Table 2.

Key Findings from Testing of Individual Tools

Tool Name	Key findings when testing these tools
Tools to Start on the Path To Improvement
Tool 1: Form a Team	If a team was not formed, change did not happen. The more diverse the team, the richer the input. Not one practice selected a patient to be on their team.
Tool 2: Assess Your Practice	More than one discipline assessing the practice brought more depth regarding strengths and weaknesses. The assessment was both motivating and a discussion starter. Completing the assessment often changed the priorities the team had identified prior to the assessment. Many liked how the assessment also listed the tool(s) to improve each deficiency and the rankings of importance of the tools.
Tool 3: Raise Awareness	The American College of Physicians Foundation video was overwhelmingly well-received as a motivator that really resonated with all staff. Many practices used the PowerPoint presentation and sometimes included it with the video. They liked its versatility, using slides to create bulletin boards or self-study projects.
Tools to Improve Spoken Communication
Tool 4: Tips for Communicating Clearly	Many practices were initially drawn to this tool, but when implementing it they often focused on one aspect such as teach-back or Ask Me Three.
Tool 5: The Teach-Back Method	Practices commented that a video of someone doing teach-back would help providers to better visualize how to incorporate this technique. Practices noted that it took some time to learn this technique and how to appropriately ask patients to teach-back without appearing to quiz the patient. Most thought that, once learned, it would not take any more time out of their day. Others noted that doing teach-back on patients who were very low literate, had English as a second language, or were receiving a complicated management plan was more difficult and therefore they avoided it. The teach-back self-evaluation form was found useful by half the practices and noted to be not very helpful by the others. One practice commented that a mentoring program for this skill may be helpful.
Tool 6: Follow-up with Patients	A practice composed of all volunteers stated it was not feasible to provide follow-up due to staff structure and patients who do not have phones. Another practice interpreted this as community outreach rather than individual patient follow-up.
Tool 7: Telephone Considerations	Practices realized they did not know what was on their message machine and appreciated the reminder to take note of it and revise if needed.
Tool 8: Brown Bag Medication Review	All practices that implemented this tool found medication-taking discrepancies and felt this was very worthwhile. The challenge for practices was getting patients to bring in their medications and finding the time to do the review.
Tool 9: How to Address Cultural and Language Differences	Financing these efforts seemed to be the biggest challenge. With practices that had limited interpreter services, trying to coordinate them with patient needs was challenging.
Tool 10: Culture and Other Considerations	Practices felt that being sensitive to cultures and customs was difficult to teach, and the most sensitive providers were ones with firsthand experience in different cultures.
Tools to Improve Written Communication
Tool 11: Design Easy-to-Read Material	Many practices preferred to collect patient information verbally rather than using a form; therefore, they did not see this as useful. This tool was avoided because practices felt there were too many hurdles in introducing new information collection forms. The scope of this tool was broadened to include strategies for developing and assessing forms and health education materials.
Tool 12: Use Health Education Material Effectively	This tool was avoided because practices felt it would take too long to implement. Practices indicated that practitioners felt using health education material would add to their day. The scope of this tool was changed to focus on using health materials rather than developing them (see Tool 11).
Tool 13: Making Your Practice Easy to Navigate	Practices suggested combining tools 13 and 14.
Tool 14: Creating a Welcoming Front Desk and Lobby Area	Practices felt this was an easy tool to accomplish, commenting that this tool should be suggested as an easy one to implement.
Tools to Improve Self-Management and Empowerment
Tool 15: Encourage Questions	This tool went well with tools 4 and 5 The Ask Me 3 program was viewed as time consuming, but they thought the three questions were good for structuring a provider’s visit.
Tool 16: Make Action Plans	Patients seemed to respond positively to this tool in all the testing. Providers liked the idea of an action plan. They initially saw it as taking more time but felt it would work more smoothly once they practiced it with a few patients.
Tool 17: Improve Medication Adherence and Accuracy	Practices saw the benefit in this, although they realized that producing graphic medication cards took more time than they could afford. They were able to revise their current electronic medical record system to create medication lists.
Tool 18: Get Patient Feedback	The 55 questions in the CAHPS questionnaire was viewed as too many, but practices were willing to incorporate some of those questions into their current surveys.
Tools to Improve Supportive Systems
Tool 19: Link Patients to Non-Medical Support	Most practices acknowledged the need for a resource manual. Some had one but it was outdated. Others had a social worker or staff member who performed these types of duties. Practices took the effort to work on their resource manuals but did not seem to adjust their referral sheet to make sure that all patients could understand it.
Tool 20: Medication Resources	No practices in either round of testing chose to test this tool.
Tool 21: Using Health Resources in Your Community	Practices suggested combining these two tools
Tool 22: Use Literacy Resources in Your Community	Practices positively received the idea of linking patients up to literacy resources and, when executed, were surprised that patients received the suggestion well.