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      Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

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          Abstract

          Introduction

          Shadow coaching improves provider-patient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time.

          Aim

          Examine whether a second coaching session (re-coaching) improves and sustains patient experience.

          Setting

          Large, urban Federally Qualified Health Center

          Program

          Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0–100-point scale) were eligible.

          Evaluation

          We used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixed-effects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible “jump” at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after re-coaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC.

          Discussion

          Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s11606-022-07881-y.

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          Most cited references41

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          Is Open Access

          The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research

          Shannon Wiltsey Stirman, John Kimberly, Natasha Cook … (2012)
          Background The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. Methods Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. Results Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. Conclusions Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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            Meta-analysis of correlates of provider behavior in medical encounters.

            J Hall, D Roter, N R Katz (1988)
            This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.
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              A systematic review of peer teaching and learning in clinical education.

              Jacinta Secomb (2008)
              The purpose of this review is to provide a framework for peer teaching and learning in the clinical education of undergraduate health science students in clinical practice settings and make clear the positive and negative aspects of this teaching and learning strategy. The practice of using peers incidentally or purposefully in the clinical education of apprentice or undergraduate health science students is a well-established tradition and commonly practiced, but lacks definition in its implementation. The author conducted a search of health science and educational electronic databases using the terms peer, clinical education and undergraduate. The set limitations were publications after 1980 (2005 inclusive), English language and research papers. Selection of studies occurred: based on participant, intervention, research method and learning outcomes, following a rigorous critical and quality appraisal with a purposefully developed tool. The results have been both tabled and collated in a narrative summary. Twelve articles met the inclusion criteria, representing five countries and four health science disciplines. This review reported mostly positive outcomes on the effectiveness of peer teaching and learning; it can increase student's confidence in clinical practice and improve learning in the psychomotor and cognitive domains. Negative aspects were also identified; these include poor student learning if personalities or learning styles are not compatible and students spending less individualized time with the clinical instructor. Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning. The findings from this systematic review, although not statistically significant, do have pragmatic implications for clinical practice. It can increase clinical placement opportunities for undergraduate health students, assist clinical staff with workload pressures and increase clinician time with clients, while further developing students' knowledge, skills and attitudes.
              Article 0 comments Cited 92 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Denise D. Quigley:
                ORCID: http://orcid.org/0000-0002-3815-908X
                quigley@rand.org
                Marc N. Elliott: elliott@rand.org
                Mary E. Slaughter: slaughter@rand.org
                Efrain Talamantes: eftalamantes@altamed.org
                Ron D. Hays: drhays@ucla.edu
                Journal
                Journal ID (nlm-ta): J Gen Intern Med
                Journal ID (iso-abbrev): J Gen Intern Med
                Title: Journal of General Internal Medicine
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0884-8734
                ISSN (Electronic): 1525-1497
                Publication date (Electronic): 7 November 2022
                Pages: 1-7
                Affiliations
                [1 ]GRID grid.34474.30, ISNI 0000 0004 0370 7685, RAND Corporation, ; 1776 Main Street, Santa Monica, CA 90407 USA
                [2 ]GRID grid.422348.b, ISNI 0000 0004 0419 886X, AltaMed, ; Los Angeles, CA USA
                [3 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, UCLA Department of Medicine, ; Los Angeles, CA USA
                Author information
                http://orcid.org/0000-0002-3815-908X
                Article
                Publisher ID: 7881
                DOI: 10.1007/s11606-022-07881-y
                PMC ID: 9640810
                SO-VID: f4a00ed6-7a85-42f5-935b-e94f53bd525e
                Copyright © © The Author(s), under exclusive licence to Society of General Internal Medicine 2022
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 20 June 2022
                Date accepted : 24 October 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000133, Agency for Healthcare Research and Quality;
                Award ID: U18 HS025920
                Award Recipient :
                Categories
                Subject: Innovations in Clinical Practice

                ScienceOpen disciplines: Internal medicine
                Keywords: coaching,patient experience,cahps,provider performance,spline models
                Data availability:
                ScienceOpen disciplines: Internal medicine
                Keywords: coaching, patient experience, cahps, provider performance, spline models

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