Reach, population need
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Assessed by interviewing the president of the organization to identify documents that pertain to the initiation of the clinic and map out existing services. Those documents include the government ombudsman reports made available on public websites, press releases, and internal consulting and environmental scans that show the gap that this clinic was created to address. These were both publicly available documents and documents internal to the organization.
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Interview
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Reach, patient characteristics
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Assessed by questionnaires asking about ethnicity, time in Canada (recent immigrant), income bracket, and education modified from a Canadian Autism National Needs Assessment Survey and published by Lai and Weiss.
73
This survey uses multiple choice options that were developed with stakeholders (community service organizations leaders and families in the ASD field), along with questions selected and validated from other research.
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Questionnaire and clinical intake forms
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Efficacy, service access
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Assessed by asking about what health and social services have been used in the last 6 months, emergency health services accessed in the past 6 months, and type of emergency department visits.
73
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Clinical intake forms
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Efficacy, caregiver factors
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We explored the use of the Brief Family Distress Scale (BFDS)
74
and the Revised Caregiver Appraisal Scale (RCAS)
75, the Depression Anxiety Stress Scales (DASS‐21)
76. After consultation with experts in this domain, we decided to use the BFDS and the DASS‐21 based on usability and brevity. In the DASS‐21, we specifically used the stress and depression subscales since that has previously been shown to be affected in caregivers (Lunsky, personal communication, 2018). Further consultation with service providers led us to not administer this as part of the intake form but as an additional survey later on. The reasoning was to avoiding the impression that caregivers were being studied while they were seeking and accessing services at the clinic. The RCAS was not used based on feasibility in this setting and length of the overall evaluation.
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Questionnaire and clinical intake forms
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Efficacy, health status
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Overall health status was measured by caregiver report (Idler and Benyamini,
77 Patient Enablement Inventory
used previously in Lai and Weiss
73
). Specific questions around oral health that had both clinical and research utility were co‐designed with the dentist. In addition, chart review of electronic medical record data forms is used to obtain the full clinical picture and offer cases to illustrate the changes in health. Data from the initial intake form and active diagnosis to track the medical complexity of the patient will be collected in the EHR. Specific variables to be included are concurrent diagnosis per patient, to be quantified by type and severity to better describe and subdivide our sample.
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Questionnaire and clinical intake forms
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Efficacy, patient satisfaction
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To have a patient‐centered measure of service quality, after a review of the Patient‐Reported Outcome Measures (PROMs) literature, we decided to use the Measures of Process of Care‐ 20 (MPOC‐20
47
), the Patient Enablement Inventory (PEI
48, 49
) with an open-ended section for comments (Bayliss et al78). The MPOC‐20 will be administered once a year to all patients, and the PEI with a comment section will be given after each visit as a proxy self‐care and self‐efficacy, a short‐term indicator of program efficacy.
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Questionnaire and clinical
end‐of‐visit forms
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Adoption, usability
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Assessed by continual feedback from staff about their satisfaction with the current model and how to improve the model.
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Interviews
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Adoption, professional development and contributions
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Assessed by interviews with the service providers in the clinic to track their career development, contributions to the field at large and teaching to trainees. This was measured in part by the number of professional collaborations and trainees reached directly and indirectly (eg, teaching, and knowledge transfer activities). Individual semistructured interviews with providers ask about the benefits they see in this specialized clinic. Interviews will target user perceptions of the efficacy and impact of the clinic and potential areas of development. In addition, we will ask about impacts on their career development. For example, we will ask “how has your involvement in the clinic impact your professional and research trajectory?”, “what are the benefits and synergies you see in this model of care?”, “how many additional trainees have you taught as part of this clinic and what do you see as the impact of those exposures?” etc.
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Interviews
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Adoption, adherence to best practices
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Assessed by EMR data that examines the number of times clinical guidelines or specific algorithms were used appropriately in an evidence‐informed fashion.
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EMR analytics
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Implementation, system reach and acceptability
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Assessed using a Consultation Services Survey on Process, Satisfaction and Utility.
50
This survey will be sent to external physicians to gain their perspective on the quality and value of the services this clinic offers. This package will be sent along each consultation report that the clinic provides.
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Questionnaire
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Implementation, time expenditure
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Assessed by using Salesforce, a platform with the ability to capture operations metrics in the clinic to optimize scheduling and workflow
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IT analytics
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Implementation, cost‐benefit analysis
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Assessed by interviews with managers and clinicians to explore the synergies between medical and dental care, team‐based care approaches and nurse‐only clinic days, including the regulatory and financial constraints in the local public health system
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Interviews
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Maintenance, capacity building
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Assessed by survey will be sent out electronically via email after a consult report has been given to the requesting service provider and surveys to trainees (eg, residents) gauging their comfort and confidence working with this population
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Questionnaire
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Maintenance, system embeddedness
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Assessed through tracking referrals and consultation requests over time through reports from the EMR. These data will be quantified and will increase our knowledge of the embeddedness of this clinic into the greater health system and how the changes in volume relate to clinic development.
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EMR analytics
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Maintenance, clinic process map and ecosystem evolution
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Individual semistructured interviews will be completed with management staff to understand the development of the clinic and the context surrounding it. Sample questions include “what were the hurdles in implementing this model?” “what were the key ingredients to integrate this model into the current health system?”, “what challenges were unforeseen and how did you overcome those?”. Pertinent documents will be analyzed to trace the path from inputs to impact in the development of the clinic. We will be able to identify partners/providers in external organizations that may provide insights around how the landscape has changed because of this. We will also map out the formal and informal corridors established with the public sector services network.
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Interviews
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