Research involves not only design, data collection, and analysis, but also addressing the administrative aspects of research. For the EvidenceNOW initiative, the key administrative aspects that were particularly challenging included recruiting and then retaining practices in the study. Additionally, because the initiative involved seven cooperatives there was a need to harmonize measures to the extent possible to facilitate a rigorous national-level evaluation. Below are some tips derived from the experiences of the EvidenceNOW Cooperatives on recruiting and retaining practices, along with samples of the resources they developed and used in their efforts. The approach used to harmonize measures across the cooperatives is also briefly described.
Practice Recruitment and Retention
The AHRQ EvidenceNOW initiative set a goal of recruiting over 1500 small and medium sized primary care practices across the seven cooperative regions. At the time EvidenceNOW was getting underway several federal and state-funded initiatives aimed at primary care practices were starting up as well. From the beginning, recruitment was a major challenge for cooperatives, and took much longer and more resources than anticipated (Fagnan et al., 2018). Thus, an early opportunity for support from the EvidenceNOW Technical Assistance Center (TAC) and for collective learning among the cooperatives was to share approaches to recruitment (i.e., the mechanics of identifying practices, informing them about the study and getting their consent to participate), establishing value-proposition statements (i.e., messages that induce practices to engage in the research despite competing priorities), and employing retention strategies. The following tipsheet describes some of these insights and lessons.
- The EvidenceNOW Tipsheet on Recruitment and Retention describes mechanics of identifying practices, provides examples of value proposition statements, and ideas on how to keep practices engaged throughout a research study.
In addition, researchers from ESCALATES (the EvidenceNOW national evaluation) examined cooperatives’ recruitment efforts, and found that an individual strategy was insufficient alone, rather “more nuanced messaging strategies such as aligning with existing initiatives and requirements, explicitly specifying project details, and customizing recruitment messages to the needs of the practice are also necessary.” (Sweeney et al., 2018)
To support future primary care researchers in their efforts to recruit practices, the EvidenceNOW cooperatives have shared several examples of resources they used in their efforts, including: brochures, letters, presentations, scripts, among others:
- Presentations: New York City & North Carolina.
- Letters: New York City (1 and 2), North Carolina, & Northwest.
- Brochures: New York City (1 and 2), North Carolina, Northwest, & Virginia (1 and 2).
- Enrollment Consent Form, North Carolina.
- Phone Recruitment Scripts (1 and 2), New York City.
- Recruitment Process Diagram, Northwest.
- Recruitment Screening Tool, New York City.
- Timeline and Checklist, North Carolina.
- Value Proposition Flyer, Midwest.
Harmonizing Measures Across the Cooperatives
The EvidenceNOW initiative began with seven different cooperatives’ proposed internal evaluations using a range of designs, methods and measures. The RFA specified the required core outcomes measures, which were ABCS measures and practice capacity (i.e., Adaptive Reserve, CPCQ); however, there were opportunities to further harmonize. Over several months, AHRQ, ESCALATES, and the cooperatives worked to harmonize a core set of measures to ensure robust findings at a national level. They selected from among the measure options for cholesterol management and blood pressure, and determined the priority items from the practice capacity instruments. The evaluators also shared their proposed instruments and items for other domains from which the group discussed and selected a parsimonious, core set of items for the practice and practice member surveys, as well as a relevant set of optional items for cooperatives to select from.
- For further perspectives on harmonizing the measures, vist ESCALATES’ blog.