Attachment D: Summary of Data Collection Instruments

Attachment D: Summary of Common Data Collection Instruments

Form	Time estimate (in minutes)	Audience (for each of the nine primary care sites)	Survey/interview topics
Primary Care Site Organizational Characteristics Survey (Attachment G)	90	1 primary care site administrator (e.g., medical director)	Organizational characteristics (e.g., patient-centered medical home status, participation in an accountable care organization) Number of different staff role types Patient record management Care coordination with hospitals
Primary Care Site Patient Characteristics Survey (Attachment H)	90	1 primary care site IT analyst	Patient demographics Patient hospitalizations, readmissions, and referrals to the hospital Timing of primary care follow-up visits
Work Flow Mapping Preliminary Interview Guide (Attachment I)	30	8 primary care site staff (e.g., nurses, medical assistants, front desk staff)	Transitional care roles and workflow Consistency of steps in the workflow Barriers and challenges experienced in delivering transitional care
Work Flow Mapping Group Interview Guide (Attachment J)	90	10 primary care site staff (e.g., nurses, medical assistants, front desk staff)	Clarification of the transitional care activities that occur during a patient’s hospitalization, post-discharge and before the primary care visit, during the primary care visit, and after the primary care visit Consistency of transitional care activities in terms of how they are delivered and to which patients
Work Flow Mapping Follow-Up Interview Guide (Attachment K)	30	8 primary care site staff (e.g., nurses, medical assistants, front desk staff)	Confirmation of transitional care roles and workflow Impact and frequency of barriers and challenges in delivering transitional care Suggestions for how to remove or reduce barriers and challenges in delivering transitional care
Patient Interview Guide (Attachment L)	30	10 primary care site patients after discharge	Reason for hospitalization Concerns and challenges post-discharge Care received post-discharge Nature of post follow-up phone call or visit Issues or recommendations to inform better transitional care
Community Agency Interview Guide (Attachment M)	60	5 community agency staff members (e.g., manager, social worker)	Overview of community agency services and clients Client post-discharge needs and relevant services delivered by the agency Number of joint clients with the primary care practice Communication and collaboration with the primary care practice

11/2016 The Re-engineered Visit for Primary Care (AHRQ REV) – Attachment D 1