Domain	Construct	Source	Measures
Perceived Utility of CDS	Perceived Utility of CDS	Primary Care Clinic Director	Mean of 3 items: “CPRS improves dissemination of new information” “CPRS improves clinical decision support” “CPRS reduces medical errors” (1=strongly disagree, 5=strongly agree)
User-Centered Design	User-Centered Design Practices	VA Medical Center Chief of Staff	Four indicators: 1) Test piloting reminders prior to full scale implementation 2) Post implementation assessment of provider satisfaction 3) Formal evaluation of reminder usability (human factors or usability assessment) 4) Analysis of reminder impact on performance improvement (1=yes, 0=no)
Structural Characteristics	Clinic type	Administrative Data	1 = Community-Based Outpatient Center 0 = VA Medical Center
	Academic affiliate	Administrative Data	Presence of a primary care training program (1=yes, 0=no)
	Size	Administrative Data	Number of unique patients, in 1000’s
Implementation Climate	Required Guideline Use	Primary Care Clinic Director	PCPs required to observe explicit practice guidelines when ordering specified tests or procedures (1=yes, 0=no)
	Health IT Use/Customization	VA Medical Center Chief of Staff	Providers sometimes turn guideline prompts off (1=yes, 0=no)
	Competing demands	Primary Care Clinic Director	2 items: 1) Hard to make any changes because so busy seeing patients 2) Competing demands across too many initiatives [serve as a barrier to improving performance] (1=strongly disagree, 5=strongly agree)
	Resistance to Performance Improvement	Primary Care Clinic Director	3 items: 1) Resistance from PCPs 2) Resistance from local managers 3) Resistance among local support staff (1=not a barrier, 4=large barrier)
Available Resources	IT staff sufficiency	Primary Care Clinic Director	Mean of 2 items: 1) Sufficiency of IRM or CPRS technical staff 2) Sufficiency of clinical application coordinators (1=not at all sufficient, 5=completely sufficient)
	HIT Expertise	VA Medical Center Chief of Staff	Access to medical informatics expertise (e.g. informatics-trained clinicians) (1=never sufficient, 5=always sufficient)
	HIT Training	Primary Care Clinic Director	Mean of 2 items: 1) Adequate types of HIT training 2) Adequate time for HIT training (1=strongly disagree, 5=strongly agree)

IRM = Information Resources Management; CPRS = Computerized Patient Record System; IT = Information Technology; CDS = Clinical Decision Support