Article Text
Abstract
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.