Achieving High Fidelity to Ensure High Quality Patient Care

Slice of PieOctober 14, 2020

Ensuring consistency in patient-centered delivery of comprehensive medication management (CMM) across the 12 organizations and over 30 pharmacists is one of the most important components to Slice of PIE. To determine the extent to which the CMM patient care process is delivered consistently, the Slice of PIE initiative utilizes implementation strategies to ensure fidelity, which is defined as the degree to which the service is implemented as intended[1]. Interventions implemented with fidelity have a higher likelihood of reaching their desired clinical and humanistic outcomes than those that are poorly implemented.[2] Therefore, achieving high fidelity to CMM is a critical component to the Slice of PIE program to ensure the highest quality of patient care. This is accomplished by several implementation strategies targeted at increasing fidelity including: 1) periodic self-reported fidelity assessments, 2) action planning and improvement work to increase areas of improvement, 3) web-based learning events, and 4) coaching supports. You can learn more about the other implementation strategies in Slice of PIE in the Implementation Science blog.

Insights from a previous CMM study, identify three purposes for assessing fidelity throughout a practice transformation effort; (1) to gain clarity on treatment outcomes; (2) to monitor and intervene if fidelity drifts over time; and (3) to facilitate replication and scaling of CMM.2 Pharmacists in the Slice of PIE collaborative assessed adherence to CMM through the CMM Patient Care Process Self-Assessment at the beginning of the initiative and re-assess fidelity every 6 months. Re-assessing fidelity provides snapshots throughout the process and coincides with strategies to improve fidelity.2 The improvement work is guided by areas of low fidelity within pharmacist, organization and across the collaborative, and facilitates data-driven conversations during pacing events and coaching calls to improve the intervention for patients.

Fidelity data on the CMM patient care process, obtained through the regular assessments in Slice of PIE, are used constructively, rather than punitively2. Pharmacists completed the baseline and second round of assessments (November 2019 and June 2020) and received a report of his or her personal fidelity assessment results. In additional to self-reports, the project team created organization-level reports to provide feedback to organization leads and facilitate coaching discussions around action planning and quality improvement. A web-based pacing event series guided the collaborative through improvement tools, examples for identification of target areas, and processes for goal setting. Pharmacists and organization-leads used these tools to create goals and concrete action plans, which were followed up on through coaching calls. Fidelity data is translated to actionable strategies to maintain consistent delivery of the CMM patient care process across the collaborative2.

In the previous blog post, actionable strategies geared to improve fidelity to the patient care process were reflected on by pharmacists in the collaborative. The pharmacists discussed confidence to provide better patient care “as we work to improve in those areas.” During the next pacing event in October, continued targeting of areas in the patient care process with actionable quality improvement strategies will be explored, including reviewing PDSA cycles and HealthPartners audit findings.  The collaborative continues to identify and target areas of improvement through assessments, pacing events and coaching calls to ensure fidelity to the CMM Patient Care Process as one of the most important components to deliver the highest quality of patient care.

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[1] Livet M, Haines ST, Curran GM, et al. Implementation science to advance care delivery: A primer for pharmacists and other health professionals. Pharmacotherapy. 2018;38(5):490–502

[2] Livet M, Blanchard C, Frail C, Sorensen T, McClurg MR. Ensuring effective implementation: A fidelity assessment system for comprehensive medication management. J Am Coll Clin Pharm. Available from: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/jac5.1155.