Form #1 Form #1 Key informant interviews with practice coaches

P

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

ractice Coach Key Informant Interview 1:

Individual practices

Date of interview:

Name:

Practice of focus:

Interviewer:

Public reporting burden for this collection of information is estimated to average 60 minutes per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Individual sites:

1. Describe the intervention from start to finish for each practice:

1. What activities occurred?

2. What change methods, strategies, tools from toolkit were used?

3. What change methods, strategies, tools not from toolkit were used?

4. Who was involved in each encounter?

5. What role did they play?

6. What was your role in them?

7. What were the outcomes of each encounter? Of each core activity? Of overall coaching intervention?

8. What were the unanticipated or iatrogenic effects of the intervention?
   
   

1. What changes did the practices make as a result of the coaching?

   1. With point of care decision supports?

   2. Clinical information systems?

   3. Self-management support?

   4. Delivery system design?

   5. Health system organization?

   6. Community linkages?
      
      

2. Did practice coaching play a role in (each change)? If so what? Where there other factors also promoting change? If practice coaching not a cause, what caused change?
   
   

3. How sustainable do you believe these changes are (by change): 1 year or less, greater than a year?

   1. Why?
      
      

5. What factors facilitated the practice coaching intervention at this site? What factors impeded it?

   1. At system level

   2. Organization level

   3. Practice level

   4. Provider level

   5. Staff level

   6. Patient level

   7. Community level

8. If not long term, what would be required to support changes long-term?

6. Overall, how effective do you believe the intervention at this site was on scale of 1 (not at all effective) to 10 (extremely effective)? If not a 10, in your opinion, what would it take to make the intervention a “10”?

7. On a scale of 1 to 10, how would you rate the Toolkit use at this site on a scale of 1 (not at all useful) to 10 (very useful)? If not a 10, what would it take to make it a 10?

8. As a practice coach, how satisfied were you with the training, support and intervention process at this site on a scale of 1 (not at all satisfied) to 10 (very satisfied)? If not a 10, what would it take to make it a 10? If a 10, what makes it a 10?

All sites combined:

9. How were the practice coaching interventions different from each other? How were they similar? And Why?

   1. By process

   2. By content

   3. By focus

   4. By use of Toolkit

   5. By barriers and facilitators

   6. By outcomes

   7. By satisfaction with process

10. Please sort practices into 3 groups, not effective, moderately effective, very effective coaching intervention. Then order from most to least within each category.

    1. What made (specify practice) more successful than (specify practice)?

       1. At system level

       2. Organization level

       3. Practice level

       4. Administrative level

       5. Clinical management level

       6. Staff level

       7. Provider level

       8. Patient level

       9. Community level

11. Overall, how effective do you believe the intervention was on scale of 1 (not at all) to 10 (extremely effective)? If not a 10, in your opinion, what would it take to make the intervention a “10”?

12. On a scale of 1 to 10, how would you rate the Toolkit? If not a 10, what would it take to make it a 10?

13. As a practice coach, how satisfied were you with the training, support and intervention process on a scale of 1 to 10? If not a 10, what would it take to make it a 10? If a 10, what makes it a 10?