Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

doi:10.1007/s11606-022-07881-y

. 2023 Jan;38(1):221-227.

doi: 10.1007/s11606-022-07881-y. Epub 2022 Nov 7.

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Denise D Quigley¹, Marc N Elliott², Mary E Slaughter², Efrain Talamantes³, Ron D Hays⁴

Affiliations

¹ RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. quigley@rand.org.
² RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
³ AltaMed, Los Angeles, CA, USA.
⁴ UCLA Department of Medicine, Los Angeles, CA, USA.

PMID: 36344646
PMCID: PMC9640810
DOI: 10.1007/s11606-022-07881-y

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Denise D Quigley et al. J Gen Intern Med. 2023 Jan.

. 2023 Jan;38(1):221-227.

doi: 10.1007/s11606-022-07881-y. Epub 2022 Nov 7.

Authors

Denise D Quigley¹, Marc N Elliott², Mary E Slaughter², Efrain Talamantes³, Ron D Hays⁴

Affiliations

¹ RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. quigley@rand.org.
² RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
³ AltaMed, Los Angeles, CA, USA.
⁴ UCLA Department of Medicine, Los Angeles, CA, USA.

PMID: 36344646
PMCID: PMC9640810
DOI: 10.1007/s11606-022-07881-y

Abstract

Introduction: Shadow coaching improves provider-patient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time.

Aim: Examine whether a second coaching session (re-coaching) improves and sustains patient experience.

Setting: Large, urban Federally Qualified Health Center PROGRAM: Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0-100-point scale) were eligible.

Evaluation: We used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixed-effects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible "jump" at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after re-coaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC.

Discussion: Re-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.

Keywords: CAHPS; coaching; patient experience; provider performance; spline models.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

**Figure 1**
Adjusted over time trend, before and after re-coaching, by measure.

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Quigley DD, Elliott MN, Qureshi N, Predmore Z, Hays RD. Quigley DD, et al. J Patient Cent Res Rev. 2024 Jul 16;11(2):88-96. doi: 10.17294/2330-0698.2056. eCollection 2024 Summer. J Patient Cent Res Rev. 2024. PMID: 39044849 Free PMC article. Review.
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References

1. Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior. Med Care. 1982;20(6):550–66. doi: 10.1097/00005650-198206000-00002. - DOI - PubMed
1. Frederickson L. Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns. 1995;25:237–46. doi: 10.1016/0738-3991(95)00801-6. - DOI - PubMed
1. Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Satisfaction, gender, and communication in medical visits. Med Care. 1994;32(12):1216–31. doi: 10.1097/00005650-199412000-00005. - DOI - PubMed
1. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26(7):657–75. doi: 10.1097/00005650-198807000-00002. - DOI - PubMed
1. Hays RD, Martino S, Brown JA, et al. Evaluation of a care coordination measure for the consumer assessment of healthcare providers and systems (CAHPS) medicare survey. Med Care Res Rev. 2014;71(2):192–202. doi: 10.1177/1077558713508205. - DOI - PMC - PubMed

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[1] Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior. Med Care. 1982;20(6):550–66. doi: 10.1097/00005650-198206000-00002. - DOI - PubMed

[2] Carter WB, Inui TS, Kukull WA, Haigh VH. Outcome-based doctor-patient interaction analysis: II. Identifying effective provider and patient behavior. Med Care. 1982;20(6):550–66. doi: 10.1097/00005650-198206000-00002. - DOI - PubMed

[3] Frederickson L. Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns. 1995;25:237–46. doi: 10.1016/0738-3991(95)00801-6. - DOI - PubMed

[4] Frederickson L. Exploring information-exchange in consultation: the patients’ view of performance and outcomes. Patient Educ Couns. 1995;25:237–46. doi: 10.1016/0738-3991(95)00801-6. - DOI - PubMed

[5] Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Satisfaction, gender, and communication in medical visits. Med Care. 1994;32(12):1216–31. doi: 10.1097/00005650-199412000-00005. - DOI - PubMed

[6] Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Satisfaction, gender, and communication in medical visits. Med Care. 1994;32(12):1216–31. doi: 10.1097/00005650-199412000-00005. - DOI - PubMed

[7] Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26(7):657–75. doi: 10.1097/00005650-198807000-00002. - DOI - PubMed

[8] Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26(7):657–75. doi: 10.1097/00005650-198807000-00002. - DOI - PubMed

[9] Hays RD, Martino S, Brown JA, et al. Evaluation of a care coordination measure for the consumer assessment of healthcare providers and systems (CAHPS) medicare survey. Med Care Res Rev. 2014;71(2):192–202. doi: 10.1177/1077558713508205. - DOI - PMC - PubMed

[10] Hays RD, Martino S, Brown JA, et al. Evaluation of a care coordination measure for the consumer assessment of healthcare providers and systems (CAHPS) medicare survey. Med Care Res Rev. 2014;71(2):192–202. doi: 10.1177/1077558713508205. - DOI - PMC - PubMed

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Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Affiliations

Follow-Up Shadow Coaching Improves Primary Care Provider-Patient Interactions and Maintains Improvements When Conducted Regularly: A Spline Model Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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Publication types

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