Form 5 Care Transitions Coordinator Interview Protocol

Care Transition Coordinator Interview Guide

Frontier Community Health Care Network Coordination Grant

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-XXXX. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

Advance Letter

Via Email

Dear Interviewee:

On behalf of the Office of Rural Health Policy, the Altarum Institute, IMPAQ International and the NORC Walsh Center for Rural Health Analysis are conducting an evaluation of the Frontier Community Health Care Network Coordination Grant. The grant is supporting the training and placement of community health workers in several Montana critical access hospitals to facilitate the coordination of care for patients.

The interview will be conducted either in-person or by telephone and will last no longer than one hour. Your participation will provide increased understanding and perspectives on access to quality care, adequate compensation, and regulations that allow for the integration and delivery of high quality care in frontier areas. With your permission, we will record the interview to assist us in taking notes and summarizing the discussion.

Findings from this evaluation will be included in reports for ORHP that may be publicly available. In those reports, data or quotations will not be linked to the identity of a particular respondent or organization.

If you have questions about this study, please contact me at knudson-alana@norc.org. Shena Popat from NORC will be contacting you within the next few days to schedule a telephone interview. For questions about your rights as a study participant, you may call the NORC Institutional Review Board Administrator at 773-256-6000.

Thank you for your participation in this very important study.

Sincerely,

Alana Knudson, PhD

Co-Director, NORC Walsh Center for Rural Health Analysis

Informed Consent

Good morning/afternoon. My name is Alana Knudson and I am a researcher at the NORC Walsh Center for Rural Health Analysis. Altarum Institute, IMPAQ International and the Walsh Center have been contracted by the HRSA Office of Rural Health Policy to ascertain your unique perspective on the Frontier Community Health Care Network Coordination Grant. The grant is supporting the training and placement of community health workers in several Montana critical access hospitals to facilitate the coordination of care for patients.

This interview will last no more than one hour. There are no risks associated with your participation. Your participation is voluntary, and you may skip questions, and stop the interview at any time without any adverse consequences. Your answers will only be reported in aggregate form, and will not identify you or your organization. Your responses will be used in a final report for ORHP. If you have any questions about your rights as a participant in this research project, please call the NORC Institutional Review Board Administrator at 773-256-6000.

Do you consent to participate in this interview? [All parties on line must say “yes” to proceed.]

Do you have any questions for me?

[If “yes” then proceed. If “no” then terminate interview.]

[BEGIN RECORDING]

NORC would like to record this interview in order to ensure our notes are as accurate and comprehensive as possible. This recording will be deleted at the end of the project. Do you consent to have this interview recorded?

[If all parties indicate “yes” then proceed, and continue to record the interview.”]

[If “no” then say: “That's fine. Please be patient as I take notes." Then, stop and delete the recording.]

Care Transition Coordinator Interview Guide

Interview Guide

1. Please tell us about your educational and training background?

Training

2. What was your role in the initial training of the community health workers?

3. What are the strengths of the training?

4. Are there any weaknesses in the training?

5. What is your role in ongoing support and training?

6. Would you change anything in future trainings?

Patient Recruitment

7. What practices are used to recruit patients into the care coordination program?

8. What are challenges to patient recruitment?

9. Are there any lessons learned for patient recruitment?

10. How long are patients retained in the care coordination program?

    1. What types of health-related situations usually attract patients into the program (e.g., episodic event, chronic conditions, transition between care, other?)?

Care Coordination

11. Please describe the types of care transitions activities that you have performed.

12. How often do you interact with the local CHWs?

    1. Please describe the support given to CHWs.

13. Are you evaluating the CHWs?

    1. If yes, what criteria are used?

    2. How often are you collecting information about the CHWs?

14. Do you have a role after a patient is referred to another provider?

15. Does the referral provider communicate with you regarding how well the care coordination approach worked?

    1. If yes, how? (e.g., communicate with the frontier provider, communicate with the referral provider, communicate with the patient and/or family)

       1. Is this coordination effective in providing high quality, integrated health care?

          1. Please provide an example of how this coordination worked well.

       2. Does the care coordination save the patient and/or insurer money?

          1. If so, how?

    2. If not, why?

       1. How do you evaluate the effectiveness of the care coordination provided by the CHW?

16. How is care coordinated with other health care services/programs, such as home health, hospice, nursing home, and ambulatory care providers?

17. Does your role involve assisting CHWs integrate health care services and other health related social services for patients?

18. What are some promising practices?

19. What are some lessons learned from your role as a care transitions coordinator?

Summary Question

20. Are there any other issues we have not discussed pertaining to your role as care transitions coordinator?

Thank you for taking the time to share your experience and ideas with us. We greatly appreciate your input.

OMB Control Number 0915-XXXX Expiration XX/XX/201X