When a Whole Practice Model Is the Intervention: Developing Fidelity Evaluation Components Using Program Theory-Driven Science for an Integrative Medicine Primary Care Clinic

Table 3

UAIHC practice theory components and fidelity measures.

Component, subcomponent	Patient experiences questionnaire	Practitioner experiences questionnaire	Medical records; audit	Administrative/billing data
Integrated care (comprehensive and coordinated) inclusive of CAM interventions
Comprehensive			Number and type of services/referrals^a
Coordinated	Rating of treatment plan coordination^a
Integrated conventional and CAM			Type and frequency conventional and CAM prescribed^a	Type and frequency conventional and CAM billed/used from tier^a
Prevention and health promotion services together with treatment and disease management
	Practitioner…; Talk about prevention; help with change; ask if health interferes; help with weight and emotions^a		Type and frequency of prevention, lifestyle interventions prescribed^a	Number and type of lifestyle/health promotion/prevention classes and groups used from membership tier^a
Use of less invasive and natural treatments and interventions
			Use of natural products, lifestyle interventions before or with Rx or invasive procedures^a
Whole person care
	Practitioner knows your…; Medical history; responsibilities; health values and beliefs^b; worries and stress^c		Whole person review of systems^a
Healing orientation to support body’s innate healing capacity
			Use of treatments, products, to support healing capacity; treatment plans support innate healing^a
IM practitioners exemplify principles and commit to self-exploration and development
		Team values self-care; healthy activity is encouraged; enough time taken for self-care; occupational stress; reflection on changes in approach to care^a
Patient-centered partnership
Practitioner communication	Practitioner…; Explain understandably; listen carefully; give information; know your medical history; show respect for you^c
Shared decision making	Practitioner discuss…; Reasons for treatment; reasons against treatment; your preferences^c
Empathy	10-item measure of provider empathy^d
Trust	Can tell anything; trust with your care; tells the truth; cares about your health; cares about you; rate trust 1–10^c
Time	Enough time spent^c
Partnership			Discussion of UAIHC Health Partnership Acknowledgement (HPA) noted in chart^a	Signed HPA in UAIHC membership file^a
Provision of other services not typically provided in primary care
			Number and type of UAIHC classes and groups recommended in treatment plans^a	Number and type of classes and groups attended through UAIHC member tier^a
Integrative team care with health coaches
Shared vision, safety, task orient, support innovation		14-item measure of team climate^e
Shared philosophies of IM health and healing		Team members…; Understand others’ philosophies; learn different modalities together; no one left out^a
Integrative treatment planning		Team/treatment plan…; Team collaborates well; patient priorities considered first; whole person plans; plans support innate healing; equal consideration of all team members^a	Patient team identified in chart^a	Complex patients documented in team meeting records^a
Health coaches				Number of visits with health coaches used through member tier^a
Hybrid financing model
				Member tier chosen, frequency of tier changes, frequency of additional visits purchased, member drop out; utilization rates of tier benefits^a
Enhanced access to care
Timeliness of visit	Wait time to appointment^a
Courtesy of staff	Helpful, courteous clerks^b
Longer visit time	Practitioner spend enough time^c		Duration of most recent visit^a	Duration of most recent visit^a

aStudy item/variable.
bAmbulatory Care Experiences Survey (ACES) [33].
cConsumer Assessment of Health Plans Study (CAHPS) [34].
dConsultation and Relational Empathy measure (CARE) [35].
eTeam Climate Inventory (TCI) [36].