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216 Is shared decision-making taking place? Process and fidelity checks for coach Mc LungsSM, an asthma shared decision-making primary care intervention
  1. Kelly Reeves1,
  2. Lindsay Shade1,
  3. Thomas Ludden1,
  4. Andrew MC Williams1,
  5. Lyn Nuse1,
  6. Cheryl Courtlandt1,
  7. Andrea Desantis1,
  8. Yhenneko Taylor1,
  9. Jeremy Thomas1,
  10. Charity Patterson2,
  11. Kasey Boehmer3,
  12. Brianna Gutch1,
  13. Nick Stevens1,
  14. Margo Burnard1,
  15. Tekeshia Jones1,
  16. Shaina Glass1,
  17. Kristen Minehart1,
  18. Rachel Fraizer1,
  19. Melanie Hogg1,
  20. Stacy Reynolds1,
  21. Melissa Calvert,
  22. Elizabeth Burton1,
  23. Diane Derkowski1,
  24. Denise Derkowski,
  25. Lindsay Deneault1,
  26. Jeffrey Cleveland1,
  27. Saul Amezquita1,
  28. Caroline Cox4,
  29. Katherine O’Hare1,
  30. Melinda Manning1,
  31. Hazel Tapp1
  1. 1Department of Family Medicine, Atrium Health, Charlotte, NC USA
  2. 2School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA USA
  3. 3Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN USA
  4. 4Wellstar Health System, Marietta, GA USA


Introduction Assessing intervention fidelity ensures that the implementation of a research study follows the protocol. Opportunities exist to strengthen the implementation of the Coach McLungsSM (CML) protocol, an app-based shared decision-making (SDM) intervention. SDM is a process by which the patient and provider jointly make a healthcare choice. CML aims to improve outcomes for pediatric patients with asthma, yielding summary reports for both the patient and provider so the two parties together can utilize SDM to reach a mutual decision about the treatment plan. With funding from the National Institutes of Health (NIH), we are implementing CML across 21 primary care practices within Atrium Health, North Carolina, USA. To assess intervention fidelity, we are monitoring documentation in the electronic medical record (EMR) of each coached patient, to check if the intervention is being delivered and that SDM is occurring.

Methods We completed chart reviews on all patients after their coaching sessions to track the delivery and fidelity of the CML intervention. We reviewed provider notes for evidence of SDM and changes to patients’ treatment plan.

Results 174 patients’ charts have been reviewed to date. The CML summary report is available within the EMR of 91%. Within the provider notes: 46% explicitly mention CML; 45% comment on asthma progress or goals; 44% have documentation of SDM (inferred or stated); 30% specifically respond to the output of the provider summary report, and 32% discuss stepping up treatment to improve asthma control. The subsequent provider visit was canceled, or patient didn’t attend visit in 12 cases.

Conclusion Given underlying wide variability of provider documentation style and content, the interim results of chart audits demonstrate that the CML intervention is being delivered and that SDM is occurring within the visits with the providers.

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