SUPPORTING STATEMENT ASOPS Part B 2-21-07

SUPPORTING STATEMENT

Voluntary Questionnaire and Data Collection Testing

to Pilot Test Proposed Medical Office Surveys on Patient Safety

B. STATISTICAL METHODS

1. Potential Respondent Universe and Sample Selection Method

The potential respondent universe will be all providers and office staff in each outpatient medical office. An outpatient medical office is a single physical office location in which its providers use the same physical office space and share support staff. While practices and health systems may consist of multiple locations or sites, or a large outpatient building may house several medical offices, we would consider each office or group to be a separate entity. The pilot test of the surveys will focus on group medical offices with 3 or more physicians because solo practitioner and 2-physician offices have so few staff that it is problematic from a practical standpoint to administer a confidential survey as an office-level assessment of patient safety culture.

A purposive sample of 97 ambulatory outpatient medical offices will be recruited. This number of sites is needed to be able to obtain enough provider responses to analyze their survey results separate from the staff survey responses, and to provide enough sites to allow for multi-level confirmatory factor analyses at both the individual and medical office levels. Sites will be distributed across medical specialty type and office size (Table 2). Further efforts will be made to obtain medical offices distributed across geographic region, type of ownership (physician owned vs. non-physician owned), and urbanicity. Office size is defined as follows: small with 3-4 physicians, medium with 5-6 physicians, and large with 7 or more physicians.

TABLE 2. PURPOSIVE SAMPLE OF OUTPATIENT MEDICAL OFFICE SITES FOR PILOT OF MEDICAL OFFICE SURVEYS ON PATIENT SAFETY

	PRIMARY CARE—SINGLE SPECIALTY				NON-PRIMARY CARE		TOTAL OFFICES
	Pediatrics	Internal Med	Family Med	Obstetrics/ Gynecology	Other Single Specialty	Multi-Specialty
SMALL OFFICE (3-4 MDs)	4	6	5	2	3	13	33
MEDIUM OFFICE (5-6 MDs)	4	3	5	5	5	10	32
LARGE OFFICE (7+ MDs)	5	5	4	6	5	7	32
TOTAL	13	14	14	13	13	30	97

All providers and staff within each medical office will be surveyed. It is estimated that a total of approximately 2,340 individuals will be surveyed for the pilot test (592 providers and 1,748 office staff). With a targeted response rate of 70%, the expected number of completed surveys is 1,638 (414 providers and 1,224 office staff). Job titles of each employee surveyed will be obtained to examine survey non-response by job title at the conclusion of data collection to determine if there are differences in response rates by job title.

2. Information Collection Procedures

The data collection will include these steps:

• Mailing of the provider and staff surveys (which include a cover letter) to the ambulatory outpatient medical office point of contact

• Medical office point of contact personally distributes survey packets to each medical office provider and staff member

• A reminder postcard distributed to nonrespondents

• Distribution of a second questionnaire to nonrespondents

Attachment B contains example data collection materials, including the cover letter, reminder postcard, and the draft pilot survey (which is currently the same survey for both providers and staff, but office managers have some additional questions to complete about the medical office’s characteristics.).

3. Methods to Maximize Response Rate

We are using site-level remuneration as noted in #9 on page 4, and we are following up with a reminder postcard and second questionnaire to nonrespondents.

4. Tests of Procedures

AHRQ and Westat will take practical steps to consult with ambulatory outpatient medical office employees to help minimize the burden of the collection of information and to develop a better, more reliable instrument. Cognitive interviews with potential respondents will be done prior to pilot testing. In-person and telephone cognitive pretests will be conducted with providers and office staff in different types of ambulatory outpatient medical offices (family practice, internal medicine, specialty, and multi-specialty) in offices with 3 or more physicians. Cognitive testing participants will be selected from a variety of staff categories, including certified medical assistants (CMAs); non-clinical office staff; nurses; nurse practitioners; physician assistants; office managers; and physicians. Revisions to the survey will be made based on feedback provided during this pretesting, in addition to input from patient safety researchers and experts in ambulatory care, to arrive at the version of the survey instruments that will be pilot tested in the 97 medical offices.

5. Statistical Consultation and Independent Review

Input from statistical analysts was used to develop the study design and plans for data analysis, including:

Veronica Nieva, PhD, Vice President, Westat, 301-251-8271

Joann Sorra, PhD, Senior Study Director, Westat, 301-294-3933

Naomi Dyer, PhD, Research Analyst, Westat, 301-610-8842

Paul Hanges, PhD, University of Maryland College Park, 301-405-5930