PBS-SDM 2012-05 Provider Substitution Guidelines

PBS | SUBSTUDY DESIGN MEMO

No. 2012-05

DATE:	July 9, 2012
TO:	PBS Study Centers
FROM:	NCS Field Support Team
SUBJECT:	Provider Substitution Guidelines

To preserve the scientific validity of the sample, it is important to ensure that a substitute provider location will be used only after thorough efforts to recruit the location fail. Once a Study Center has determined that an individual provider location will not be recruited, they will complete a brief report on efforts to recruit that location. Reports will be sent to Field Support, who will forward it to Westat. Westat will then identify a substitute provider location.

Ideally, efforts to recruit a provider location could be spaced over weeks or months to address the logistical hurdles. However, due to the short time frame for the PBS study, you will have two months or less to recruit a given provider location. Below are guidelines for the appropriate level of effort to expend to recruit a provider location before moving to the substitute.

1. Request a substitute immediately if you find:

• Location is out of scope

  • Out-of-Scope is defined as permanently closed or no longer providing OB care.

  • Moving to a new address does not make a location out-of-scope.

  • Situations that would be out of scope include a physician with a solo-practice retired, or a joint practice dissolved and physicians joined other practices.
    
    

• Hostile refusal, such as threats to call police or political officials.

• Refusals or logistical issues that cannot be overcome in the recruitment time frame. Some examples would include a provider with an IRB clearance process that always takes 6 months, or a practice with institutional policies about not participating in research that cannot be changed.

2. Request a substitute after 2-3 discussions with decision makers in the location (physician, midwife, office manager) or larger umbrella organization if there is no progress toward an agreement to participate.

• These discussions may include soft refusals (e.g. we are too busy) and hard refusals (e.g., we do not want to participate.)

• If you have prior experience attempting to recruit a provider location for research that leads you to believe that they will not participate in the NCS, make at least one attempt to recruit them for the NCS before moving on to the substitute.

3. Request a substitute after 8-10 unsuccessful attempts to initiate discussion with decision makers.

• These attempts could include meetings with decision makers that do not seem to be making any progress toward agreeing to participate. For example, a provider location may ask you to come in multiple times to describe the Study to different staff, but if multiple meetings have not resulted in a concrete indication that the location is likely to participate, these meetings can be considered unsuccessful attempts.

Ideally, in situations where you encounter refusals or no progress, the discussions and attempts to have discussions with provider location staff can be spaced out over weeks or a month, but this will depend on the time it takes to engage the provider location in discussions. Additionally, remember to use the following best practices in both situations:

• Use refusal aversion and conversion techniques and document all contacts in the contact records.

• Make sure to vary the method and time of contacts. Make both phone calls and in-person visits.

• If you get a refusal from the office manager, try to reach out to the medical staff. Or if you cannot get through to the provider, try the office manager.

• Be flexible and offer to address logistical hurdles, such as staff time to build the list, HIPAA regulations, etc.

• Offer incentives; you may be able to compensate provider location staff for time spent building the list of patients.

Questions/Comments: If you have any questions or concerns about this memo or are in need of Field Support assistance, please contact the NCS Help Desk at [email protected] or call toll free at 866-817-7033.

Keywords: provider substitution; provider recruitment 1