APPENDIX D

Pre-Interview

INSTITUTE OF MEDICINE PRE-INTERVIEW SURVEY OF MICRO-SYSTEMS

Please fax both sides of this survey to Molla Donaldson, Institute of Medicine, Fax: 202-334-3862. E-mail: mdonalds@nas.edu. Phone 202-334-2184. If you prefer e-mail, we can send this to you as an attachment.

Optional: Name of person completing this survey (please print)

Phone:

Title:

If you would like to discuss more than one micro-system during the interview, please include a survey for each.

1. Your Micro-system

What is the clinical focus of your micro-system (for example, primary care, cardiothoracic surgical care, hospice care) (Check as many as apply)

_ Primary care _ Specialty care _ Condition-specific (e.g., back, OB)

_ hospital unit (e.g., ICU) _ Other, please specify:

Please provide a 1 to 3-sentence description of your micro-system —who belongs to it, how it is organized, what does it do? Please feel free to attach a diagram.

What are the number and specialty mix of physicians working in your micro-system?

How many and what type of non-physician practitioners does your micro-system include (for example, PAs, NPs, nutritionists, psychologists)?

What is the composition of the rest of the staff of the micro-system (for example, nurses, technicians, office staff)?

Does your micro-system include medical students, residents, or other trainees? If so, please indicate what kind and how many. _ No _ Yes, please specify:

How often are they present?

Does your micro-system use any volunteers? _ No _ Yes, please describe how you use volunteers.

How would you describe the micro-system's patient population/practice location? Please check all that apply.

Primarily: _ acute care _ chronic care _ palliative care OR: _ mixture of preventive, acute, chronic, palliative

Age: _ pediatric _ adolescent _ working-age adult _ elderly/geriatric

Other: _ minority _ underserved _ long-term care _ safety net

Practice Location: _ urban _ suburban _ rural _ frontier



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OCR for page 71
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis APPENDIX D Pre-Interview INSTITUTE OF MEDICINE PRE-INTERVIEW SURVEY OF MICRO-SYSTEMS Please fax both sides of this survey to Molla Donaldson, Institute of Medicine, Fax: 202-334-3862. E-mail: mdonalds@nas.edu. Phone 202-334-2184. If you prefer e-mail, we can send this to you as an attachment. Optional: Name of person completing this survey (please print) Phone: Title: If you would like to discuss more than one micro-system during the interview, please include a survey for each. 1. Your Micro-system What is the clinical focus of your micro-system (for example, primary care, cardiothoracic surgical care, hospice care) (Check as many as apply) _ Primary care _ Specialty care _ Condition-specific (e.g., back, OB) _ hospital unit (e.g., ICU) _ Other, please specify: Please provide a 1 to 3-sentence description of your micro-system —who belongs to it, how it is organized, what does it do? Please feel free to attach a diagram. What are the number and specialty mix of physicians working in your micro-system? How many and what type of non-physician practitioners does your micro-system include (for example, PAs, NPs, nutritionists, psychologists)? What is the composition of the rest of the staff of the micro-system (for example, nurses, technicians, office staff)? Does your micro-system include medical students, residents, or other trainees? If so, please indicate what kind and how many. _ No _ Yes, please specify: How often are they present? Does your micro-system use any volunteers? _ No _ Yes, please describe how you use volunteers. How would you describe the micro-system's patient population/practice location? Please check all that apply. Primarily: _ acute care _ chronic care _ palliative care OR: _ mixture of preventive, acute, chronic, palliative Age: _ pediatric _ adolescent _ working-age adult _ elderly/geriatric Other: _ minority _ underserved _ long-term care _ safety net Practice Location: _ urban _ suburban _ rural _ frontier

OCR for page 71
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis About how many patients does your micro-system care for? / Day, week, year, etc. Is your micro-system embedded in a larger organization such as a hospital or hospital system, chain, academic medical center, staff model HMO, or integrated delivery system? _ No _ Yes, please provide the organization's name: What sort of organization is this? 2. Reimbursement Mix Please provide the approximate proportion of patients in each reimbursement category: __ % FFS% __ Prepaid __ % Uninsured or self-pay (Total = 100%) __ % Commercial __ Medicare __ % Medicaid __ Uninsured or self-pay (Total = 100%) Has this reimbursement mix been changing in the last year? If so, how? Do you expect the reimbursement mix to change in the coming year? If so, how? How is compensation for the physicians in your micro-system determined? (Check as many as apply) _ FFS/fee schedule _ salary _ capitation _ bonus _ witholds Are formulas based on: _ panel size _ productivity _ patient satisfaction _ clinical performance _ financial performance _ other?, please specify: 3. Computer-based Information Technology Most offices have computer-based billing information, but we are particularly interested in this section in computer-based clinical information. Does your micro-unit have computer-based patient records? __ No, Patient records are paper-based (If No, Please skip to section 4 below) __ Yes, Patient records and financial systems are computer based, but separate __ Yes, Patient records and financial systems are to some extent or entirely integrated If you answered yes above, is the clinical information system linked to any data sources outside the micro-system, such as laboratories, pharmacies, or ER? __ No __ Yes, please specify: Does the clinical information system include direct data input by patients _ No _ Yes (e.g., blood glucose levels or blood pressure measurements)? Our computer-based information system is used for: Please check all that apply _generating reports about the practice _ real-time patient care _ clinical decision support (e.g., reminders, drug-drug warnings) 4. Other Do patients interact with clinicians by e-mail? _ No _ Yes Using web-based resources? _ No _ Yes

OCR for page 71
Exploring Innovation and Quality Improvement in Health Care Micro-Systems: A Cross-Case Analysis Who (or what organizational unit) makes information technology decisions for your micro-system? Who (or what organizational unit) makes human resource policy decisions for your micro-system (hiring, assigning support staff, etc.)? Who would you consider to be the leader of this micro-system? Please fax both sides to Molla Donaldson, IOM: Fax: 202-334-3862, Phone: 202-224-2184