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ACCP Report - September 2018

Highlights from the CMM Effectiveness and Implementation Grant: A Report from the CMM Study Team

Written by Todd D. Sorensen, Pharm.D., FCCP


As our CMM study team approaches the end of the “CMM in Primary Care” study, our work has changed significantly since the last update. With data collection almost complete, we are now focused on analyzing data and articulating the results from several of the research streams embedded in the overall study design. This is a brief review of the status of several study outputs – many individual projects have been completed, almost completed, or scheduled to be completed by December, making it impossible to list them all in this month’s ACCP Report.

Implementation of CMM Findings

We’ve previously described that our study has two general areas of focus: (1) studying how to implement CMM in an accelerated manner and with fidelity and (2) measuring the impact of CMM via clinical and economic outcomes. With respect to the implementation stream of our research, a “big-picture” accomplishment is that our experience over the past 2½ years has allowed us to define an implementation system for CMM. A paper describing this system has been accepted and will be published in the first issue of the new Journal of the American College of Clinical Pharmacy next month.

This implementation system is designed to scale our work beyond the study and to guide practitioners and organizations through the process of CMM implementation and improvement. The CMM implementation system will be available via a web-based technology platform, to be showcased at the upcoming ACCP Global Conference on Clinical Pharmacy, October 20–23, in Seattle, Washington. Learnings and deliverables from this project will be packaged within the implementation system through a series of guided steps and activities. Each step of this implementation system will also include tangible resources to support pharmacists and organizations in their implementation efforts moving forward. The following figure provides an overview of the implementation system and key deliverables in the form of activities and resources that have emerged, or will yet emerge, from our study.

A significant outcome of our study is the development of a “common language” for the patient care process of CMM. The framework outlined in the Patient Care Process for Delivering CMM resource was developed via a rigorous research methodology consistent with an implementation science strategy critical to producing fidelity in practice. This resource will not only be housed within the technology platform (Step 1: Get Started), but has also been translated into a self-assessment tool with built-in reporting features to be used by practitioners as a means of assessment and quality improvement (Step 4: Assess Your Foundations). We believe the common language document is a significant resource that will shape the national ongoing conversations in practice and education around the patient care process for CMM. As an example, this document was shared with schools of pharmacy via the American Association of Colleges of Pharmacy (AACP) in July as part of discussions in the AACP House of Delegates focused on the need for consistency in teaching a common patient process. We have also been asked to discuss this document with the Joint Commission of Pharmacy Practitioners at its meeting in November.

Additional learnings and deliverables from our study that are forthcoming and that will also be embedded in the implementation system include the following.

  • We have completed the analysis of data associated with patient responsiveness, one component of which includes patient satisfaction with CMM services. Findings will be presented as a poster presentation at the Global Conference. Ultimately, the instrument will be available for practitioners to capture patient perceptions of CMM, which is an important part of the value proposition for CMM.
  • We have concluded an evaluation of CMM encounter notes by our study sites (a component of our fidelity assessment) and developed a series of recommendations regarding CMM documentation. This work will also be presented as a poster at the Global Conference.
  • We have almost finished evaluating the improvement cycle experience, an analysis of the experience of study sites applying improvement cycles to their efforts to enhance CMM service delivery. Learnings stem from a review of PDSA improvement cycle logs, results from a feasibility survey, and insights from practitioner interviews. Lessons learned from this structured improvement experience are now being summarized.
  • We have also developed a framework that describes the impact of CMM on the experience of primary care providers. A series of single and dyadic interviews with primary care providers have allowed us to articulate CMM’s perceived value on physician productivity and professional well-being. We are targeting primary care, family medicine, and pharmacy audiences for dissemination of these findings.

Disseminating CMM Implementation Resources

Aside from the traditional academic dissemination of all of our learnings through publications, one of the study’s goals was to develop strategies to engage practitioners in our study findings. We envisioned that we would create active and immersive strategies that would accelerate CMM adoption and implementation. One example of this type of strategy was the Patient-Centered Team-Based Practice Forum held during the 2018 ACCP Updates in Therapeutics® meeting this past February in Jacksonville, Florida.

An additional strategy for engaging practitioners in an active and immersive experience is through our web-based technology platform (i.e., the implementation system described above), which provides a home for many of the findings and tools produced from the study. This resource is being built to reflect the “implementation system” described above and will provide users with numerous educational materials, assessment tools, and a clinical documentation resource. As mentioned previously, we will showcase a portion of the site via a “demo station” in ACCP Central at the Global Conference in October.

Clinical and Economic Outcomes Evaluation

We are working closely with our colleagues at the American Academy of Family Physicians, who are leading this component of the study. We have received electronic health record data from the study sites participating in this aim of the study, which are being formatted for analysis and for which an analytical code is being written. The analysis on clinical measures will be completed first, followed by its results, which will feed into the cost-savings evaluation. We may have some preliminary results in October, but we don’t expect to have this part of the study completed until late 2018.

Our research team can fully sense that we are in the “wrap-up” period of this grant – we’ve had 2 years of data collection and experience and are finalizing the ways we can package this information to support and accelerate CMM adoption nationally. We are excited to share many of our study findings via a variety of venues, including at the ACCP Global Conference in October.

In closing, we have reached a period of the study in which we are now reflecting on the importance of the partnership that has existed between the research team and the study sites over the past 2½ years. The “implementation stream,” rich with many learnings and experiences, is unique, adding an entirely new dimension to previous research around CMM. This research study goes well beyond the traditional dissemination of data produced by a clinical practice and relies critically on the engagement of the “subjects” of the study – the frontline practitioners who took the time to test new ideas, participate in coaching calls and webinars, complete many forms and surveys, and share their experiences through interviews and focus groups. We greatly appreciate the commitment, adaptability, and expertise of the 40+ practitioners from the health care organizations that have participated in this project.