Field Note v2_3 (Colorado)

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FIELD NOTE (Colorado)

Facilitators, HEROs, Regional Health Connectors, and CHITAs complete regular field notes. We want to hear about what could affect (positively and negatively) the practice's improvement work on cardiovascular disease care.

Complete a new field note after each substantive contact with a practice, such as planned meetings and conference calls. A brief field note should also be completed if a meeting was canceled or missed. NOTE: All items on the form are required. Please give the best answer you can.

The field note answers three basic questions:

(1) What did you do at this visit? (activities, resources, tools, training)

(2) What's next? (plans and responsibilities for follow up, including the next visit or contact)

(3) What other essential information do we need to know? (key "takeaways" and assessment of engagement and teamness)

Thank you.

State

* must provide value

Your role:

* must provide value

Facilitator

HERO

CHITA

Regional Health Connector

Other

Please specify "Other" role:

* must provide value

Your organization:

* must provide value

Please specify "Other organization"

Your first name:

* must provide value

Your last name:

* must provide value

Clinic name:

* must provide value

Date of Meeting/Contact:

* must provide value

M-D-Y

Meeting/Contact Description

* must provide value

Regular QI Team meeting

Clinic leadership meeting

Practice-wide meeting (all staff and clinicians)

IT/EHR/Technical support staff

System-level meeting (e.g., system-level director, officer, IT)

Kickoff or "Go!" Meeting (i.e., initial facilitation visit)

Other type of contact or meeting...

Briefly describe "Other" meeting type:

Was the meeting/contact canceled or missed?

* must provide value

Yes

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Briefly explain why the meeting was canceled or missed:

* must provide value

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Who was at the meeting/contact (do not include yourself)?

* must provide value

Provider(s) (MD, DO, NP, PA)

Practice staff (RN, MA, LPN)

Clerical staff (front desk, billing)

Administration (practice manager, other admin)

CHITA, Practice Facilitator, HERO or RHC

System-level staff/admin/or resource (e.g., director of clinical services, ambulatory medical director, IT support)

Other...

Briefly describe "Others" who were at the meeting or contact:

Meeting mode:

* must provide value

In-person

Telephone or web-conference

Other format

Please specify "Other format"

Approximately how long was the meeting/contact?

* must provide value

Less than 30 minutes

30 minutes

45 minutes

60 minutes (1 hour)

75 minutes (1.25 hours)

90 minutes (1.5 hours)

105 minutes (1.75 hours)

120 minutes (2 hours)

More than 120 minutes (more than 2 hours)

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Which coaching/facilitation activities, tools, training, or support services did you provide?

* must provide value

5 Whys

Agendas

Aim Statement

Brainstorming

Data Quality Improvement Plan

E-Learning modules

Empanelment

Evidence-based guidelines

Huddles

Managing complex change

Model for Improvement

Motivational Interviewing

Patient satisfaction/experience monitoring

PDSA

Practice Improvement Plan

Process mapping

Registry development

Risk stratification

Quality measure performance reports

Shared decision making

SMART Goals

SMS (self-management support)

Standing orders

Strategic planning

Team-based care

Toolkits

SOMETHING ELSE...

Which coaching/facilitation activities, tools, training, or support services did you provide?

* must provide value

Data Quality Improvement Plan

Empanelment

Process mapping

Registry development

Risk stratification

Quality measure performance reports

Standing orders

Strategic planning

SOMETHING ELSE...

SOMETHING ELSE: Briefly describe any other activities, tools, training, or support you provided:

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Tell Us What's Going On

What are your most important observations or "takeaways" from this meeting/contact?

* must provide value

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Tell Us What's Next

What is planned and/or needed for the next visit or follow-up, including dates, responsibility, or outreach to facilitators, CHITAs, or HEROs / RHCs?

* must provide value

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How engaged were the clinicians (MD,DO,NP,PA) during this contact?

* must provide value

NOT AT ALL ENGAGED (e.g., showed little or no interest, significantly distracted, were in and out, did not seem to listen, did not contribute or speak)

SOMEWHAT ENGAGED (e.g., showed some interest, minor distractions, present for most of the meeting, seemed to listen, contributed or spoke a little)

VERY ENGAGED (e.g., showed interest, no apparent distractions, present for the entire meeting, listened attentively, actively contributed and spoke)

N/A (no clinicians present or could not assess)

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How engaged were the staff members (RN, LPN, MA, front desk, back office, office manager) during this contact?

* must provide value

NOT AT ALL ENGAGED (e.g., showed little or no interest, significantly distracted, were in and out, did not seem to listen, did not contribute or speak)

SOMEWHAT ENGAGED (e.g., showed some interest, minor distractions, present for most of the meeting, seemed to listen, contributed or spoke a little)

VERY ENGAGED (e.g., showed interest, no apparent distractions, present for the entire meeting, listened attentively, actively contributed and spoke)

N/A (no staff members present or could not assess)

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How well did this team/group seem to work together?

* must provide value

Not at all well

Somewhat well

Mostly well

Very well

N/A (could not assess)

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What is your level of confidence in this practice's ability to make progress on important EvidenceNOW practice improvements?

* must provide value

If your confidence is less than 7 explain what needs to happen to increase your confidence:

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Please note anything else about this contact/meeting you think is important.

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Is this your FINAL field note for this practice?

Check "Yes" ONLY if your facilitation support has ended and this is your final planned field note entry for this practice (usually at the end of the 9-month facilitation support period).

* must provide value

Yes

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Because this is your final field note for this practice, we want to capture, from your point of view, essential pieces of the ENSW story that should not be lost.

Please answer the following questions with just a few sentences each.

You only have to answer these questions ONCE for each practice you work with. This completed final field note section will count as your Final Progress Report for this practice.

Thank you.

Describe the most important improvement(s) this practice made around cardiovascular care for its patients.

* must provide value

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Describe what you think helped most in making the improvement(s) you noted above.

* must provide value

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What do you think was the single most important barrier to progress or improvements in this practice?

* must provide value

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Please describe the most important information we should know about the facilitation or HIT support you provided to this practice.

(For example: What was notable or unique about the support you provided? What was the most effective aspect of your approach?)

* must provide value

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In what ways did this practice address patient or family engagement, if at all?

* must provide value

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