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Practice Structure Outcomes Measure (Time Interval) Change Model Change Process Practice Characteristics Model Content Patient Experience Practice Experience Quality of Carea a Preventive care, chronic illness care, acute illness care, depression care. b Facilitated practices. c Self-directed practices. Quantitative Baseline practice survey (BPS)b,c (before 1/06) X – X X – X – Medical record auditb,c (baseline: 7/06; 9 months: 4/07; 26 months: 8/08) – – – – – – X Patient outcomes survey (POS)b,c (baseline, 9 months, 26 months) – – – X X – X Clinician staff questionnaire (CSQ)b,c (baseline, 9 months, 26 months) X – X – – X – Financial surveyb,c (4/08) X – X – – – – Qualitative Facilitator-generated data Observation field notesb (7/06-12/07) X X X – – X – Stakeholders interviewsb (7/06-8/06) X X X – – X – Practice environment checklist (PEC)b (7/06-12/07) X X X – – X – Evaluation team–generated data Regular monthly conference callsb (7/06-5/08) X X X – – – – E-mail streamsb (7/06-5/08) X X X – – – – Learning sessions (observational field notes/interviews)b (6/06, 10/06, 9/07, 4/08c) X X X X – – – Evaluation team conference callsb,c (7/06-12/07) – X X – – – – Multiday site visits (observations/interviews)b,c (7/07-12/07; 6/08-10/08) X X X X – – – Artifact data Web sites, practice documentsb,c X X X X – X – Multimethod TransforMED implementation indexb,c (7/06-3/08) – – – X – – – Factors and Items Attribute Assessed Adaptive reserve (items loading >.40 across all samples; Cronbach α =.97) 1. We regularly take time to consider ways to improve how we do things Mindfulness 2. People in our practice actively seek new ways to improve how we do things Mindfulness 3. People at all levels of this office openly talk about what is and isn’t working Mindfulness 4. People are aware of how their actions affect others in this practice Heedful interactions 5. Most people in this practice are willing to change how they do things in response to feedback from others Respectful interaction 6. This practice encourages everyone (front office staff, clinical staff, nurses, and clinicians) to share ideas Cognitive diversity 7. I can rely on the other people in this practice to do their jobs well Trust 8. Difficult problems are solved through face-to-face discussions in this practice Communication 9. We regularly take time to reflect on how we do things Reflection 10. After trying something new, we take time to think about how it worked Reflection 11. The practice leadership makes sure that we have the time and space necessary to discuss changes to improve care Leadership 12. Leadership in this practice creates an environment where things can be accomplished Leadership 13. Practice leadership promotes an environment that is an enjoyable place to work Leadership 14. Leadership strongly supports practice change efforts Leadership 15. This practice learns from its mistakes Learning culture 16. It is hard to get things to change in our practice (reverse score) Learning culture 17. Mistakes have led to positive changes here Learning culture 18. People in this practice have the information that they need to do their jobs well Sensemaking 19. When we experience a problem in the practice, we make a serious effort to figure out what’s really going on Sensemaking 20. I have many opportunities to grow in my work Teamwork (emergent property) 21. People in this practice operate as a real team Teamwork (emergent property) 22. Most of the people who work in our practice seem to enjoy their work Work environment (emergent property) 23. This practice is a place of joy and hope Work environment (emergent property) Community knowledge (items loading >.60 across all samples; Cronbach α =.82) – 1. This practice works effectively together as a team with community organizations – 2. This practice utilizes community resources to meet the health care needs of patients – 3. This practice is aware of community resources that are accessible to patients – 4. People in this practice are connected with community organizations that serve patients – Health information technology integration (items loading >.60 across all samples; Cronbach α =.73) – 1. The electronic medical record is well integrated into the practice’s daily work flow – 2. The use of the electronic medical record during patient visits interferes with the doctor-patient relationship – 3. I have what I need to do my work well – 4. The practice can easily identify patients with a particular disease or medication – Cultural sensitivity (items loading >.60 across all samples; Cronbach α =.68) – 1. I am aware of my racial/ethnic/cultural stereotypes – 2. I believe cultural issues are important in my interaction with health professional colleagues – 3. I believe cultural issues are important in my interactions with patients – Patient safety culture (items loading >.60 across all samples; Cronbach α =.81) – 1. Staff feel like their mistakes are held against them – 2. It is just by chance that more serious mistakes don’t happen in our practice – 3. Staff worry that mistakes they make are kept in their personal file – 4. Staff are afraid to ask questions when something does not seem right – 5. We tend to let setbacks and problems stop our change efforts –
Additional Files
Supplemental Appendixes 1-10
Supplemental Appendix 1. Baseline Practice Survey; Appendix 2. Medical Record Audit; Appendix 3. Depression Measures; Appendix 4. Clinician Staff Questionnaire; Appendix 5. Financial Survey; Appendix 6. Practice Environment Checklist; Appendix 7. TransforMED Key Stakeholder Interview Guide; Appendix 8. TransforMED Practice Interview Guide; Appendix 9. NDP Evaluation Team Site Visit Guide; Appendix 10. TransforMED Implementation Index
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 19 pages, 2.2MB
- Supplemental data: Appendix 10 - PDF file, 10 pages, 1.5MB
- Supplemental data: Appendix 2 - PDF file, 14 pages, 2.3MB
- Supplemental data: Appendix 3 - PDF file, 2 pages 1.4MB
- Supplemental data: Appendix 4 - PDF file, 8 pages, 1MB
- Supplemental data: Appendix 5 - PDF file, 5 pages, 960KB
- Supplemental data: Appendix 6 - PDF file, 16 pages, 2.5MB
- Supplemental data: Appendix 7 - PDF file, 2 pages, 965KB
- Supplemental data: Appendix 8 - PDF file, 5 pages, 1.6MB
- Supplemental data: Appendix 9 - PDF file, 3 pages, 707KB
Shorter Adaptive Reserve Measures
Shorter Adaptive Reserve Measures
Files in this Data Supplement:
- Shorter Adaptive Reserve Measures - PDF file, 2 pages
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