Table 6.
Intervention and implementation adaptations organized by the FRAME (29)
| Time (quarter) | Modification category | Description | Goal of modification | Rationale |
|---|---|---|---|---|
| Q1 | Context | Changed session delivery timing to approach patients after analgesic medication administration | Increase reach/engagement | Patient level: improve motivation and readiness to participate |
| Q1 | Context | More flexible session delivery, including options to break up sessions | Improve feasibility | Organization/setting level: reduce clinical workflow interruptions; work within time constraints and accommodate competing clinical demands |
| Q1–2 | Training | Revised staff and clinician education to clarify program goals and list more explicit eligibility criteria | Improve fit with patients Improve effectiveness Reduce cost |
Provider level: improve understanding of program and reduce referrals of patients who were inappropriate for the program (e.g., patients with altered mental status) |
| Q1 | Content | Added patient expectation setting component, including clarification the program is an additional service rather than replacement for analgesics | Increase reach/engagement Increase satisfaction |
Patient level: improve patient receptivity to program and motivation to participate; set realistic expectations for outcomes |
| Q1–3 | Content | Tailored coaching sessions and toolkit materials (e.g., simplified analogies, toolkit items appropriate for patient needs and resources) | Improve fit with recipients |
Patient level: tailor to patient education/literacy level, available resources, and comorbidities Organization/setting level: address communication barriers due to Covid personal protective equipment requirements |
| Q2–4 | Content | Addition of educational topics, toolkit items, and services (e.g., art therapy, pain journal, chaplain service referrals) | Increase satisfaction Improve effectiveness Address cultural factors |
Patient level: align intervention with patient needs, preferences, and culture |
| Q3 | Implementation and scale-up activities | ‘PAMI Star of the Month’ clinician recognition program modeled after existing practices (e.g., resident of the month) | Increase reach/engagement | Organization/setting level: align implementation strategies with clinic culture and existing incentives and recognition practices |
| Q3–4 | Implementation and scale-up activities | More proactive identification of patients via EHR by program staff (rather than only clinician referral) | Increase reach/engagement | Organization/setting level: compensate for reduced referrals due to increased provider workload and burnout during Covid surges; leverage newly available technology (EHR secure chat) which facilitates communication with providers |
| Q3–4 | Implementation and scale-up activities | Flexible education and promotion delivery (e.g., increased or decreased rounding) | Increase reach/engagement |
Organization/setting level: reduce activities during Covid surges to accommodate increased workload Provider level: increase awareness of program when referrals decrease |