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Table 1 Fidelity of the CHAPS Model and Its Implementation among N = 140 intervention study participants

From: Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson’s disease (CHAPS) in meeting challenges in care management

Chronic Care Model Elements Fidelity of the CHAPS Model Components to the Chronic Care Model [7] Fidelity of CHAPS Implementation of CHAPS Model [14] to Hasson’s Model
Health System Resources and Policies
  5 Veterans Affairs Healthcare Systems medical centers Greater Los Angeles, Las Vegas, Loma Linda, Long Beach, San Diego
(Content)
Community Resources and Policies
  Local/regional/national organizations and services (local APDA, LA-CRC, NPF, and PRO; and other local Parkinson’s disease support groups) Recommended use of community services (n = 78, 29.5% of all service referrals)
(Content) (Frequency)
Delivery System Redesign
  CHAPS nurse care managers 8 nurses hired and oriented to deliver CHAPS care management
(Content)
  Parkinson’s disease specialist and CHAPS nurse care manager regularly scheduled huddles CHAPS nurse care managers reported to principal investigator that huddles occurred monthly
(Content) (Frequency)
  Telephone encounters with participants n = 656 telephone encounter notes abstracted
  n = 68 (prior to Initial CHAPS Assessments)
  ➢ Initial CHAPS Assessments n = 140 (Initial CHAPS Assessments)
  ➢ Follow-up calls n = 317 (~ 3 follow-ups per participant) a
  ➢ 6-month reassessments n = 67 (6-month reassessment, for 50% of eligible candidates
  ➢ Annual reassessments n = 29 (Annual reassessment, for 23% of eligible candidates)
  n = 35 (2nd 6-month reassessment at 18-months for 29% of eligible candidates)
(Frequency – partial fidelity) (Duration)
  Siebens Domain Management Model™ (SDMM™) b as the organizing framework Domain headings used in documentation of 4870 (97.7%) of CHAPS problems/topics.
These distributed over the 4 domains:
• Domain I 38.8%
• Domain II 27.5%
• Domain III 14.3%
• Domain IV 19.4%
(Content) (Frequency)
  Siebens Health Care Notebook [18] • Personalized self-care tool sent to each participant (n = 140) c
• Notebook discussed with participants n = 108 (77.1%)
(Content) (Frequency)
Decision Support
  31 standard CHAPS problems/topics identified through algorithms Problems/topic types were documented (n = 4938)
(Content) (Frequency)
  CHAPS problem/topic intervention protocols with care recommendations d CHAPS nurse care manager activities (n = 4012) (27 types)
(Content) (Frequency)
  CHAPS nurse care manager meetings Meetings twice a month for mutual support and clinical problem-solving
(Content) (Frequency)
  Decision support provided by Parkinson’s disease specialists directly to CHAPS nurse care managers through huddles CHAPS nurse care managers reported to principal investigator huddles occurred monthly
(Content) (Frequency)
Clinical Information Systems
  Computerized Patient Record System - CPRS (Veterans Affairs electronic medical record for inpatient and outpatient services) CHAPS nurse care manager notes (n = 656)
(Content) (Frequency)
  CHAPS structured Initial Assessment with algorithm-identified CHAPS standard problems/topics in Microsoft Access CHAPS Assessments (n = 140) and problems/topics identified
(Content) (Frequency)
  Participant panel tracking tool in Microsoft Access Tool cumbersome and discontinued; alternative secure methods used
(Content)
Self-management Support
  Prioritizing problems/topics with participant input Most frequent concerns:
• medications (n = 58 participants)
• physical activity (n = 49 participants)
• falls (n = 49 participants)
(Content) (Frequency)
  Coaching by nurse care managers • Education: verbal (n = 310), print (n = 168), Internet or DVD (n = 68) notes
• Counseling and emotional support (n = 387 notes)
• Motivational collaborative-problem solving (n = 144 notes)
(Content) (Frequency)
  Siebens Health Care Notebook • Participants (n = 83, 59.3%) interacted with Notebook
• Problem-focused education sheets (n = 2.6 (SD 2.4)) added from 69 unique education sheets
(Content) (Frequency)
  My HealtheVet (online tool for partnering with health care team with secure messaging) Referral to My HealtheVet patient portal (n = 23 notes)
(Content) (Frequency)
  1. CHAPS Care Coordination for Health Promotion and Activities in Parkinson’s Disease
  2. APDA American Parkinson Disease Association; LA-CRC – Los Angeles Caregiver Resource Center; NPF National Parkinson Foundation; PRO – Parkinson’s Resource Organization; Notebook – Siebens Health Care Notebook [18]
  3. Note: Content, frequency, and duration per Hasson’s Model [21]
  4. a Of 140 participants who received the CHAPS Assessment, 119 received follow-up care management [14]
  5. b Siebens Domain Management Model™ has four domains: I Medical/Surgical Issues, II Mental Status/Emotions/Coping, III Physical Function, and IV Living Environment (© Hilary C Siebens MD 2005) [19]. Used with permission
  6. c One standard education sheet per domain added to each Notebook: I Levodopa and protein; II PD At Home (monthly education and support via telephone call); III Exercise and PD; IV Fall Proofing Your Home
  7. d Problem/Topic Intervention Protocol steps: Assess further, Provide information, Problem solve collaboratively, Clinical referrals, and Community and social services referrals [7, 14]