Measures of Effectiveness (Dependent Variables)
| Concept/Definition | Measure/How Scored | How and when collected |
|---|---|---|
| Ability to deliver Facilitation | ||
| Amount of facilitation delivered | Total number of hours and months of facilitation a Cooperative delivered to each practice | Collected by each Cooperatives’ facilitators. Collected from facilitators first contact with practices to their last contact. |
| Clinical Capacity | ||
| Adaptive Reserve (AR) | 14-item measure assessing practice capacity for adapting to change; individual practice members assessed experience of organization’s communication, teamwork, mindfulness, leadership, heedful interaction, sensemaking, work environment, learning culture and trust. Scores from (0 to 1). | Collected by survey distributed to clinical practice members by Cooperatives. Collected at baseline and at end of the intervention |
| Change Process Capacity Questionnaire (CPCQ) | 14-items of CPCQ; we selected the measures focused on the extent to which practices used different types of quality improvement strategies for cardiovascular disease prevention. Scores from (−28 to 28). | Collected by survey that was completed by lead clinician or office manager. Collected at baseline and at end of the intervention. |
| Clinical Quality | ||
| Aspirin Therapy (CMS164v4) | Percentage of patients 18 years of age and older with ischemic vascular disease with documented use of aspirin or another antithrombotic. Scored from (0 to 100%). | Collected by Cooperatives through EHR-generated reports, EHR chart review, and health information exchange reports. Quarterly rolling 12-month performance on each measure at the practice level |
| Blood Pressure Management (CMS165v4) | Percentage of patients 18 to 85 years of age with a diagnosis of hypertension whose BP was adequately controlled (<140/90 mm Hg). Scored from (0 to 100%). | |
| Cholesterol Management (CMS347v1) | Percentage of adult patients at high risk for a cardiovascular event who were using or prescribed statin therapy. Scored from (0 to 100%). | |
| Smoking Cessation (CMS138v4) | Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling, if identified as a tobacco user. Scored from (0 to 100%). | |
For the ABCS data, we reviewed data, including trajectories of change over time, computing descriptive statistics related to variability and removing practices that exhibited extreme, implausible jumps or otherwise implausible trajectories that could not be addressed by Cooperatives. Practices were also removed that had submissions with non-standard measurement periods. For all other variables and outcomes, data quality checks were performed in an iterative manner, with our team identifying anomalies or irregularities (e.g., excessive missingness, implausible or non-sensical inputs) and Cooperatives addressing those on their end and resubmitting corrected data.
Abbreviations: ABCS, Aspirin, Blood Pressure, Cholesterol, and Smoking; EHR, electronic health record.