Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

PURPOSE: The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. METHODS: The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. RESULTS: A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. CONCLUSIONS: Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more.

A Peer Support Scale for Adults Treated for Psychoactive Substance-Use Disorder: A Rasch Analysis.

UNLABELLED: The literature suggests that peer support is protective of relapse for adults treated for substance-use disorder. However, to our knowledge there is no standard measure of peer support. Therefore, the purpose of this research was to use Rasch analysis to assess a 13-item peer support scale used in a group of adults treated for primary psychoactive substance-abuse disorder. The participants (n = 408) are adults who were discharged from an inpatient substance-abuse treatment program from five successive years, 2004-2009. Overall, it is acceptable to surmise that items 1-12 are part of the same dimension for the 13-item scale. Given the prominence of therapeutic communities as a mode of primary treatment and the importance of peer support, it is important to both the academic and treatment communities to have a standard way to measure peer support. The scale presented here can be useful for this purpose. HIGHLIGHTS: We asses a peer support scale for those treated for substance abuse.We examine characteristics of the peer support scale.We provide an option to measure peer support for those treated for substance abuse.

Peer relations scale for adolescents treated for substance use disorder: a factor analytic presentation.

BACKGROUND: The literature indicates that peer relations are an important aspect of the treatment and recovery of adolescents with substance use disorder (SUD). Unfortunately, no standard measure of peer relations exists. The objective of this research is to use exploratory factor analysis to examine the underlying factor structure of a 14-item peer relations scale for use in this treatment population. METHODS: Participants are 509 adolescents discharged from primary substance abuse treatment from 2003-2010. The data are from research conducted between six and twelve months post discharge via a 230-item questionnaire that included the 14-item peer relations scale. The scale has questions that assess the degree to which the adolescent's social contacts conform to norms of positive behavior and therefore foster non-use and recovery. The response rate was 62%. RESULTS: The scale was decomposed by principal component factor analysis. When the matrix was rotated by varimax a three factor solution explaining 99.99% of the common variance emerged. The first factor yielded ten items that measure association with peers who engage in positive versus delinquent social behavior (positive versus negative social behavior). The three items in the second factor specify association with peers who use versus those who don't use drugs, and thereby encourage recovery and discourage drug use (drug use). The third and factor contained two items measuring the degree to which the recovering adolescent associates with new or previous friends (post treatment peer association). CONCLUSIONS: This scale is useful as a standard measure in that it begins to identify the measurable dimensions of peer relations that influence sustaining post treatment recovery.