Supporting Statement Part B 3-3-2008

SUPPORTING STATEMENT

Part B

Improving Quality through Health IT: Testing the Feasibility and Assessing the Impact of Using Existing Health IT Infrastructure for Better Care Delivery

Version: March 3, 2008

Agency for Healthcare Research and Quality (AHRQ)

Project Officer:

Bob Mayes

Senior Advisor

Center for Primary Care, Prevention & Clinical Partnerships

Agency for Healthcare Research & Quality

540 Gaither Road, Room 6131

Rockville, MD 20850

Tel. 301-427-1492

Fax 301-427-1597

E-mail: [email protected]

Table of contents

B. Collections of Information Employing Statistical Methods 3

1. Respondent universe and sampling methods 3

2. Information Collection Procedures 3

3. Methods to Maximize Response Rates 4

4. Tests of Procedures 4

5. Statistical Consultants 4

B. Collections of Information Employing Statistical Methods

1. Respondent universe and sampling methods

The respondent universe for the qualitative study is the staff members, including physicians, nurse practitioners, nurses, medical assistants, IT personnel, lab personnel administrators at the two Centers as well as organizational leaders. We will attempt to interview all physicians and nurse practitioners employed by the Centers. There are approximately 5 physicians and nurse practitioners at Howard Brown and 8 at Heartland Health Outreach. In addition we will conduct approximately 28 additional interviews with 2- 4 of each of the following types of informants at each site: nurses, medical assistants, IT personnel, lab personnel, and administrators.  By interviewing all the physicians and nurse practitioners as well as informants in each of the various other staff roles, we will be able to obtain varied perspectives on the questions of interest without unduly burdening the staff at the two clinics.  This strategy also provides a balanced view of the two facilities as well as a balance between clinical and non-clinical personnel.

2. Information Collection Procedures

To recruit study participants potential interviewees will be sent a letter describing the study and the interview process and requesting their participation (see Attachment 8). The letter will underscore the voluntary nature of their participation and will include a copy of the informed consent. The letter will be signed by Fred Rachman, MD, Chief Medical Officer of the Alliance. In follow up to the letter the interviewee will be called to ascertain their interest in participating and to schedule the interview. Should the individual agree to participate, he or she can fax a signed copy of the informed consent to HRET or can bring it to the interview (see Attachment 7). Persons who consent to participate will be interviewed in person. Telephone interviews may be used to supplement site visit interviews.

A semi-structured interview guide will be used to conduct the interviews with multiple key informants (see Attachment (6). Interviews with organizational leaders and administrative personnel will provide information about the history, development and processes involved in laboratory ordering facilitated by HIT. Interviews with clinical personnel including physicians, nurse practitioners, nurses, and medical assistants will provide information about the processes, roles, and individual IT tools and forms used in laboratory ordering processes from the clinical perspective. All key informants will be asked about barriers and facilitators to the process, and will be asked for their suggestions about how to improve the process.

The interviewers are members of the research team with extensive interviewing and research experience. The team will be led by Ann Scheck McAlearney, Sc.D. She is an Associate Professor in the Division of Health Services Management and Policy in the College of Public Health and in the Department of Pediatrics at Ohio State University with extensive qualitative research experience.

To ensure quality control and consistency among interviewers a code book has been developed by Dr. McAlearney (see Attachment 5). A draft codebook has been developed with 16 preliminary codes proposed based on the interview questions to be asked in the qualitative portion of this study. The process of coding will also include the development of emergent codes, which will be included upon agreement across the coders. These emergent codes will be fully specified with conditions for appropriate use once they are adopted by the coding team.

3. Methods to Maximize Response Rates

While every attempt will be made to schedule and complete the 41 interviews, the study team will be sensitive to staff members uninterested in participating. Potential interviewees will be sent the recruitment letter and numerous phone attempts will be made to attempt to schedule the interview. However, if the interviewee expresses unwillingness to participate that individual will not be re-contacted. If there are other staff members of that type in the Center we will attempt to recruit an additional staff member. Replacement of physicians and nurse practitioners will not be possible given we will attempt to interview all staff members of those types.

4. Tests of Procedures

A pretest of the interview guide will be conducted at a similar Center within the Alliance. We will attempt to interview approximately seven staff members with various roles to refine the interview guide and resolve any unforeseen issues. The interviews will be conducted in person at the Center with two interviewers observing/participating in each interview.

5. Statistical Consultants

No consultants outside the study team were utilized for the design of this study.

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