Evidence-Based Complementary and Alternative Medicine / 2013 / Article / Tab 3

Research Article

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, subcomponentPatient experiences questionnairePractitioner experiences questionnaireMedical records
Administrative/billing data

Integrated care (comprehensive and coordinated) inclusive of CAM interventions
ComprehensiveNumber and type of services/referralsa
CoordinatedRating of treatment plan coordinationa
Integrated conventional and CAMType and frequency conventional and CAM prescribedaType and frequency conventional and CAM billed/used from tiera

Prevention and health promotion services together with treatment and disease management
Talk about prevention; help with change; ask if health interferes; help with weight and emotionsa
Type and frequency of prevention, lifestyle interventions prescribedaNumber and type of lifestyle/health promotion/prevention classes and groups used from membership tiera

Use of less invasive and natural treatments and interventions
Use of natural products, lifestyle interventions before or with Rx or invasive proceduresa

Whole person care
Practitioner knows your…
Medical history; responsibilities; health values and beliefsb; worries and stressc
Whole person review of systemsa

Healing orientation to support body’s innate healing capacity
Use of treatments, products, to support healing capacity; treatment plans support innate healinga

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 carea

Patient-centered partnership
Practitioner communicationPractitioner…
Explain understandably; listen carefully; give information; know your medical history; show respect for youc
Shared decision makingPractitioner discuss…
Reasons for treatment; reasons against treatment; your preferencesc
Empathy10-item measure of provider empathyd
TrustCan tell anything; trust with your care; tells the truth; cares about your health; cares about you; rate trust 1–10c
TimeEnough time spentc
PartnershipDiscussion of UAIHC Health Partnership Acknowledgement (HPA) noted in chartaSigned HPA in UAIHC membership filea

Provision of other services not typically provided in primary care
Number and type of UAIHC classes and groups recommended in treatment plansaNumber and type of classes and groups attended through UAIHC member tiera

Integrative team care with health coaches
Shared vision, safety, task orient, support innovation14-item measure of team climatee
Shared philosophies of IM health and healingTeam members…
Understand others’ philosophies; learn different modalities together; no one left outa
Integrative treatment planningTeam/treatment plan…
Team collaborates well; patient priorities considered first; whole person plans; plans support innate healing; equal consideration of all team membersa
Patient team identified in chartaComplex patients documented in team meeting recordsa
Health coachesNumber of visits with health coaches used through member tiera

Hybrid financing model
Member tier chosen, frequency of tier changes, frequency of additional visits purchased, member drop out; utilization rates of tier benefitsa

Enhanced access to care
Timeliness of visit
Wait time to appointmenta
Courtesy of staffHelpful, courteous clerksb
Longer visit timePractitioner spend enough timecDuration of most recent visitaDuration of most recent visita

Study item/variable.
Ambulatory Care Experiences Survey (ACES) [33].
Consumer Assessment of Health Plans Study (CAHPS) [34].
Consultation and Relational Empathy measure (CARE) [35].
Team Climate Inventory (TCI) [36].

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