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Table 3 Interview Guide

From: Audit and feedback and clinical practice guideline adherence: Making feedback actionable

CONCEPT TAPPED PRIMARY QUESTION POSSIBLE PROBES
Quality of Care in General 1. How do you or your staff identify quality of care issues in need of improvement for your OUTPATIENT primary care clinics? Probe for explicit processes (e.g., strategic planning, balanced score cards, data that is monitored, etc.)
   a. Who would be responsible for initiating and carrying out such efforts?
   b. Who would be responsible for monitoring such efforts?
Mental Models of Clinical Practice Guidelines (CPG) 2. What does the term "Clinical Practice Guidelines" mean to you? a. What role do you see for clinical practice guideline use as a method for improving quality of care?
   b. Do you believe clinical practice guidelines are effective for improving quality of care? Please explain.
   If no, follow up with, "Despite your beliefs, what is your experience?
  3. How do guidelines help you improve the quality of care you provide your patients? a. As a source of data feedback?
   b. How is data collected and utilized in your facility to improve the quality of patient care (e.g., administrative "scorekeeping" or as feedback for improving the quality of care)?
   c. Was EPRP data or other data on performance distributed?
   d. Did EPRP results affect individual performance evaluations?
   e. Does the facility collect clinical outcome data (mortality, readmission, functional status) related to the guideline?
CPG Success Story 4. Could you tell us the story of a time you and your team successfully implemented a clinical practice guideline (e.g., smoking cessation, depression screening, diabetes mellitus, hypertension, etc.)? Probe for the Who, What, When, Where, & How of the story.
   a. What were the steps?
   b. Who was involved? To what extent are clinicians involved in determining how to implement guidelines?
   c. How was this guideline effort brought to the attention of clinicians and managers in your facility? (e.g., formal meetings, guideline champions, grand rounds, e-mail distributions, web sites, etc)?
   d. To what extent were committees (one steering committee for all guidelines or guideline specific committees) used to implement guidelines?
   e. What made it a success?
CPG Training Development 5. Please describe the training (i.e., professional development) that clinicians have received for implementing guidelines. a. Would clinicians say they have been provided adequate support for professional development with respect to CPG implementation?
   b. Any training in the use of technology (e.g., CPRS, clinical reminders, etc.)?
   c. CME credit?
Facilitators 6. What are the most important factors that facilitate guideline implementation? a. Technology (CPRS, clinical reminders)?
   b. Targeted educational or training programs, patient specific reminder systems, workshops, retreats?
   c. Incentives (e.g., monetary, extra time off from work, gift certificates, etc.)?
   d. Mentoring or coaching?
   e. Additional resources (e.g., equipment, staff, etc.)?
   f. Social Factors such as teamwork or networks?
   g. Representation from a diversity of service lines?
   h. Presence of a guideline champion?
   i. Supportive leadership (i.e., VISN and/or facility)?
   j. Pocket cards or "lite" versions of the guidelines?
Barriers 7. What are the most important factors that hinder guideline implementation? a. Lack of resources or staff?
   b. Time (i.e., patient interactions are targeted for 20 minutes)?
   c. Lack of training?
   d. Not enough support?
   e. Financial?
Innovations 8. Were there any changes or redesigns in the clinical practices or equipment that supported the use of CPGs. a. How were forms/procedures or reports changed to support adherence to guidelines?
   b. How were the responsibilities of nurses, aides, other personnel changed to support adherence?
   c. How were resources allocated/reallocated to support adherence?
Structural, logistic, and organizational factors 9. Please describe any other conditions that may influence CPG implementation? a. Size of the facility?
   b. Academic affiliation?
   c. Competition with other QI initiatives?
   d. Location (e.g., remote vs. main facility)?