Form #5 Form #5 Provider Interview Tool (Baseline)

Provider Interview (Drivers)

Hospital Name:
Interviewer Name:
Date of Interview:
Case #:
Position:
Setting:
Relationship with Patient:
Provider Interviewed:
Description of Strategy/Quality Improvement Being Tested (during QI cycles):

Purpose:	The purpose of the provider interviews is to elicit input from the variety of providers who cared for the patient regarding the circumstances leading to a patient’s readmission, and gather any suggestions for the cross-continuum team to consider for improvement.
Sample Size:	10-20 cases – until themes converge and very little new information is being learned (same number as records reviews conducted).
Selection Criteria:	Provider from hospital or from community who cared for the person who was readmitted (e.g., hospitalist, admitting physician, emergency room physician, primary care provider, provider at skilled nursing facility, home health nurse, etc.). Providers involved with current readmission (i.e., patient is still in hospital).
Conduct:	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.
Time:	10 minutes maximum per interview.
Introduction: Interviewer: “The hospital is conducting a review of recently readmitted patients with Medicaid coverage. The purpose of this review is for quality improvement. There is no implication that there was any deficiency in the specific care provided for this patient. Rather, we assume that we have numerous opportunities to improve care transitions, and are interested in understanding your perspective about this patient’s circumstances as an illustration. This will only take 5 minutes of your time.” Add one-line about the patient to remind the provider (Mr. X is a xx-year old gentleman who was admitted on xx with a complaint of xx. After a xx day hospitalization for xx, he was discharged to xx, and returned for readmission on xx with a complaint of xx.) Provide any additional clarifying information to assist the clinician’s memory.

Do you remember the patient?	Yes No If “No” end interview & identify another provider
Why do you think the patient was readmitted?
Do you think there was anything that could have been done to avoid the readmission? Please explain.
Do you think there are any services or supports that need to be in place to better support this patient long-term in the outpatient setting?
We were attempting to implement a new strategy related to Medicaid readmissions [insert strategy]. Do you think this was helpful in this case?	Yes No Comments: ___________________________ _________________________________________
Anything else you would like to add?

Provider Interview (Drivers) Page 2

Adapted from STAAR Readmissions Diagnostic Tool