Skip to main content

Table 1 Overview of study methods, by objective

From: Linking clinician interaction and coordination to clinical performance in Patient-Aligned Care Teams

Element Objective 1 Objective 2 Objective 3
Objective (a) Characterize coordination practices utilized by PACTs and (b) examine their association with clinical performance Determine the level of coordinative complexity required for each outpatient clinical performance measure Evaluate the role of measure complexity in how PACT coordination measures relate to EPRP performance measures
Design Web-based survey of coordination practices Expert ratings of EPRP measures on coordinative complexity, obtained via functional job analysis (FJA) Statistical analysis of the impact of coordinative complexity on the association between coordination practices and clinical performance
Participants Initial validation sample will include teamlet members of 500 PACTs. Full survey deployment will include teamlet members of 1600 PACTs nationwide 6–8 3rd or 4th year residents in VA Primary Care rotations, to serve as subject matter experts (SME) None. This aim combines datasets from aims 1 and 2
Measures Outcome: clinical performance, measured by 25 outpatient EPRP measures Clinical performance: same as objective 1b Outcome: clinical performance, measured the same as in objectives 1b and 2
Predictors: coordination practices, measured via web-based survey developed for this project Coordinative complexity: average Worker Interaction scale ratings for the set of tasks comprising each EPRP measure Predictor: coordination, measured the same as in objective 1b
Covariate: PACT integration, calculated with PACT recognition metrics, available via the Patient-Aligned Care Teams Compass Cube Coordinative complexity ratings: same as objective 2
Procedures Survey development: coordination survey to be developed and piloted using small groups of PACT teamlet members (n = 6–8) FJA focus groups: SMEs will generate FJA-style lists of task statements comprising the work required to perform each EPRP measure to standard No new procedures, this aim is strictly analytical
Survey deployment: web-based deployment via SurveyMonkey, using recruitment strategy recommended by Dillman Coordinative complexity rating: research team will rate each task on the worker interaction FJA scale
Data analysis (a) To evaluate O&B’s measurement model: series of two-level CFAs, followed by EFAs (where fit is unacceptable) and Cronbach’s alphas. To evaluate O&B’s structural model: structural equations modeling (b) hierarchical linear models with PACT level coordination as predictors of clinical performance No hypothesis tests planned; descriptive statistics for coordinative complexity and number of tasks per EPRP measure Same as objective 1b, except that we will conduct hierarchical linear models separately for higher versus lower complexity measures and will then compare regression coefficients between models