Attachment E: Fielding, Data Collection, and Analysis Methods

Attachment E: Fielding, Data Collection, and Analysis Methods

As described in Supporting Statement A, the purpose of these data collection activities for the Re-engineered Visit for Primary Care (AHRQ REV) project is to investigate the primary care-based transitional care workflow from the primary care staff, patient, and community agency perspectives.

The data collection instruments were developed by the contractor John Snow, Inc. (JSI) in consultation with outside consultants and technical experts (see Attachment B: Contract Staff, Consultants, and Technical Expert Panel Members) and tested in a pilot project from June to August 2016 (see Attachment C: Pilot Methods and Results).

This document describes the fielding, data collection, and analysis methods that will be implemented by the research team with nine primary care sites across the country (see Attachment F: Primary Care Site Overview). The fielding and data collection methods described are organized by instrument, and specify the research participants involved, the mode of data collection (e.g., email, in person), location in which the data is collected, materials and who uses the materials, and the data collection process. This information is also included on the individual instruments. This document concludes with a description of the data analysis process.

Data Collection Methods

Primary Care Site Organizational and Patient Characteristics Forms (Attachments G & H)

Research Participants:

For the Primary Care Organizational Characteristics form, the research participants will be one primary care staff member who knowledgeable about the clinical and administrative operations of the site, such as medical director, for each primary care site. For the Primary Care Patient Characteristics form, the research participants will be one primary care staff member who is able to access and review the primary care site’s billing, clinical, or other information technology (IT) systems regarding patient characteristics, such as an IT analyst, for each primary care site. For some sites, the same person may complete both of these forms. Primary care sites must be willing to share this information in order to participate in this project. The principal investigator (PI) for each organization will work with the site to identify the person(s) who is/are the most appropriate to collect this information. The PI will let them know that the survey is optional and that they may opt out at any time.

Mode of Data Collection: Email, with attached data collection instruments in Microsoft Word files that can be filled out by research participants.

Location: N/A

Materials: Data collection instruments to be completed by research participants.

Data Collection Process:

The research team will email these forms to the site investigator of each primary care site. The site investigator will ask the appropriate persons to complete the forms and return them to the research team.

Work Flow Mapping Preliminary Interview Guide (Attachment I)

Research Participants:

The principal investigator (PI) of each of the three partner organizations - Cambridge Health Alliance, Kaiser Permanente, and Altamed - will work with the nine primary care sites to identify who may be available to participate in these interviews and recruit them to participate. For each primary care site, the PI will work with the site to determine who is involved with the care of patients who have recently been discharged as well as who may be available to participate in interviews. Eight individuals per primary care site, representing a variety of roles such as PCPs, nurse practitioners, physician assistants, RNs, LPNs, pharmacists, behavioral health providers, community health workers and office staff, will be recruited for this data collection activity. Potential participants will be informed that the interviews are optional and can opt out of participation at any time.

Mode of Data Collection: In person.

Location: At the primary care practice.

Materials: Data collection instruments to be used by interviewers, laptop for interviewer note taking.

Data Collection Process:

Working in pairs comprised of an interviewer and note-taker, the research team will interview primary care staff about their roles and responsibilities regarding transitional care services. The questions are designed to be answered directly by primary care staff without looking up any additional information. Notes from these interviews will be reviewed and summarized prior to the group workflow mapping session.

Work Flow Mapping Group Interview Guide (Attachment J)

Research Participants:

Same as the preliminary interviews, except there will be 10 research participants per site for this data collection activity. For each primary care site, the PI will work with the site to determine who is involved with the care of patients who have recently been discharged as well as who may be available to participate in the work flow mapping group exercise. Previous participation in workflow mapping data collection activities or lack thereof will have no bearing on eligibility to participate in this interview. Potential participants will be informed that the work flow mapping group exercise is optional and can opt out of participation at any time.

Mode of Data Collection: In person.

Location: At the primary care practice.

Materials: Data collection instruments to be used by interviewers, laptop for interviewer note-taking, whiteboard/flipchart to be used by facilitator with the research participants.

Data Collection Process:

Having reviewed the notes from the preliminary interviews, the PI of each of the three partner organizations will facilitate the group workflow mapping sessions. The facilitators will describe the research team’s understanding of the transitional care activities at the site, and then use the group interview as a collaborative, iterative process to further define the workflow involved in planning for and executing post-hospital follow-up services. These processes will be mapped on a whiteboard or flipchart during the group interview for visual reference. The workflow map from the session will be digitized for data analysis. Notes from the group workflow mapping session will be recorded to ensure the accurate recall of the discussion, and help to clarify workflow understanding for the follow-up interviews.

Work Flow Mapping Follow-Up Interview Guide (Attachment K)

Research Participants:

Same as the preliminary interviews. Previous participation in workflow mapping data collection activities or lack thereof will have no bearing on eligibility to participate in this interview.

Mode of Data Collection: In person.

Location: At the primary care practice.

Materials: Data collection instruments to be used by interviewers, laptop for interviewer note-taking, workflow map used as a reference by research participants.

Data Collection Process:

Working in pairs comprised of an interviewer and note-taker, the research team will interview primary care staff about the workflow map developed during the group workflow mapping session. For each primary care site, every effort will be made to interview those that participated in the work flow mapping group exercise. Staff from each role type will be asked to review to correct, add, or confirm detail to the document during a follow-up interview. This process serves as a confirmation that the information documented during the process workflow mapping was captured correctly. The staff will also be asked about the challenges for particular steps in the workflow and how they might be addressed. Notes from these interviews will be recorded for data analysis. Potential participants will be informed that the interviews are optional and can opt out of participation at any time.

Patient Interview Guide (Attachment L)

Research Participants:

Respondents will include primary care patients who have been recently hospitalized. T convenience sample of 10 adult primary care patients who have been recently discharged from the hospital will be interviewed per primary care site. Patients will have been discharged from general adult medical units (not the ICU or surgical patients) without a terminal diagnosis. The patients participating in this research must be proficient in English from the primary care sites in Boston and Denver (Cambridge Health Alliance, Kaiser Permanente Colorado, and nearby independent primary care sites); the patients participating from the primary care sites in Los Angeles (Altamed and the nearby primary care site) must be proficient in English or Spanish.

Research participants will be asked the study questions while on the phone with the interviewer; voicemail messages about participation in this study will not be left. Participants who cannot be reached or refuse to participate will not count towards this sample.

Mode of Data Collection: Phone.

Location: N/A

Materials: Data collection instruments to be used by interviewers, computer for interviewer note-taking.

Data Collection Process:

The PI of each of the three partner organizations will work with the nine primary care sites to select and train primary care staff (e.g. nurse, community health worker) on how to select patients to interview, and how to administer the patient interview guide over the telephone. The interview style should be conversational and allow the interviewee to express him/herself rather than following strict adherence to the questions – the interview tool is provided more as a guide to this interview than as a survey tool. Interview responses will be recorded by the interviewing staff. The interviewers for the Los Angeles primary care sites will be proficient in both English and Spanish. A Spanish language version of the instrument was developed and tested successfully in the pilot.

Community Agency Interview Guide (Attachment M)

Research Participants:

For each primary care site, five staff members will be interviewed from different community agencies, which will likely include an aging services organization, a visiting nurse association, and a visiting nurse association specific to mental health. Consideration will be given to recruit different types of staff roles (e.g. manager, social worker, etc.) from different types of organizations based on services offered and the frequency with which they interact with the primary care site. For each primary care site, the PI will work with the community agency to determine who is involved with the care of patients who have recently been discharged. Potential participants will be informed that the interviews are optional and can opt out of participation at any time.

Mode of Data Collection: Phone.

Location: N/A

Materials: Data collection instruments to be used by interviewers, computer for interviewer note taking.

Data Collection Process:

Working in pairs comprised of an interviewer and note taker, the research team will interview community agency staff about their organization’s services and coordination with the primary care site. Notes from these interviews will be recorded on a computer for data analysis.

11/2016 The Re-engineered Visit for Primary Care (AHRQ REV) – Attachment E 6