Table 3 Study variable measurement

Reach: rate of guideline-appropriate prescribing of ACE/ARBs, statins

[primary dependent variables]

(a) % clinic’s “indicated” patients with an active prescription (Rx issued in last year) for each indicated medication group

(b) % of patients indicated for statins, on the correct dosage

Monthly EHR data

Effectiveness: proportion of patient BP, LDL “under control” (targeted by statins, ACE/ARBs, respectively)

[secondary outcome]

% clinic’s “indicated” patients with:

(a) last systolic BP <135, last diastolic BP <80

(b) last LDL <100

Adoption: use of toolkit elements

- Site participation/uptake rates

- Staff participation/uptake rates overall/by staff role

[Process outcome]

(a) % indicated patient encounters where

 (i) appropriate prescription given

 (ii) statin dosage corrected

(b) rates of use of the roster tools

(c) rates of responses to “charting alerts:” how often the recommended change is made in the chart

(d) rates of responses to health maintenance alerts: data entered/recommended care provided

(e) % staff attending relevant trainings

(f) perceived value of patient/staff education materials

Monthly EHR data; qualitative data

Implementation: Compliance with, fidelity / adaptation to toolkit elements across and within sites

How toolkit elements are used: e.g., use of staff training materials, patient education materials, patient panel management rosters, other reminder tools; any adaptations made to these materials

Qualitative data

Maintenance: uptake of toolkit elements; primary, secondary outcome effects, over time

All measures at 1, 2, 3 years post-implementation

EHR, qualitative data