CMS-10622 Peer Coach Interview

CMS Independent Evaluation Center (IEC) OMB No. xxxx-xxxx

Peer Coach Interview Guide Expires xx/xx, 20xx

Appendix A3. Interview Guide for Peer Coaches Participating in the QIN‑QIO Collaborative for Quality Improvement

Interview Introduction and Informed Verbal Consent

Hello (Name of Peer Coach), I want to thank you for taking the time to talk to me today.

My name is ____________________ and I am calling from _______________________.

I am part of the Centers for Medicare and Medicaid Services (CMS) Independent Evaluation Center (IEC), and I would like to talk with you about your role as a Peer Coach in the [STATE] Nursing Home Quality Care Collaborative. We are conducting an evaluation of this QIO program.

We hope you will participate in the interview and provide information that will help CMS improve its quality improvement programs. You should know that this interview is voluntary, you may stop participating in the interview at any time, and you do not have to answer every question.

This interview should take about 30 minutes. I would like to record the interview with your permission because I don’t want to miss any of your comments. You should also know that neither your name nor the name of your facility will ever appear in any reports from the findings. What you say in the interview will remain private and will not in any way affect your facility’s relationship with CMS.

Do you have any questions about the interview? Do we have your permission to record the interview? Do I have your permission to proceed?

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-XXXX.  The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. *****CMS Disclaimer*****Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Mr. Robert Kambic at 410-786-1515.

Peer Coaches Interview Guide

1. First, please tell me about your role as a peer coach.

   1. What are your responsibilities as a Peer Coach in the [STATE] Nursing Home Quality Care Collaborative?

   2. How does your role as a peer coach affect your other duties?

   3. How much time is spent on your peer coaching duties?

2. What specific activities are you involved in as a Peer Coach?

[Probe: What activities are you involved in to impact [specific goal]?]

3. Are you familiar with Quality Assurance and Performance Improvement plans, otherwise known as a QAPI plans?

   1. Do you help individual nursing homes with their QAPI plan? [Probe: Ask about specific role, e.g. selection of goal, development, or implementation]

4. What types of organizational support from the Collaborative or QIN-QIO and resources are provided to you as a Peer Coach?

5. What types of training has the QIN-QIO provided to support your role? [Probe: coaching, quality improvement methodology, Certification and Survey Provider Enhanced Reporting (CASPER) data, and adult learning]

6. Are there additional trainings, support, or resources that would make you more effective as a Peer Coach?

7. What is your level of satisfaction with being a Peer Coach?

[Prompt 1: on a scale of 1=totally unsatisfied; 2=unsatisfied; 3=somewhat satisfying 4=satisfied; 5=totally satisfied]

8. What do you find most rewarding about being a Peer Coach?

[Probe: improved patient quality of care, improved staff morale, improved clinical outcomes, etc.]

9. What types of challenges do you face as a Peer Coach in the collaborative?

[Probe 1: What do you consider to be the most challenging responsibility/activity as a Peer coach in the collaborative?];

[Probe 2: What actions have you taken to address these challenges?]

10. Is there anything CMS or the QIO could do that would help you to fulfill this role? Is there anything that the QIO could do to improve the Peer Coach program?

11. Do you have recommendations for improvements or changes to the program? Please explain.

Closing

Thank you for your time and sharing your experiences with the QIO program. Your comments are very helpful and insightful.

Other Topics Discussed:

Any Documents Obtained:

Post Interview Comments or Questions:

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