Health System Leaders Interview Guide

Attachment F. Health System Lead Interview Guide

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Exp. Date: xx-xx-xxxx

Public Reporting burden of this collection of information is estimated at 60 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn:  PRA (xxxx-xxxx).

Hello, I’m (NAME) from Abt Global. Thank you for taking the time to speak with me.

As a reminder, in 2022 the Centers for Disease Control and Prevention (CDC) released the Clinical Practice Guideline for Prescribing Opioids for Pain, which provided up to date evidence regarding pain management approaches and emphasizes the need for prescribers to be focused on patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. For shorthand, we call it the 2022 CDC Clinical Practice Guideline throughout this interview.

General Dynamics Information Technology (GDIT) and Abt Global are conducting a research study for the CDC to better understand the adoption, implementation and outcomes of the 2022 CDC Clinical Practice Guideline on evidence-based care for pain management.

This interview aims to better understand your experiences as a health system leader with implementing pain management policies and guidelines and the effects of these policies and guidelines on patient outcomes. This study is funded by the CDC.

Before we begin, I want to read a few points about this interview:

• Participating in this interview is voluntary.

• You will receive a $100 virtual gift card for participating in this interview.

• Your answers will not be connected to any information that could individually identify you, such as your name in any internal CDC reports or publicly-facing publications. With your permission, the name of your organization will be included in the acknowledgements in any report or publication; however, we will not attribute our findings to you or your organization explicitly. You can decline to answer any question, without affecting your continued participation in the interview or your relationship with the CDC. There is a small risk of loss of privacy. We have many procedures in place to reduce this risk.

• This interview will last approximately 60 minutes.

We also would like to record the interview, so we do not miss anything. The recording will not be shared with anyone outside Abt Global, GDIT or CDC. We will use this recording to make de-identified transcripts of the recordings, which will be shared with GDIT and CDC. This recording will be deleted once our notes from the interview have been completed. 

Do any of you have any questions before we get started?

Do I have your consent to participate in this interview? Yes _____ No _____

May we record this interview? Yes _____ No _____

RESPONDENT’S ROLE

1. Please describe your title and your role in your health system.

2. What is or has been your experience with setting or implementing policies related to pain management and opioid prescribing?

3. What role does your organization serve in setting, administering, recommending, or implementing policies/regulations related to pain management, opioid prescribing and management, or medications for opioid use disorder (MOUD)?

4. Does your organization monitor opioid prescribing generally? Please describe how.

   • If yes, how well do prescribers within your organization adhere to set policies?

AWARENESS

SAY: I’m going to ask a few questions about your level of awareness of the 2022 CDC Clinical Practice Guideline and your thoughts on how aware clinicians and clinical practices are of the Guideline.

5. In 2022, the CDC released its 2022 Clinical Practice Guideline for Prescribing Opioids for Pain. How did you learn of the 2022 CDC Clinical Practice Guideline?

6. What is your general sense of the 2022 CDC Clinical Practice Guideline and its recommendations?

7. It’s been about two years since the 2022 CDC Clinical Practice Guideline was released. What’s your sense of the level of awareness of the Guideline among clinicians or clinical departments that you interact with at your health system?

HEALTH SYSTEM APPROACH TO PAIN

SAY: I’m now going to ask a few questions about your health system’s processes and procedures for managing patients with acute, subacute, or chronic pain.

8. What specific protocols, policies, or guidelines for pain management does your practice or health system have? What about for opioids, specifically?

Probes: Treatment agreements, tapering policies, involvement of behavioral health in prescribing opioids

9. Have these protocols, policies, or guidelines been updated since the release of the 2022 CDC Clinical Practice Guideline? If so, what has changed?

• If no changes have been made or are planned, why do you think that is?

10. In your organization, what factors drive the development of new protocols, policies or guidelines, such as for pain management?

11. Under what circumstances would patients not be allowed to receive pain management from clinicians in your health system? What about opioids specifically?

IMPLEMENTATION SUPPORT

SAY: I’m now going to ask a few questions about you and your organization’s role in supporting the roll out, awareness, and adoption of the 2022 CDC Clinical Practice Guideline with clinicians and in clinical practices.

12. Please briefly describe what your organization has done or is doing to support the roll out, awareness, and adoption of the 2022 CDC Clinical Practice Guideline with clinicians and in clinical practices.

PROBES:

• Any organization-level communication? Email blasts? Campaigns?

• Any changes in how you interact or communicate with clinicians or clinical practices? If so, describe.

• How has the communication or support for the adoption of the 2022 CDC Clinical Practice Guideline changed over time, from initial release to now?

13. To your knowledge, how well do you think the 2022 CDC Clinical Practice Guideline aligns with your organization’s/agency’s existing guidelines, policies, or protocols?

FROM THE FIELD

SAY: Now I’m going to ask a few questions about what you’ve seen or heard related to the roll out of the 2022 CDC Clinical Practice Guideline and adoption of this Guideline amongst peer organizations/agencies.

14. More generally, and not necessarily specific to your organization, what have you seen or heard in the field about the 2022 CDC Clinical Practice Guideline?

15. What is your sense of how the Guideline and its specific recommendations are being used by health systems to create or implement practices or policies around pain management?

PROBES:

• Were many of the recommendations already a standard of practice? If so, which recommendations?

• Do you think this has been a big shift or a light shift in terms of clinical practice changes?

• How do you think it is being used by clinicians?

• How do you think it is being used by payers?

BARRIERS & FACILITATORS

SAY: Now I’m going to ask a few questions about any challenges or successes you’ve perceived or experienced related to the roll out, awareness, or adoption of the 2022 CDC Clinical Practice Guideline within your organization/agency.

16. What is going well, or went well, related to the roll out, spreading awareness, or adoption of the 2022 CDC Clinical Practice Guideline?
    PROBES:

• What are you hearing from within your agency/organization?

• Specific examples…

17. What were some challenges that your organization faced as a result of the 2022 CDC Clinical Practice Guideline release?

PROBES:

• Conflicted with existing protocols/policies

• Any pushback from health systems or staff
  
  
  

18. From your perspective within your organization, how has the 2022 CDC Clinical Practice Guideline improved or worsened pain management practices since its release two years ago?

PROBES:

• What specific improvements?

• What specific shortfalls? Shortfalls that may need attention?

19. Part of the 2022 CDC Clinical Practice Guideline’s aim was to re-emphasize the need for patient-centered care, shared decision making between patients and clinicians, equitable care for those in pain, and flexibility for clinicians in patient care. Do you think the recommendations in the 2022 CDC Clinical Practice Guideline facilitate accomplishing these goals? Let’s walk through each one…

FOLLOW-UPS: Does implementing the recommendations from the 2022 CDC Clinical Practice Guideline…

• Promote patient-centered care? In what ways?

• Encourage shared decision making between patients and clinicians? In what ways?

• Improve equitable care for those in pain? In what ways?

• Address inequities between patients, or in patient care more generally? In what ways?

• Allow for needed flexibility for clinicians as they care for patients in pain? In what ways?

• Are there specific recommendations that do NOT achieve some of these goals? Why not?
  
  
  

20. What are some changes you have seen (positive or negative; intended or unintended) in clinical practice since the release of the 2022 CDC Clinical Practice Guideline that you weren't expecting?

RECOMMENDATIONS OR LESSONS LEARNED

Thinking about the roll out of the 2022 CDC Clinical Practice Guideline overall…

21. What are some of your key takeaways or lessons learned from roll out, awareness, and adoption of the 2022 CDC Clinical Practice Guideline?

PROBES:

• Any takeaways or lessons learned from YOUR experiences supporting the roll out, awareness, and adoption of the 2022 CDC Clinical Practice Guideline?

22. Before we conclude today’s interview, is there anything else that you would like to share?

23. You may remember that earlier I indicated that with your permission, the name of your organization can be included in the acknowledgements in any report or publication; however, we will not attribute our findings to you or your organization explicitly. Would you be willing to have us include the name of your organization in the acknowledgements in reports or publications?

• If yes: What is the full, formal name of your organization.

24. Are there any questions before we wrap up? [Address questions]