Table 2. Summary of Elements of the Eight Methods

Method	Main Elements	Subcategories
Centralized training	1. Select an attractive city	Link to another meeting Choose a “vacation” city
	2. Brief and focused presentations
	3. All central team members make presentations
	4. Introduce all site champion teams and announce randomization	Celebrate with both groups Extra support for usual care initial disappointment
	5. Introduce site champions to the central site liaison
	6. Introduce the topic of the protocol and reasons for the study
	7. Provide detailed information in the slides and handbooks	Continually refer to the handbook when champions return home Use the handbook to reinvigorate, remind, and refresh
	8. Introduce the intervention to appropriate sites	Use practical examples based on patient care Let the group brainstorm anticipated problems and solutions Introduce the concept of implementation flexibility
	9. Provide time for each set of site champions to discuss their local implementation strategies while central team members are present to answer questions.
	10. Take and share pictures of site champions and central teams	It may be harder to ignore calls from someone whose picture is right over the phone Helps central team to remember more details about each champion
	11. Provide time to complete human subjects training with central team mentors	Reinforce that support is readily available Helps when the champions may have to repeat training in 2 to 3 years
	12. Provide concise slide set for site champions to use to train practices when they go home
	13. Use humor and interactive, supportive sessions to model behavior for interactions for the rest of the study period
Liaisons	1. Assign to specific practices for the entire study
	2. Serve as primary contact for practices to the central team
	3. Include in all study meetings
	4. Become an early warning system for practice problems and “voltage drop”
FAQs	1. Develop and use a consistent format with study logo at top
	2. Send to sites on a consistent day of the week
	3. Share by fax or E-mail as sites request
	4. Use for continuing education, maintaining same style as central training
	5. Reinforce complex or apparently confusing steps in implementation
	6. Recognize accomplishments such as enrollment numbers
	7. Share local sites' stories	Successes New strategies or tools developed by sites Occurrence and burden of natural disasters Floods, earthquakes, fires, hurricanes, tornadoes Share interpractice support given
	8. Use humor and cartoons to illustrate issues and celebrations
	9. Develop and use mini crossword puzzles or other study-related “contests”
	10. Share case reviews and questions
	11. Celebrate holidays
Incentives	1. Foster recognition and acknowledgement	Press releases for local media Framed certificates of participation for display in the local office
	2. Set achievable goals and recognize them when they are met
	3. Provide small but fun rewards, eg, boxes of microwave popcorn
	4. Use variety to continue encouraging participation
	5. Increase the frequency at lulls in enrollment or other dips in activity
	6. Provide larger rewards for major achievements like meeting total enrollment goals	Pizza party Ice cream social
	7. Provide personalized thank you from the PI for special recognition
Case reviews	1. Assume sites have important insight to offer and expect to learn from sites
	2. Highlight positive aspects of care
	3. Ask what could be done to make care even better
	4. Relate the care questions to the intervention
	5. Allow site attendees to teach each other
	6. Present alternatives from other sites or the PI's experience or expertise
	7. Guide problem solving
	8. End by setting up the next review and perhaps follow up on the cases presented
Appreciation	1. Respect is mainstay
	2. Acknowledge all members of the practice
	3. Praise the work of the site champions during case reviews and in FAQs
	4. Schedule interactions at the convenience of the sites
	5. Consider using emails for some interactions—especially PI to site physician champions
	6. Give site champions study shirts or mugs
	7. Give modest holiday gifts for all practice members	Candy or fruit for winter holidays Cookies or gift card for an ice cream party in summer
IRB support	1. Offer to do initial submission
	2. Provide support for all IRB interactions	Serious adverse events reporting Annual reports
	3. Copy and mail new consent forms required annually
	4. Offer to provide telephone support for all site-required IRB interactions
	5. As requested, teach sites to do its own IRB submissions with oversight and support

FAQ, frequently asked question; IRB, institutional review board; PI, primary investigator.