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<ul class="grey_brief_altformat_list"><li><p><a href="arra-cer.pdf">PDF File</a> - 2.76 MB</p></li>
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<h1 class="page__title title" id="page-title">Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts</h1>
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<h2 class="field-item even">Section II: Study Design and Methodology</h2>
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<div class="field field-name-ahrq-generic-body field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><h3><a id="21" name="21"> </a>2.1 General Research Approach</h3>
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<p>The goal of the surveys is to ascertain changes in awareness, understanding, use, and perceived benefits of CER among consumers and clinicians over two points in time. AHRQ is particularly interested in understanding:</p>
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<ul>
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<li>The level of increase in dissemination of products to consumers and clinicians that promote communication of evidence about the comparative effectiveness of different medical interventions.</li>
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<li>The level of increase of stakeholders reporting that they use EHC Program products as a resource, both before and after AHRQ-funded dissemination activities.</li>
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<li>The degree of change in behavior based on level of use after dissemination.</li>
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</ul>
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<p>To collect the consumer and clinician survey data, the IMPAQ team developed two separate survey instruments (one for consumers and one for clinicians) designed to elicit information regarding awareness, understanding, perceived benefits, and use of CER. These surveys allow the evaluation team to determine barriers to uptake of CER and EHC Program products. The same surveys were used at both Wave 1 and Wave 2.</p>
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<p><a href="http://ahrqrxprod1:9992/Rhythmyx/assembler/render?sys_authtype=0&sys_variantid=561&sys_revision=1&sys_contentid=89672&sys_context=0&sys_siteid=305">Return to Contents</a></p>
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<h3><a id="22" name="22"> </a>2.2 Development of Consumer and Clinician Survey Instruments</h3>
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<p>The IMPAQ team developed the consumer (telephone) and clinician (paper-based) surveys using key metrics in the dissemination and adoption process. The team operationalized and incorporated into the survey instruments each of the variables captured in the key metrics tables (Exhibit 1). Survey questions were designed to obtain reliable, valid data. Once the team finalized questions and response categories, it organized the modules and the question order within each module to facilitate efficient survey administration. The team also tested and confirmed the logic and operationalization of the survey skip patterns, a critical component to the survey development process, and formatted the CATI screens and paper-based instruments to maximize ease of completion and generate clear, accurate responses.</p>
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<h3>Exhibit 1. Key Metrics, Survey Variables, and Definitions</h3>
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<table border="1" cellpadding="3" cellspacing="0" width="90%">
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<tbody>
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<tr valign="top">
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<th scope="col" width="20%">Variable</th>
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<th scope="col" width="40%">Conceptual Definition</th>
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<th scope="col" width="40%">Operational Definition</th>
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</tr>
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<tr valign="top">
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<td scope="row"><strong>Awareness</strong></td>
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<td>Extent to which consumers and clinicians are aware of CER in general and of AHRQ's EHC Program and EHC Program products in particular</td>
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<td>Unaided and aided awareness of CER (in general and AHRQ's EHC Program and its Web site)</td>
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</tr>
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<tr valign="top">
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<td scope="row"><strong>Understanding</strong></td>
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<td>Extent to which consumers and clinicians understand the general concepts and principles of CER and AHRQ's EHC Program</td>
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<td>Knowledge of information<br />
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Ability to describe CER principles and cite specific CER findings</td>
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</tr>
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<tr valign="top">
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<td scope="row"><strong>Benefits</strong></td>
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<td>The extent to which consumers and clinicians have found AHRQ's EHC Program products helpful in reaching decisions about medical care</td>
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<td>Perceived utility of using CER compared to traditional methods of clinical practice and perceived utility of using EHC Program products in clinical practice</td>
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</tr>
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<tr valign="top">
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<td scope="row"><strong>Behavior Change/Use (Outcome)</strong></td>
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<td>Extent to which consumers and clinicians make use of CER study results and change their behavior in deciding what medical care they will use or recommend</td>
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<td>Self-reported intent to use CER and actual use of CER in self report clinical practices<br />
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Physicians' self-reported clinical practice</td>
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</tr>
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</tbody>
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</table>
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<p>
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The consumer and clinician surveys consisted of 65 and 119 questions, respectively. However, due to skip patterns, respondents were unlikely to have answered all questions. The surveys contained a variety of closed-ended, Likert-scale, semantic differential scale, and open-ended questions. When clinician respondents were asked to report numbers such as age or hours spent in clinical practice each week, respondents provided specific numbers (that is, respondents did not select from a pre-specified range), enabling the team to segment these variables to match the different approaches used by the four dissemination contractors. The second wave consumer survey was fielded between June 10, 2013 and August 28, 2013. The second wave clinician survey was fielded between June 3, 2013 and September 23, 2013. The consumer and clinician surveys took approximately 15-20 minutes to complete.</p>
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<p><a href="http://ahrqrxprod1:9992/Rhythmyx/assembler/render?sys_authtype=0&sys_variantid=561&sys_revision=1&sys_contentid=89672&sys_context=0&sys_siteid=305">Return to Contents</a></p>
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<h3><a id="23" name="23"> </a>2.3 Consumer and Clinician Survey Testing and Revisions</h3>
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<p>Prior to fielding the first wave of the consumer survey, the evaluation team pre-tested the consumer instrument through one-on-one cognitive interviews with nine IMPAQ staff members. To pre-test the clinician survey, the team conducted cognitive interviews with seven clinicians selected through a convenience sample. The participating clinicians included two physicians, two nurse practitioners, two physician assistants, and one nurse.</p>
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<p>The IMPAQ team fielded the same consumer and clinician surveys for wave 2 as used for wave 1. After reviewing the consumer survey, some skip patterns were adjusted in the wave 2 consumer survey to enable a more robust sample size for more questions.</p>
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<p>The final consumer survey is available in <a href="/research/findings/final-reports/arracer/arracer-apb.html">Appendix B</a>; the final clinician survey is in <a href="/research/findings/final-reports/arracer/arracer-apc.html">Appendix C</a>.</p>
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<p><a href="http://ahrqrxprod1:9992/Rhythmyx/assembler/render?sys_authtype=0&sys_variantid=561&sys_revision=1&sys_contentid=89672&sys_context=0&sys_siteid=305">Return to Contents</a></p>
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<h3><a id="24" name="24"> </a>2.4 Consumer and Clinician Survey Samples</h3>
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<h4>2.4.1 Consumer Survey Sample</h4>
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<p>The IMPAQ team, in consultation with AHRQ, selected key eligibility criteria for potential respondents. This eliminated the following consumers from the respondent pool:</p>
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<ul>
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<li>Non-English speakers.</li>
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<li>Individuals employed by AHRQ or residing in a household with an AHRQ employee.</li>
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<li>Health care providers (e.g., physicians, nurses, allied health workers) or employees of medical device or prescription drug companies.</li>
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<li>Individuals who had not recently been patients (that is, each surveyed consumer confirmed that he or she visited a doctor or other health care professional in the past 12 months).</li>
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</ul>
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<p>The team worked with a sampling statistician to obtain the appropriate sample frame for the consumer survey and determined that a sample size of 1,000 respondents would be more than sufficient to generate a sample of consumers, based on conservative assumptions of a power of 80 percent to detect a 0.1 change in a proportion for a one-sided test with alpha = 0.05. To generate the largest possible sample size in the absence of adequate information on the potential response distribution, we assumed a conservative sample proportion of 50 percent on key variables of interest.</p>
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<p>To generate the sample frame for the consumer survey, the IMPAQ team procured a random sample of the general adult population of the United States (those 18 years and older) with a landline telephone from Survey Sampling Inc. (SSI). Based on wave 1 field efforts results and our screening eligibility criteria, the IMPAQ team purchased 12,000 individual telephone numbers and corresponding addresses to meet the conservative target of 1,000 completed responses for findings that are nationally generalizable by age group. SSI transferred the data to IMPAQ in an ASCII delimited format utilizing a secure FTP. The evaluation team reviewed the data for completeness and gave each sample member a unique ID number.</p>
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<h4>2.4.2 Clinician Survey Sample</h4>
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<p>The target population for the clinician survey included primary care physicians, nurse practitioners, and physician assistants (i.e., internal medicine, family medicine, general practice, pediatrics, and obstetrics/gynecology) who spend at least eight hours each week involved in direct patient care.</p>
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<p>The IMPAQ team purchased the initial sample frame for each survey administration from Medical Marketing Services (MMS), Inc., which maintains a list of physicians and allied health professionals. In addition, the team used the AMA Physician Master File, the most comprehensive list of physicians in the United States (including both members and non‐members of the AMA). For physician assistants, the team obtained the master list from the American Academy of Physician Assistants (AAPA), which maintains a comprehensive index of over 95,000 physician assistants, also including AAPA members and non-members. For nurse practitioners, the evaluation team worked from a comprehensive, proprietary list of 230,000 Advanced Practice Nurses (including 176,000 Nurse Practitioners) compiled from the Medical and Nursing Boards of the 50 States and the District of Columbia.</p>
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<p>Statisticians on the IMPAQ team based the sample size on a power calculation assuming a one-sided test to detect a four percent change in a proportion of the population aware of EHC Program with 80 percent power at alpha = 0.05. The power calculations required an estimate of the "pre-intervention" proportion in the population (0-100 percent) for the outcome of interest (i.e., awareness of EHC Program). However, due to the lack of existing estimates on the outcome, we chose the most conservative pre-intervention estimate (50 percent). This yielded a sample size of 1,926 per survey administration. Assuming a response rate of 75 percent, an initial sample of 2,568 clinicians per administration was required to achieve the desired final sample size. The sample breakdown by clinician subgroup per administration is provided in the table below.</p>
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<h3>Exhibit 2. Sample Breakdown by Clinician Subgroup</h3>
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<table border="1" cellpadding="3" cellspacing="0" width="90%">
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<tbody>
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<tr valign="top">
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<th scope="col" width="25%">Subgroup</th>
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<th scope="col" width="15%">Number in Sample List</th>
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<th scope="col" width="15%">Final sample target (75% response rate)</th>
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<th scope="col" width="15%">Ineligible<sup><a href="#star">*</a></sup></th>
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<th scope="col" width="15%">Eligible<sup><a href="#plus">+</a></sup></th>
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<th scope="col" width="15%">Percentable of Sample List</th>
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</tr>
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<tr valign="top">
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<td colspan="6" scope="row"><strong>Wave 1 </strong></td>
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</tr>
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<tr valign="top">
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<td scope="row">Physicians</td>
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<td differentids="true" style=" text-align: center;">856</td>
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<td differentids="true" style=" text-align: center;">642</td>
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<td differentids="true" style=" text-align: center;">20</td>
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<td differentids="true" style=" text-align: center;">511</td>
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<td differentids="true" style=" text-align: center;">60</td>
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</tr>
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<tr valign="top">
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<td scope="row">Physician Assistants</td>
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<td differentids="true" style=" text-align: center;">856</td>
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<td differentids="true" style=" text-align: center;">642</td>
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<td differentids="true" style=" text-align: center;">29</td>
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||
<td differentids="true" style=" text-align: center;">630</td>
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<td differentids="true" style=" text-align: center;">74</td>
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</tr>
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<tr valign="top">
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<td scope="row">Nurse Practitioners</td>
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<td differentids="true" style=" text-align: center;">856</td>
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<td differentids="true" style=" text-align: center;">642</td>
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||
<td differentids="true" style=" text-align: center;">40</td>
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||
<td differentids="true" style=" text-align: center;">549</td>
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<td differentids="true" style=" text-align: center;">64</td>
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</tr>
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<tr valign="top">
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<td scope="row"><strong>Total</strong></td>
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<td differentids="true" style=" text-align: center;"><strong>2,568</strong></td>
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<td differentids="true" style=" text-align: center;"><strong>1,926</strong></td>
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||
<td differentids="true" style=" text-align: center;"><strong>89</strong></td>
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||
<td differentids="true" style=" text-align: center;"><strong>1,690</strong></td>
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<td differentids="true" style=" text-align: center;"><strong>66</strong></td>
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</tr>
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<tr valign="top">
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<td colspan="6" scope="row"><strong>Wave 2</strong></td>
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</tr>
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<tr valign="top">
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<td scope="row">Physicians</td>
|
||
<td differentids="true" style=" text-align: center;">858</td>
|
||
<td differentids="true" style=" text-align: center;">644</td>
|
||
<td differentids="true" style=" text-align: center;">34</td>
|
||
<td differentids="true" style=" text-align: center;">471</td>
|
||
<td differentids="true" style=" text-align: center;">55</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Physician Assistants</td>
|
||
<td differentids="true" style=" text-align: center;">858</td>
|
||
<td differentids="true" style=" text-align: center;">644</td>
|
||
<td differentids="true" style=" text-align: center;">37</td>
|
||
<td differentids="true" style=" text-align: center;">560</td>
|
||
<td differentids="true" style=" text-align: center;">65</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Nurse Practitioners</td>
|
||
<td differentids="true" style=" text-align: center;">857</td>
|
||
<td differentids="true" style=" text-align: center;">643</td>
|
||
<td differentids="true" style=" text-align: center;">35</td>
|
||
<td differentids="true" style=" text-align: center;">544</td>
|
||
<td differentids="true" style=" text-align: center;">63</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row"><strong>Total</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>2,573</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>1,930</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>106</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>1,575</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>61</strong></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
<a id="star" name="star"> </a><sup>*</sup> Survey respondents were ineligible if they indicated in Q12 of the questionnaire that they spend less than eight hours per week providing direct patient care. These respondents were instructed to stop and return the survey after completing Q12.<br />
|
||
<a id="plus" name="plus"> </a><sup>+</sup> Survey respondents were eligible if they indicated in Q12 that they spend 8 hours or more per week providing direct patient care.</p>
|
||
<p><a href="http://ahrqrxprod1:9992/Rhythmyx/assembler/render?sys_authtype=0&sys_variantid=561&sys_revision=1&sys_contentid=89672&sys_context=0&sys_siteid=305">Return to Contents</a></p>
|
||
<h3><a id="25" name="25"> </a>2.5 Consumer and Clinician Survey Field Work</h3>
|
||
<h4>2.5.1 Consumer Survey Field Work</h4>
|
||
<p><strong>Computer-Assisted Telephone Interviewing (CATI) Training</strong></p>
|
||
<p>The IMPAQ team trained nine interviewers to administer the consumer survey. Each of the trainings included an introduction to AHRQ and an overview of CER, frequently asked questions and suggested answers, special considerations of the target population, and a question-by-question review of the entire consumer survey instrument. IMPAQ's survey center supervisors closely monitored interviewers' performance and production throughout the inbound and outbound calling phases.</p>
|
||
<p><strong>Sample Waves</strong></p>
|
||
<p>The IMPAQ team randomly selected consumers from the sample in waves of 2,000, giving each name a unique ID number. IMPAQ's programmer uploaded each wave to a secure site, enabling the team's Printer to access the data securely and merge name and address fields into the introductory letter (see Exhibit 3). The team sent a personal introductory letter to each potential respondent in each wave.</p>
|
||
<h3>Exhibit 3. Consumer Survey Summary of Waves (Replicates)</h3>
|
||
<table border="1" cellpadding="3" cellspacing="0" width="90%">
|
||
<tbody>
|
||
<tr valign="top">
|
||
<th scope="col" width="20%">Wave Number</th>
|
||
<th scope="col" width="20%">Count</th>
|
||
<th scope="col" width="20%">Date of data upload to printer</th>
|
||
<th scope="col" width="20%">Mailing date</th>
|
||
<th scope="col" width="20%">Wave starts in CATI system</th>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 1</td>
|
||
<td>n=2,000</td>
|
||
<td>6/3/2013</td>
|
||
<td>6/7/2013</td>
|
||
<td>6/10/2013</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 2</td>
|
||
<td>n=2,000</td>
|
||
<td>6/11/2013</td>
|
||
<td>6/14/2013</td>
|
||
<td>6/18/2013</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 3</td>
|
||
<td>n=2,000</td>
|
||
<td>6/18/2013</td>
|
||
<td>6/21/2013</td>
|
||
<td>6/25/2013</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 4</td>
|
||
<td>n=2,000</td>
|
||
<td>6/23/2013</td>
|
||
<td>6/27/2013</td>
|
||
<td>7/1/2013</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 5</td>
|
||
<td>n=2,000</td>
|
||
<td>7/9/2013</td>
|
||
<td>7/12/2013</td>
|
||
<td>7/15/2013</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Wave 6</td>
|
||
<td>n=1,500</td>
|
||
<td>8/6/2013</td>
|
||
<td>8/9/2013</td>
|
||
<td>8/12/2013</td>
|
||
</tr>
|
||
<tr valign="center">
|
||
<td colspan="5" scope="row">Waves 1 through 6 finished August 28, 2013</td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
For quality assurance purposes, at the start of each wave, the IMPAQ team manually verified between two and four percent of the sample to ensure matched names and ID numbers on both the mailed letters and the CATI system records.</p>
|
||
<p><strong>Introductory Letters</strong></p>
|
||
<p>The IMPAQ team mailed introductory letters to each of the consumers selected to participate in the telephone survey. The introductory letter may be found in <a href="/research/findings/final-reports/arracer/arracer-apd.html">Appendix D</a>. IMPAQ's survey center managed all inbound calls initiated by participants after receiving the introductory letter. In addition, the IMPAQ team established a toll-free number (listed in the introductory letter) and fielded several inquiries from respondents seeking additional information about the study. Potential participants who called in to request removal from the survey were pulled from the sample and excluded from the survey. Similarly, CATI interviewers did not attempt interviews with respondents they identified as "refusals" or "ineligible," and removed those identified as "deceased" from the sample.</p>
|
||
<p>The post office was unable to deliver a total of 335 (2.9 percent) of the 11,500 introductory letters mailed during the seven waves of mailings. Exhibit 4 illustrates the reasons.</p>
|
||
<h3>Exhibit 4. Results of Consumer Introductory Letters Not Delivered</h3>
|
||
<table border="1" cellpadding="3" cellspacing="0" width="90%">
|
||
<tbody>
|
||
<tr valign="top">
|
||
<th scope="col" width="70%">Reason for Introductory Letter Not Delivered</th>
|
||
<th scope="col" width="15%">Number Not Delivered</th>
|
||
<th scope="col" width="15%">Percentage</th>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Moved with no forwarding address</td>
|
||
<td differentids="true" style=" text-align: center;">6</td>
|
||
<td differentids="true" style=" text-align: center;">1.8</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Attempted - not known</td>
|
||
<td differentids="true" style=" text-align: center;">76</td>
|
||
<td differentids="true" style=" text-align: center;">23</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Not deliverable as addressed</td>
|
||
<td differentids="true" style=" text-align: center;">149</td>
|
||
<td differentids="true" style=" text-align: center;">45</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">No mail receptacle</td>
|
||
<td differentids="true" style=" text-align: center;">47</td>
|
||
<td differentids="true" style=" text-align: center;">14</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Insufficient address</td>
|
||
<td differentids="true" style=" text-align: center;">13</td>
|
||
<td differentids="true" style=" text-align: center;">4</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Refused</td>
|
||
<td differentids="true" style=" text-align: center;">3</td>
|
||
<td differentids="true" style=" text-align: center;"><1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Vacant</td>
|
||
<td differentids="true" style=" text-align: center;">12</td>
|
||
<td differentids="true" style=" text-align: center;">4</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">No such street or no such number</td>
|
||
<td differentids="true" style=" text-align: center;">9</td>
|
||
<td differentids="true" style=" text-align: center;">3</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Deceased (return to sender)</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
<td differentids="true" style=" text-align: center;"><1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Unable to Forward</td>
|
||
<td differentids="true" style=" text-align: center;">4</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Unclaimed</td>
|
||
<td differentids="true" style=" text-align: center;">9</td>
|
||
<td differentids="true" style=" text-align: center;">2.7</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Returned (no reason given)</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
<td differentids="true" style=" text-align: center;"><1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Forward time expired</td>
|
||
<td differentids="true" style=" text-align: center;">5</td>
|
||
<td differentids="true" style=" text-align: center;">1.5</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row"><strong>Total</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>355</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>100</strong></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
<strong>Screening and Recruitment of Participants</strong></p>
|
||
<p>The outbound CATI phase of the study began one week after IMPAQ mailed the first wave of introductory letters. During the outbound CATI portion of the study, interviewers made up to six attempts to reach each telephone survey respondent. The IMPAQ team fully managed and coordinated the outbound CATI effort.</p>
|
||
<p>The team's approach to successful telephone data collection relied on precise and detailed sample management and case tracking. IMPAQ's call center emphasized efficient scheduling to distribute call attempts at optimum times. The CATI system facilitates case delivery for the interviewing staff by setting "call-backs" at preset times or resuming partially completed interviews. The system also produces progress reports and clean data files.</p>
|
||
<p>As noted above, the IMPAQ team screened potential respondents using AHRQ-approved eligibility criteria for potential respondents. As a result, surveyed consumers excluded the following:</p>
|
||
<ul>
|
||
<li>Non-English speakers.</li>
|
||
<li>Individuals employed by AHRQ or residing in a household with an AHRQ employee; Health care providers (e.g., physicians, nurses, allied health workers) or employees of medical device or prescription drug companies.</li>
|
||
<li>Individuals who had not recently been patients (that is, each surveyed consumer confirmed that he or she visited a doctor or other health care professional in the past 12 months).</li>
|
||
</ul>
|
||
<p>The screener questions may be found in <a href="/research/findings/final-reports/arracer/arracer-ape.html">Appendix E</a>. Exhibit 5 illustrates the results of the eligibility screening for the respondents that were reached and agreed to participate.</p>
|
||
<h3>Exhibit 5. Results of Consumer Screener Questions S4-S8</h3>
|
||
<table border="1" cellpadding="3" cellspacing="0" width="90%">
|
||
<tbody>
|
||
<tr valign="top">
|
||
<th scope="col" width="70%">Screen Question</th>
|
||
<th scope="col" width="15%">Number of Respondents</th>
|
||
<th scope="col" width="15%">Percentage</th>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Not fluent in English</td>
|
||
<td differentids="true" style=" text-align: center;">12</td>
|
||
<td differentids="true" style=" text-align: center;">6.3</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Works for AHRQ / household member works for AHRQ</td>
|
||
<td differentids="true" style=" text-align: center;">3</td>
|
||
<td differentids="true" style=" text-align: center;">1.6</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Health care provider</td>
|
||
<td differentids="true" style=" text-align: center;">114</td>
|
||
<td differentids="true" style=" text-align: center;">60.0</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Not visited doctor / health care provider past 12 months</td>
|
||
<td differentids="true" style=" text-align: center;">58</td>
|
||
<td differentids="true" style=" text-align: center;">30.5</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Refused to continue</td>
|
||
<td differentids="true" style=" text-align: center;">3</td>
|
||
<td differentids="true" style=" text-align: center;">1.6</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row"><strong>Total</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>190</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>100</strong></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
Of the 190 consumers who were ineligible for the survey, over half (60 percent) were health care providers and one third (30.5 percent) reported that they had not visited a doctor or health care provider in the past 12 months. Approximately ten percent were not fluent in English, while three percent refused to complete the interview and less than one percent reported that they or a household member worked for AHRQ.</p>
|
||
<p>CATI interviewers completed 948 consumer surveys during the field period. Exhibit 6 illustrates the results of all of the call attempts by outcome category.</p>
|
||
<h3>Exhibit 6. Outcome of Consumer Call Attempts</h3>
|
||
<table border="1" cellpadding="3" cellspacing="0" width="90%">
|
||
<tbody>
|
||
<tr valign="top">
|
||
<th scope="col" width="70%">Outcome</th>
|
||
<th scope="col" width="15%">Total</th>
|
||
<th scope="col" width="15%">% of Total</th>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Completed</td>
|
||
<td differentids="true" style=" text-align: center;">948</td>
|
||
<td differentids="true" style=" text-align: center;">8</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Partially completed (majority completed screener only)</td>
|
||
<td differentids="true" style=" text-align: center;">48</td>
|
||
<td differentids="true" style=" text-align: center;"><1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Non-response (no answer, busy, un-locatable, connection issue, wrong number, disconnected number, etc.)</td>
|
||
<td differentids="true" style=" text-align: center;">7,205</td>
|
||
<td differentids="true" style=" text-align: center;">63</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Respondent deceased</td>
|
||
<td differentids="true" style=" text-align: center;">145</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Refusal</td>
|
||
<td differentids="true" style=" text-align: center;">2,089</td>
|
||
<td differentids="true" style=" text-align: center;">18</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Language barrier</td>
|
||
<td differentids="true" style=" text-align: center;">155</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Voice mail or privacy managers, left message household member</td>
|
||
<td differentids="true" style=" text-align: center;">562</td>
|
||
<td differentids="true" style=" text-align: center;">5</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Did not pass screener (see Exhibit 5)</td>
|
||
<td differentids="true" style=" text-align: center;">190</td>
|
||
<td differentids="true" style=" text-align: center;">2</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Mental / physical incapacity / institutionalized</td>
|
||
<td differentids="true" style=" text-align: center;">158</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row"><strong>Total</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>11,500</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>100</strong></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
<strong>Data Management</strong></p>
|
||
<p>After completing the data collection phase, the IMPAQ team exported the data from the CATI into a master database stored on a password-protected secure server at IMPAQ. The team implemented multiple rounds of data quality checks to confirm that the data were exported without any loss or distortion of content.</p>
|
||
<p>To facilitate analysis, IMPAQ's programming staff exported the data into a SAS file. IMPAQ team members checked the data for logical inconsistencies, created analytical variables from the survey questions, tabulated each survey question, and generated frequencies and percentages. The frequency tables on all the survey questions, including verbatim responses to open-ended questions, are displayed in <a href="/research/findings/final-reports/arracer/arracer-apf.html">Appendix F</a>.</p>
|
||
<p><strong>Survey Weighting</strong></p>
|
||
<p>The IMPAQ team anticipated that the younger age group (i.e., 18 through 44 year olds) would be underrepresented in the pool of survey respondents for several reasons:</p>
|
||
<ul>
|
||
<li>Younger potential respondents may be more likely to be screened out because they are less likely than their older counterparts to have seen a health care professional in the past 12 months.</li>
|
||
<li>Younger potential respondents may be less likely than retirees to answer landline telephones during daytime hours.</li>
|
||
<li>A landline sample may be disproportionately older than the population at large, which may rely more heavily on mobile devices as the sole telephone in the household.</li>
|
||
</ul>
|
||
<p>After conducting wave 1, the IMPAQ team confirmed a higher average respondent age than is represented in the U.S. population and investigated strategies to increase representation of younger consumers. After consulting with telephone listing vendors who explained that a skewed age distribution among landline samples is a common and growing issue in survey research, the IMPAQ team conducted a literature review on coverage bias of landline versus cell phone-based samples. Go to <a href="/research/findings/final-reports/arracer/arracer-apg.html">Appendix G</a> for a further discussion of the literature review. Per evidence suggested by the literature review, we also increased weekend and evening hours, which ultimately helped increase representation of younger consumers.</p>
|
||
<p>The IMPAQ team closely monitored the age distribution with AHRQ throughout the data collection period. We jointly concluded that the team was surveying the most relevant population and that IMPAQ need not execute a separate mobile telephone wave to achieve AHRQ's research goals. Based on this decision, IMPAQ proceeded with the survey administration as planned.</p>
|
||
<p>After cleaning the final interview data, the IMPAQ team checked the age distribution of survey respondents, as depicted by Exhibit 7, below.</p>
|
||
<h3>Exhibit 7. Age Distribution of Consumer Survey Respondents</h3>
|
||
<table border="1" cellpadding="3" cellspacing="0" width="90%">
|
||
<tbody>
|
||
<tr valign="top">
|
||
<th scope="col" width="70%">Age Range</th>
|
||
<th scope="col" width="15%">Frequency</th>
|
||
<th scope="col" width="15%">Percentage</th>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">18-44 years</td>
|
||
<td differentids="true" style=" text-align: center;">65</td>
|
||
<td differentids="true" style=" text-align: center;">5.8</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">45-64 years</td>
|
||
<td differentids="true" style=" text-align: center;">334</td>
|
||
<td differentids="true" style=" text-align: center;">35.23</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">65 years or older</td>
|
||
<td differentids="true" style=" text-align: center;">544</td>
|
||
<td differentids="true" style=" text-align: center;">57.38</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Refused</td>
|
||
<td differentids="true" style=" text-align: center;">14</td>
|
||
<td differentids="true" style=" text-align: center;">1.48</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row">Don't Know</td>
|
||
<td differentids="true" style=" text-align: center;">1</td>
|
||
<td differentids="true" style=" text-align: center;">0.11</td>
|
||
</tr>
|
||
<tr valign="top">
|
||
<td scope="row"><strong>Total</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>948</strong></td>
|
||
<td differentids="true" style=" text-align: center;"><strong>100</strong></td>
|
||
</tr>
|
||
</tbody>
|
||
</table>
|
||
<p>
|
||
The final respondent pool remained disproportionately older than the population at large. Only 5.8 percent of the respondents were in the 18 to 44 year old age group. Therefore, in consultation with a survey statistician and with AHRQ's permission, the IMPAQ team age-adjusted the survey data. Using the percentage of the population of various age groups who visited a doctor or health care professional in the past 12 months, available in Centers for Disease Control and Prevention's (CDC) National Health Interview Survey, the team's sampling statistician determined appropriate weights to apply to the consumer survey data. The specific weighting procedure is discussed in detail in <a href="/research/findings/final-reports/arracer/arracer-aph.html">Appendix H</a>.</p>
|
||
<p>All of the results presented in this chapter are weighted percentages. <a href="/research/findings/final-reports/arracer/arracer-apf.html">Appendix F</a> displays responses to all the survey questions in tabular form and reports frequencies as well as both actual and weighted percentages. The raw frequencies are presented in the cells of Appendix F tables without any data suppression so that the reader may have a clear picture of the actual survey responses. However, because percentage estimates may not be reliable when the associated sample size is very small, we present the actual frequency rather than the weighted percentage for any question with a numerator of less than ten respondents.<sup><a href="#ref3">3</a></sup></p>
|
||
<p><strong>Analytic Methodology of Consumer Survey</strong></p>
|
||
<p>The IMPAQ team identified key questions to be discussed in this report and generated graphs to display the results. In addition to aggregate-level analysis, we conducted sub-group analysis on key questions with relatively large numbers of respondents to explore differences among demographic groups in their responses. For the sub-group analysis, we ran cross-tabulations and statistical tests of differences among categories using Chi-Square tests.</p>
|
||
<p>The statistical goal of the current longitudinal survey analysis is to examine the changes in the key outcome variables between wave 1 to wave 2, and test to see if those changes are statistically significant. Specifically, the longitudinal survey analysis aims to estimate changes in the proportion of consumers who are aware of CER broadly, aware of the EHC Program specifically, seek out and understand CER products and research (generally and AHRQ-specific), consider CER to be beneficial, and incorporate CER into decisionmaking. For each outcome variable, we tested whether there was a statistically significant increase between survey waves (wave 2 minus wave 1) at the p<0.05 level using a one-sided test. If the Wave 3 survey is conducted, then we will also examine, at a future date, the point estimates and changes in those variables across all three waves of the survey.</p>
|
||
<h4>2.5.2 Clinician Survey Field Work</h4>
|
||
<p><strong>Introductory Letters and Survey Packet</strong></p>
|
||
<p>To alert potential respondents of the forthcoming survey and confirm eligibility and mailing addresses, the IMPAQ team sent an advance letter and a return postcard to each clinician in the sample (go to <a href="/research/findings/final-reports/arracer/arracer-apk.html">Appendix I</a>). A survey package was mailed to all clinicians via express delivery, followed by up to four reminders (i.e., two postcard reminders, a second survey package, and a third postcard reminder) as necessary. Because clinicians who spend most of their time in direct patient care are a particularly difficult group to survey, the study used a version of Dillman's Tailored Design Method (1999)<sup><a href="#ref4">4</a></sup> modified by Battelle<sup><a href="#ref5">5,6</a></sup> to maximize response rates. Exhibit 8 illustrates the main steps of the survey administration process.</p>
|
||
<p>The survey package for wave 2 included: a cover letter emphasizing the importance of the survey, the questionnaire, a postage‐paid return envelope, and a $50 cash incentive. The incentive was included only in the first survey package. Go to <a href="/research/findings/final-reports/arracer/arracer-apj.html">Appendix J</a> for the survey package materials; go to <a href="/research/findings/final-reports/arracer/arracer-apk.html">Appendix K</a> for follow-up materials.</p>
|
||
<h3>Exhibit 8. Clinician Survey Administration</h3>
|
||
<p><img alt="Exhibit 8 illustrates the main steps of the survey administration process: Advanced Letter (+ return postcard). Mail Survey Packets (+ $50 incentive). Reminder/Follow-up - 1st reminder: Postcard, 2nd reminder: Postcard, 3rd reminder: 2nd Survey Packet (express mail or FedEx) minus, 4th reminder: Postcard. Survey Completed and Returned." src="ex2-8.jpg" /></p>
|
||
<p><strong>Data Management</strong></p>
|
||
<p>The IMPAQ team developed a systematic procedure for entering data from the hard copy instruments that it received from clinician respondents. This procedure included team members submitting file layouts to a data preparation manager in written form with clear specifications as to columns, data types, missing values codes, and editing requests (e.g., range and logic checks and automatically filling skip patterns). The data preparation manager was responsible for overall survey management, including overseeing all mailings and data entry screen programming and training staff on both handling received surveys and using the survey questionnaire management database. The manager also oversaw data entry and performed quality checks on data entry. After manually quality checking ten percent of surveys to identify and correct any data entry errors, staff flagged discrepancies to be resolved by a survey team supervisor. In addition, the IMPAQ team tracked keying error rates and confirmed an error rate of less than one percent.</p>
|
||
<p>Any problems encountered during the keying process were referred to the data preparation manager, who maintained a decision log to keep a thorough record of all decisions made during this process. Data keyers documented difficulties encountered during keying by attaching suitable notations to the source documents and posting them in the decision log.</p>
|
||
<p>To ensure confidentiality, the IMPAQ team stored completed mail surveys in locked file cabinets. Only authorized project staff had access to password protected electronic files. All project personnel signed an Assurance of Confidentiality statement (go to <a href="/research/findings/final-reports/arracer/arracer-apl.html">Appendix L</a>) and received training on measures to safeguard data. The IMPAQ team maintained a link between respondents and their respective ID numbers and tracked survey mailings and responses, and follow-up contacts. However, the team stored links between respondent contact information and ID numbers securely and separately. Upon completion of data collection, the IMPAQ team destroyed the links between survey ID numbers and identifying information, including the respondent's contact information.</p>
|
||
<p><strong>Analytic Methodology of Clinician Survey</strong></p>
|
||
<p>The clinician survey provides information that can be used to estimate general trends in the key study metrics among the U.S. population of clinicians, elucidating the barriers to CER consumption and adoption.</p>
|
||
<p>We report the cross-sectional analyses for the survey questions. When appropriate, this report includes analyses by clinician type and campaign exposure. Significance tests were conducted using Pearson Chi-Square, two-sided t-test for difference in means, or ANOVA, as appropriate, at alpha = .05. Proportions are reported on the sample as a whole.</p>
|
||
<p>The statistical goal of the current longitudinal survey analysis is to examine the changes in the key outcome variables between wave 1 to wave 2, and test if those changes are statistically significant. If the Wave 3 survey is conducted, then we will also examine at a future date the point estimates and changes in those variables across all three waves of the survey.</p>
|
||
<p>For each outcome variable, we tested whether there was a statistically significant increase between survey waves (wave 2 minus wave 1) at the p<0.05 level using a one-sided test.</p>
|
||
<p>For the dichotomous variables of interest, we estimated the population proportions using the sample proportions from each wave. Inferences related to the difference in these two estimated proportions were based on the large sample approximation of the normal distribution to the binomial. For some categorical variables with more than two categories, we focused on the proportion of respondents who chose a subset of the possible categorical responses.</p>
|
||
<p>For the continuous variables, including ordinally-scaled variables, we assumed both waves' samples come from a normally distributed population. We tested the difference in means from the two waves assuming the variances are unequal. For the resulting t-test of no difference in wave means we used Satterthwaite's approximation for the t distribution degrees of freedom.</p>
|
||
<p><a href="http://ahrqrxprod1:9992/Rhythmyx/assembler/render?sys_authtype=0&sys_variantid=561&sys_revision=1&sys_contentid=89672&sys_context=0&sys_siteid=305">Return to Contents</a></p>
|
||
<h3><a id="26" name="26"> </a>2.6 Limitations to Consumer and Clinician Survey Findings</h3>
|
||
<p>Although the evaluation team randomly selected respondents to participate, those who chose to complete the survey may not be representative of all consumers and clinicians in the U.S. Thus, threats to validity due to self-selection bias are inherent in our methodology.</p>
|
||
<p>Additionally, measurement of outcomes was based on self-report with the associated inherent threats to validity and potential for unreliability. However, the evaluation team modeled both aided and unaided awareness questions after items used in other national campaign evaluations to help mitigate that bias.<sup><a href="#ref7">7,8</a></sup> Such measures have been shown to track well with actual campaign exposure.</p>
|
||
<p>Lastly, several survey items were asked contingent upon awareness of CER, AHRQ, or the EHC Program. The low level of awareness of CER, AHRQ, and the EHC Program among respondents led to smaller sample sizes for certain questions and their results should be interpreted with caution. The IMPAQ team included sample sizes to aid in the reader's understanding of the results.</p>
|
||
<hr />
|
||
<p><a id="ref3" name="ref3"> </a><sup>3.</sup> See Klein R. J. et al. , July 2002 (Healthy People 2020 Criteria for Data Suppression, No. 24, July 2002, National Center for Health Statistics, Centers for Disease Control and Prevention) for data suppression rules followed by the various health surveys from which Healthy People 2020 baseline data are drawn.<br />
|
||
<a id="ref4" name="ref4"> </a><sup>4.</sup> D.A. Dillman. Mail and Internet Surveys: The Tailored Design Method. Canada: John Wiley & Sons, 1999.<br />
|
||
<a id="ref5" name="ref5"> </a><sup>5.</sup> D. Kasprzyk, D.E. Montano, J.S. Lawrence, W.R. Phillips. The Effects of Variations in Mode of Delivery and Monetary Incentive on Physicians' Responses to a Mailed Survey Assessing STD Practice Patterns. Evaluation and Health Professionals, 2001; 24(1): 3 -17.<br />
|
||
<a id="ref6" name="ref6"> </a><sup>6.</sup> Montaño DE, Kasprzyk D, Hall IJ, Richardson LC, Greek A, and Ross L. Effect of incentive amount and telephone follow-up on response to a physician survey: findings from a prostate cancer screening survey of primary care physicians. Evaluation and the Health Professions. (under review)<br />
|
||
<a id="ref7" name="ref7"> </a><sup>7.</sup> Southwell BG, Barmada CH, & Hornik RC. (2002). Can we measure encoded exposure? Validation Evidence from a national campaign. Journal of Health Communication, 7:445-453.<br />
|
||
<a id="ref8" name="ref8"> </a><sup>8.</sup> Huhman M, Potter LD, Wong FL, Banspach SW, Duke JC & Heitzler CD (2005). Effects of a Mass Media Campaign to Increase Physical Activity Among Children: Year-1 Results of the VERB Campaign. Pediatrics 2005;116;e277 DOI: 10.1542/peds.2005-0043.</p>
|
||
<hr />
|
||
<p><a href="/research/findings/final-reports/arracer/index.html">Return to Contents</a><br />
|
||
<a href="/research/findings/final-reports/arracer/arracer-3.html">Proceed to Next Section</a></p>
|
||
</div></div></div><div class="field field-name-field-last-reviewed field-type-datestamp field-label-hidden">
|
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<div class="field-items">
|
||
<div class="field-item even">
|
||
Page last reviewed <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2013-10-01T00:00:00-04:00">October 2013</span> <br />Page originally created December 2014 </div>
|
||
</div>
|
||
</div>
|
||
<div id="block-ahrq-citation" class="block block-ahrq first odd">
|
||
|
||
|
||
Internet Citation: Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts. Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/research/findings/final-reports/arracer/arracer-2.html<div class="citation-flag"> </div> </div> <!--</div>--> <div class="footnote"> <p> The information on this page is archived and provided for reference purposes only.</p> </div> <p> </p> </div> </div></td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div>
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