minutes; generate reports using an automated process; and electronically transmit data to third parties. Provider champions and support from the EHR development team ensured that we balanced the needs of the hospital with those of frontline providers. This work summarizes the development and implementation of our stroke quality system.