Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

Lyle J. Fagnan; Theresa L. Walunas; Michael L. Parchman; Caitlin L. Dickinson; Katrina M. Murphy; Ross Howell; Kathryn L. Jackson; Margaret B. Madden; James R. Ciesla; Kathryn D. Mazurek; Abel N. Kho; Leif I. Solberg

doi:10.1370/afm.2199

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Table 1

Recruitment Approaches by Cooperative

Characteristic	Northwest: Healthy Hearts Northwest	Midwest: Healthy Hearts in the Heartland
Participating states	Washington, Idaho, Oregon	Illinois, Indiana, Wisconsin
Recruitment organizations	Washington: Qualis Health	Illinois: Northern Illinois University, Northwestern University, Telligen
	Idaho: Qualis Health
	Oregon: ORPRN	Indiana: Purdue
		Wisconsin: MetaStar
		All: American Medical Association, Alliance
Recruitment period	14 mo (May 1, 2015–June 30, 2016)	14 mo (Aug 27, 2015–Oct 14, 2016)
Recruiters	4 Physicians (0.5 FTE)	3 Physicians (0.3 FTE)
	4 Investigators (nonphysicians) (0.4 FTE)	16 Practice facilitators (5.6 FTE)
	19 Practice facilitators (8.5 FTE)	6 Managers (1.8 FTE)
	5 Managers (1.9 FTE)	3 Research staff (0.7 FTE)
	3 Communications specialists (0.7 FTE)
Primary communication methods	In-person, e-mail, e-mail blasts, conferences	In-person, e-mail, telephone
Targeted number of practices	250	250
	30, Washington	50, Illinois
	20, Idaho	60, Indiana
	100, Oregon	40, Wisconsin
Prior relationships	139, Washington	360, Illinois
	Qualis Health	Northern Illinois University: Illinois health information technology regional extension center; Telligen;
		Northwestern University: Chicago health information technology regional extension center
	22, Idaho	147, Indiana
	Qualis Health	Purdue Healthcare Advisors: health information technology regional extension center
	80, Oregon	132, Wisconsin
	ORPRN (members)	MetaStar: Wisconsin health information technology regional extension center
Priority stakeholders	Primary care associations	Primary care associations
	State family medicine organizations	State family medicine organizations
	Hospital systems leadership	Hospital systems leadership
	Independent physician associations	Independent physician associations
	State Medicaid service delivery organizations	State government health authority
	State government health authorities	State government health authorities
	State rural health associations	State rural health associations

FTE = full-time-equivalent; ORPRN = Oregon Rural Practice-based Research Network.

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Table 2

EvidenceNOW Recruitment Success Rates per Cooperative by Prior Relationships With Practices, Initial Recruitment Interactions With Practices, and Practice Ownership

	Healthy Hearts Northwest		Healthy Hearts in the Heartland		Both Cooperatives Combined

Characteristic	% Enrolled	% Success (Enrolled/Recruited)	% Enrolled	% Success (Enrolled/Recruited)	% Enrolled	% Success (Enrolled/Recruited)
Relationship
Prior partnership	43	36 (110/302)	46	31 (104/336)	44	33 (214/638)
Referral/warm handoff	28	18 (72/404)	23	66 (53/80)	26	26 (125/484)
No prior connection	29	11 (76/682)	31	4 (69/1,865)	30	6 (145/2,547)
Initial interactions
Conference or presentation	12	42 (32/76)	0	NA (0/0)	7	42 (32/76)
In person	15	46 (39/85)	33	32 (74/228)	23	36 (113/313)
Telephone	7	13 (19/152)	15	31 (34/111)	11	20 (53/263)
Individual e-mail	46	24 (118/490)	33	11 (75/680)	40	17 (193/1,170)
E-mail blast	12	15 (30/203)	0	NA (0/0)	6	15 (30/203)
Fax	1	10 (3/29)	0	NA (0/0)	1	10 (3/29)
Mail	7	6 (17/286)	19	3 (43/1243)	12	4 (60/1,529)
Missing or no activities	0	0 (0/67)	0	0 (0/19)	0	0 (0/86)
Ownership
FQHC	17	22 (43/200)	28	63 (64/101)	22	36 (107/301)
Health or hospital system	39	19 (100/536)	29	29 (65/226)	34	22 (165/762)
Other health organizations	4	20 (11/54)	1	17 (3/18)	3	19 (14/72)
Independent	40	17 (104/598)	42	5 (94/1936)	41	8 (198/2,534)
Total	100	19 (258/1,388)	100	10 (226/2,281)	100	13 (484/3,669)

FQHC = federally qualified health center; NA = not applicable.
Note: P <.001 for all relationships and initial interactions and for the ownership for Health Hearts in the Heartland and both cooperatives combined. P =.75 for ownership for Health Hearts Northwest.

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Table 3

Average Number of Interactions per Enrolled Practices for Cooperatives

	Healthy Hearts Northwest		Healthy Hearts in the Heartland			Both Cooperatives Combined

Interaction	Average No. (SD)	Range	Average No. (SD)	Range	No.	Average No. (SD)	Range	No.
Relationship
Prior partnership	7 (5)	2–25	6 (4)	2–24	104	7 (5)	2–25	214
Referral/warm handoff	9 (5)	2–20	4 (4)	2–27	53	7 (5)	2–27	125
No prior connection	7 (4)	1–20	9 (7)	2–44	69	8 (6)	1–44	145
Ownership
FQHC	7 (5)	2–25	6 (7)	2–44	64	6 (6)	2–44	107
Health/hospital system	9 (5)	2–20	5 (5)	2–27	65	8 (6)	2–27	165
Other health organizations	10 (5)	2–20	13 (10)	6–25	3	11 (6)	2–25	14
Independent	7 (4)	1–20	8 (5)	3–29	94	7 (4)	1–29	198
Total	8 (5)	1–25	7 (6)	2–44	226	7 (5)	1–44	484

FQHC = federally qualified health center.

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Table 4

Costs Associated With Cooperatives’ Recruitment Efforts

Characteristic	Healthy Hearts Northwest	Healthy Hearts in the Heartland	Both Cooperatives Combined
Total recruitment time, h	11,397	17,703	29,100
Recruiter^a hourly rate, average $	141	67	104
Total recruitment cost, $	1,595,824	1,080,051	2,675,875
Practices enrolled, No.	258	226	484
Average cost per recruited practice, $	6,185	4,779	5,529