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Supplemental Table 1. PACT Implementation Progress Index (Pi2) Data Sources, Domains, and Items Domain: ACCESS Patient Survey Asked only of those who phoned their providers office Asked only if they made an appointment, CAHPS-PCMH questions In the last 12 months… When you phoned this provider’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed? When you made an appointment for a check-up or routine care with this provider, how often did you get an appointment as soon as you needed? Asked only those who reported needing this type of care, How often were you able to get the care you needed from this provider’s office during evenings, weekends, or holidays? Asked only if they phoned their providers office, When you phoned this provider’s office during regular office hours, how often did you get an answer to your medical question that same day? Asked only if they phoned after hours, When you phoned this provider’s office after regular office hours, how often did you get an answer to your medical question as soon as you needed? Wait time includes time spent in the waiting room and exam room, How often did you see this provider within 15 minutes of your appointment time? Values 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 Domain: ACCESS Administrative Data Clinic Access Corporate Data Warehouse (CDW) facility-level means Use of non-face-toface modalities Electronic access Same day access 7-day access Telephone clinics Group visits Secure messaging, % use Values Proportion of total primary care encounters, 0-1 Proportion of total primary care encounters, 0-1 Proportion of total primary care encounters, 0-1 Proportion of patients who either sent or received a message in the past year, 0-1 Domain: CONTINUITY Patient Survey Sustained relationship CAHPS-PCMH questions How long have you been going to this provider? Values 1 = Less than 6 months 2 = At least 6 months but less than 1 year 3 = At least 1 year but less than 3 years 4 = At least 3 years but less than 5 years 5 = 5 years or more Administrative Data Continuity Values Continuity Discontinuity Proportion of visits to assigned Primary Care provider Number of assigned Primary Care providers Proportion, 0-1 Count 2 Domain: CARE COORDINATION Patient Survey Reminders between visits CAHPS-PCMH questions In the last 12 months… Some offices remind patients between visits about tests, treatment or appointments, did you get any reminders from this provider’s office between visits? When this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider’s office follow up to give you those results? (Asked if they had something ordered, n=64,317) Coordination of Care Information How often did the provider named … seem informed and up-to-date about the care you got from specialists? (Asked if they saw a specialist, n=48,103) Did you and anyone in this provider’s office talk at each visit about all the prescription medicines you were taking? Did this provider’s office give you information about what to do if you needed care during evenings, weekends, or holidays? Administrative Data Values 1 = Yes 2 = No 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Yes 2 = No 1 = Yes 2 = No Values % of high risk patients enrolled in Care Coordination Home Telemonitoring (home tele‐monitoring for chronic conditions) Proportion, 0‐1 % contacted within 2 days post‐hospital follow‐up Proportion, 0‐1 3 Domain: COMPREHENSIVENESS Patient Survey CAHPS-PCMH questions In the last 12 months… Values Did anyone in this provider’s office ask you if there was a period of time when you felt sad, empty or depressed? 1 = Yes 2 = No Did you and anyone in this provider’s office talk about things in your life that worry you or cause you stress? 1 = Yes 2 = No Did you and anyone in this provider’s office talk about a personal problem, alcohol use, drug use or a mental or emotional illness? 1 = Yes 2 = No Domain: SELF MANAGEMENT SUPPORT Patient Survey CAHPS-PCMH questions In the last 12 months… Values Did anyone in this provider`s office talk with you about specific goals for your health? 1 = Yes 2 = No Did anyone in this provider`s office ask you if there are things that make it hard for you to take care of your health? 1 = Yes 2 = No 4 Domain: PATIENT-CENTERED CARE AND COMMUNICATION Patient Survey CAHPS-PCMH questions In the last 12 months… How often did this provider explain things in a way that was easy to understand? How often did this provider listen carefully to you? How often did this provider give you easy to understand information about these health questions or concerns? (asked if they had a health concern, n = 61,020) How often did this provider seem to know the important information about your medical history? How often did this provider show respect for what you had to say? How often did this provider spend enough time with you? Values 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 1 = Never 2 = Sometimes 3 = Usually 4 = Always 5 Domain: SHARED DECISION MAKING Patient Survey CAHPS-PCMH questions In the last 12 months… When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might want to take a medicine? Medication Decisions, asked if they were starting or stopping a medication, When you talked about starting or stopping a prescription medicine, how much did this provider talk about the reasons you might not want to take a medicine? When you talked about starting or stopping a prescription medicine, did this provider ask you what you thought was best for you? Values 1 = Not at all 2 = A little 3 = Some 4 = A lot 1 = Not at all 2 = A little 3 = Some 4 = A lot 1 = Yes 2 = No 6 Domain: TEAM-BASED CARE Domain Delegation of care management tasks to RN care manager Membership in PACT teamlet Time spent in team huddles Perception of staffing levels Provider Survey Question Delegation of activities (% responding ‘a great deal’): a. Gathering patient preventive services utilization history (e.g., immunization history) b. Screening patients for diseases (e.g., doing a depression screen) c. Responding to prescription refill requests d. Receiving messages from patients (other than requests for prescriptions) e. Resolving messages from patients (other than requests for prescriptions) f. Evaluating patients and making treatment decisions g. Assessing patient lifestyle factors (e.g., diet, smoking cessation) h. Encouraging lifestyle modifications (e.g., diet, smoking cessation) i. Educating patients about disease-specific self-care activities (e.g., foot care in diabetes) j. Educating patients about medications k. Completing forms for patients (e.g., disability documentation) l. Responding to requests for Home Health Care orders m. Tracking patient diagnostic data (e.g., labs, radiology studies) n. Responding to patient diagnostic and treatment data (e.g., labs, radiology studies) o. Following-up on referrals (e.g., to specialists) Values 1 = Not at all 2 = Slightly 3 = Somewhat 4 = A great deal % assigned to a teamlet, 0-100% % spending >=0.5 hours daily huddles, 0-100% Proportion, 0-1 % staffed to recommended ratio, 0-100% 7