biostudies-literatureNoel PHNational Center for Advancing Translational SciencesNCATS NIH HHSHSRD VAVA Health Services Research and Development95-103https://www.ebi.ac.uk/biostudies/studies/S-EPMC8739408biostudies-literatureUnknown37(1)<h4>Background</h4>Given persistent gaps in coordination of care for medically complex primary care patients, efficient strategies are needed to promote better care coordination.<h4>Objective</h4>The Coordination Toolkit and Coaching project compared two toolkit-based strategies of differing intensity to improve care coordination at VA primary care clinics.<h4>Design</h4>Multi-site, cluster-randomized QI initiative.<h4>Participants</h4>Twelve VA primary care clinics matched in 6 pairs.<h4>Interventions</h4>We used a computer-generated allocation sequence to randomize clinics within each pair to two implementation strategies. Active control clinics received an online toolkit with evidence-based tools and QI coaching manual. Intervention clinics received the online toolkit plus weekly assistance from a distance coach for 12 months.<h4>Main measures</h4>We quantified patient experience of general care coordination using the Health Care System Hassles Scale (primary outcome) mailed at baseline and 12-month follow-up to serial cross-sectional patient samples. We measured the difference-in-difference (DiD) in clinic-level-predicted mean counts of hassles between coached and non-coached clinics, adjusting for clustering and patient characteristics using zero-inflated negative binomial regression and bootstrapping to obtain 95% confidence intervals. Other measures included care coordination QI projects attempted, tools adopted, and patient-reported exposure to projects.<h4>Key results</h4>N = 2,484 (49%) patients completed baseline surveys and 2,481 (48%) completed follow-ups. Six coached clinics versus five non-coached clinics attempted QI projects. All coached clinics versus two non-coached clinics attempted more than one project or projects that were multifaceted (i.e., involving multiple components addressing a common goal). Five coached versus three non-coached clinics used 1-2 toolkit tools. Both the coached and non-coached clinics experienced pre-post reductions in hassle counts over the study period (- 0.42 (- 0.76, - 0.08) non-coached; - 0.40 (- 0.75, - 0.06) coached). However, the DiD (0.02 (- 0.47, 0.50)) was not statistically significant; coaching did not improve patient experience of care coordination relative to the toolkit alone.<h4>Conclusion</h4>Although coached clinics attempted more or more complex QI projects and used more tools than non-coached clinics, coaching provided no additional benefit versus the online toolkit alone in patient-reported outcomes.<h4>Trial registration</h4>ClinicalTrials.gov identifier: NCT03063294.Journal of general internal medicineThe Coordination Toolkit and Coaching Project: Cluster-Randomized Quality Improvement Initiative to Improve Patient Experience of Care Coordination.PMC8739408UL1TR001881UL1 TR001881QUE 15-276Noel PHBarnard JMChawla NOlmos-Ochoa TTFinley EPBharath PSLeng MRubenstein LVSimon AGanz DARose DEPenney LSStockdale SELee MLfalseThe Coordination Toolkit and Coaching Project: Cluster-Randomized Quality Improvement Initiative to Improve Patient Experience of Care Coordination.<h4>Background</h4>Given persistent gaps in coordination of care for medically complex primary care patients, efficient strategies are needed to promote better care coordination.<h4>Objective</h4>The Coordination Toolkit and Coaching project compared two toolkit-based strategies of differing intensity to improve care coordination at VA primary care clinics.<h4>Design</h4>Multi-site, cluster-randomized QI initiative.<h4>Participants</h4>Twelve VA primary care clinics matched in 6 pairs.<h4>Interventions</h4>We used a computer-generated allocation sequence to randomize clinics within each pair to two implementation strategies. Active control clinics received an online toolkit with evidence-based tools and QI coaching manual. Intervention clinics received the online toolkit plus weekly assistance from a distance coach for 12 months.<h4>Main measures</h4>We quantified patient experience of general care coordination using the Health Care System Hassles Scale (primary outcome) mailed at baseline and 12-month follow-up to serial cross-sectional patient samples. We measured the difference-in-difference (DiD) in clinic-level-predicted mean counts of hassles between coached and non-coached clinics, adjusting for clustering and patient characteristics using zero-inflated negative binomial regression and bootstrapping to obtain 95% confidence intervals. Other measures included care coordination QI projects attempted, tools adopted, and patient-reported exposure to projects.<h4>Key results</h4>N = 2,484 (49%) patients completed baseline surveys and 2,481 (48%) completed follow-ups. Six coached clinics versus five non-coached clinics attempted QI projects. All coached clinics versus two non-coached clinics attempted more than one project or projects that were multifaceted (i.e., involving multiple components addressing a common goal). Five coached versus three non-coached clinics used 1-2 toolkit tools. Both the coached and non-coached clinics experienced pre-post reductions in hassle counts over the study period (- 0.42 (- 0.76, - 0.08) non-coached; - 0.40 (- 0.75, - 0.06) coached). However, the DiD (0.02 (- 0.47, 0.50)) was not statistically significant; coaching did not improve patient experience of care coordination relative to the toolkit alone.<h4>Conclusion</h4>Although coached clinics attempted more or more complex QI projects and used more tools than non-coached clinics, coaching provided no additional benefit versus the online toolkit alone in patient-reported outcomes.<h4>Trial registration</h4>ClinicalTrials.gov identifier: NCT03063294.2022-01-01T00:00:00Z2022 Jan2024-11-05T18:07:34.238Z2024-11-05T18:07:34.238ZS-EPMC87394083410954510.1007/s11606-021-06926-y