| 1. Delineation of duties among researchers and sites (develop an administrative map). |
| 2. Centralized training for the practice teams. |
| a. Initial training for study should be done with all team leaders (see #5) and central staff in-person at a central site. |
| b. Future training for study, such as moving from usual care to intervention arm, may be completed by telephone or video conferencing. |
| 3. Use video conferencing when feasible to enhance interaction. |
| a. Video can be used when reviewing or teaching techniques such as spirometry or use of inhaled medications. |
| b. Video allows sites to demonstrate what they have learned. |
| 4. Designate central liaisons to guide each site. |
| a. Physician leader: one of study investigators (physicians) |
| i. Usually only requires 1 or 2 research physicians to do this |
| b. Central liaison: one of central study coordinators |
| i. Each coordinator has responsibility for 3 to 15 sites, depending on the complexity of the study |
| 5. Designate physician and nursing practice site leaders as primary contacts. |
| 6. Use weekly FAQ to disseminate uniform information in a simple format based on actual practice questions whenever possible. |
| 7. Hour-long weekly central team meetings |
| a. Review issues identified at each site. |
| i. Identify and celebrate successes. |
| ii. Discuss problems and brainstorm possible solutions. |
| 8. Develop a topic of the week (or month) for each liaison to discuss with their assigned sites. |
| 9. Use a listserv to allow sites to interact with each other. |
| 10. Consider site visits for remedial actions. |