Table 1 Definitions of facility characteristics planned for inclusion

Number of annual primary care visits

Total number of outpatient visits in primary care clinics (CDW)

Quartiles

Patient severity

VA calculates patient severity using a Nosos Risk Score, which is based on a risk adjustment model developed by Center for Medicaid & Medicare Services and further calibrated with VA pharmacy data, VA priority status, and VA-computed costs [41]. Scores are scaled such that the mean Nosos score = 1, so scores > 1 indicate greater-than-average cost and clinical complexity. (VA PACT Compass*)

Continuous, scaled by 0.10

Facility complexity

Based on an algorithm that takes into account patient risk, number and breadth of available specialists, intensive care unit availability, and teaching and research activities. (VA Office of Productivity, Efficiency, and Staffing)

1a, 1b, 1c, 2, or 3 (1a = most complex)

Region

Region of country defined by Census (HHS Area Resource File)

Northeast, Midwest, South, or West

Primary care patient panel size

Average panel size of primary care providers (VA PACT Compass*)

Continuous, scaled by 100

Primary care staff ratio

Number of primary care support staff divided by the number of direct-care primary care providers (medical doctors or other direct-care providers such as nurse practitioners). Higher staff ratios indicate more support staff per direct-care provider, with 3 being the recommended minimum ratio for successful PACT implementation. (VA PACT Compass*)

Continuous

Mental health staff

Number of mental health full time equivalents relative to enrollees (Office of Mental Health and Suicide Prevention)

Continuous

Specialty pain program workload

Number of unique patients with at least one pain clinic visit (stop code 420) relative to enrollees (Office of Mental Health and Suicide Prevention)

Continuous

Academic detailing

Number of staff who undergo academic detailing on STORM, specifically, and other topics related to opioid risk management (SalesForce Database)

Continuous or categorical, as appropriate

Workgroup psychological safety

Degree to which employees agree that members of their workgroup are able to bring up problems and tough issues (1 = strongly disagree; 5 = strongly agree). Measured using a single item from the 2018 All Employee Survey.

Continuous

Servant leadership

Summary measure calculated from 5 items from the 2018 All Employee Survey assessing whether the work environment is a place where organizational goals are achieved by empowering others. Scores range from 0 to 100, with higher scores being more favorable.

Continuous

Raise and discuss ethics

Degree to which employees agree that their direct supervisor raises and discusses ethical concerns (i.e., uncertainty or conflict about the right thing to do) (1 = strongly disagree; 5 = strongly agree). Measured using a single item from the 2018 All Employee Survey.

Continuous

Workplace performance

“Workplace Performance” is a summary measure calculated using 6 items from the 2018 All Employee Survey that assess the degree to which the workplace environment has the right resources, training, goals, and innovation in place to support optimal performance. Scores range from 1 to 5, with higher scores being more favorable.

Continuous