Table 2. List of Dependent and Independent Variables.
Variables for Analysis including Description, Data Source, and Classification.
| Variable | Description | Data Source | Variable Classification |
| Dependent Variables | |||
| Up-To-Date Cancer Screening | A binary variable indicating the patient is up to date on screening tests for breast, cervix, and colorectal cancer by 12 months following the index visit. | EHR Procedure Results | Binary |
| Up-To-Date Colorectal Cancer Screening | A binary variable indicating the patient is up to date on colorectal cancer screening by 12 months following the index visit. | EHR Procedure Results | Binary |
| Up-To-Date Breast Cancer Screening | A binary variable indicating the patient is up to date on breast cancer screening by 12 months following the index visit. | EHR Procedure Results | Binary |
| Up-To-Date Cervical Cancer Screening | A binary variable indicating the patient is up to date on cervical cancer screening by 12 months following the index visit. | EHR Procedure Results | Binary |
| All HPV Vaccinations Complete | A binary variable indicating the patient has had all 3 or 2 HPV vaccinations by age as recommended by ACIP within 12 months of the index visit. | EHR Procedure Results | Binary |
| Some HPV Vaccinations Complete | A binary variable indicating the patient has had at least 1 HPV vaccination as recommended by ACIP within 12 months of the index visit. | EHR Procedure Results | Binary |
| Referral to Obesity Management Programs | A binary variable indicating that a referral was provided to a patient for internal or communitybased obesity management programs within 12 months of the index visit. | EHR Procedure Results | Binary |
| Referral to Smoking Cessation Programs | A binary variable indicating that a referral was provided to a patient for internal or communitybased smoking cessation programs within 12 months of the index visit. | EHR Procedure Results | Binary |
| Prescription of Smoking Cessation Medications | A binary variable indicating that a prescription was made for smoking cessation medications within 12 months of the index visit. | EHR Procedure Results | Binary |
| Provider satisfaction with CPW use*** | Provider post-intervention period: Proportion indicating highest satisfaction | Provider surveys | Interval |
| Patient visit experience: perceptions of CPW, provider communication, exposure to CPW and SDMTs*** | Pre and multiple post intervention time points. Proportion indicating highest satisfaction. Description of change in proportion over time. | Patient survey and interviews | Interval |
| Provider perceptions of and experience with CPW–CDS *** | Pre- & post-intervention time points: Proportion indicating highest satisfaction. Description of change in proportion over time. | Provider surveys | Interval |
| Provider knowledge, attitudes, & beliefs of cancer prevention care *** | Pre- & post-intervention time points Change over time. | Provider surveys | Interval |
| Independent Variables | |||
| Study Arm | UC, CPW, CPW+SDMT | Administrative | Nominal |
| Patient Sex | Male or Female | Administrative | Nominal |
| Patient Age | Years | Administrative | Interval |
| Patient Race | Standard categories | EHR Clarity | Nominal |
| Patient Ethnicity | Standard categories | EHR Clarity | Nominal |
| Body Mass Index (BMI) | Weight in kilograms divided by the square of height in meters. Used as a descriptive variable and to select patients for analysis. | EHR Vitals | Interval |
| Smoking Status | Indicator variables for current, former, or never smoker. Used as a descriptive variable and to select patients for analysis. | EHR Clarity | Nominal |
| Medicaid Status | Insurance status. Medicare, Medicaid, Commercial, Other, None | Administrative | Nominal |
| Date of Death | Exclusion criteria for study eligibility. | EHR, administrative, state death data | Date |
| Family History of Cancer | A binary variable indicating a family history for colorectal or breast cancer is present. | EHR Family History | Binary |
| Coronary Heart Disease Status | Indicator variable for CHD comorbidity based on one or more inpatient or outpatient ICD-10 codes. | EHR Diagnosis Codes, Administrative Claims Data | Nominal |
| Diabetes Status | Indicator variable for diabetes mellitus based on inpatient and outpatient diagnosis codes. | EHR Diagnosis Codes, Procedure Results, Pharmacy | Nominal |
| Charlson Comorbidity Score (Modified) | Indicator of serious comorbid conditions that may shorten life expectancy. Modified to exclude CV components. Limited to 2 levels, and excludes from study eligibility if > 3 at any time in intervention period (Deyo modified score). | EHR Encounters, Clarity | Nominal |
| Cancer Diagnosis | Indicator variable for existing cancer diagnosis other than non-melanoma skin cancer. Exclusion criteria for study eligibility. | EHR Diagnosis Codes, Administrative Claims Data | Nominal |
| Cancer Chemotherapy | In a defined period of time, one or more ICD9/ICD-10 procedure codes for cancer chemotherapy. Exclusion criteria for study eligibility. | EHR Procedure Codes and Administrative Claims Data | Nominal |
| Hospice Care | In a defined period of time, one or more HPMG special codes for Hospice Care on EHR Problem List. Exclusion criteria for study eligibility. | EHR Problem List | Nominal |
| Alzheimer’s Disease Status | Indicator variable for Alzheimer’s disease based on one or more inpatient or outpatient ICD-10 | EHR Diagnosis Codes | Nominal |
| Atherosclerotic Cardiovascular Disease (ASCVD) Event | A set of indicator variables a defined time period, for occurrence of inpatient primary discharge codes indicating: acute myocardial infarction/acute coronary syndrome, ischemic stroke, transient ischemic attack/RIND, peripheral artery disease including abdominal or thoracic aneurysms or occlusions, or bypass or stent placement in the arterial tree. Exclusion criteria for study eligibility. | Administrative Inpatient Claims Data | Nominal |
| Patient Enrollment | An indicator variable for sufficient enrollment during defined period of time. Exclusion criteria for study eligibility. | Administrative | Nominal |
| Number of Office Visits | Outpatient primary care and subspecialty visits, separately, in a defined period of time. | EHR Encounters | Interval |
| CDS Activations | Count of CDS activations within 12 months of the patient index date within the intervention arms | CDS | Interval |
| Clinic ID | Clinic identification number needed for randomization and for use as a random effect in the analysis. | Administrative | Nominal |
| Clinic Location: Rural vs. Urban | Based on RUCA2-UR codes | Administrative | Nominal |
| Provider Type | Primary care physician, NP, other. Used to determine provider study eligibility. | Administrative | Nominal |
| Number of Patients per Provider | Number of study eligible patients cared for by provider. Used for provider study eligibility | Administrative | Nominal |
| Provider Age | Years | Administrative | Interval |
| Provider Years Since Graduation | Number of years elapsed since provider completed training. | Administrative | Interval |
| Provider Gender | Male or female | Administrative | Binary |
| Provider Full-Time Status | Full-time of part-time | Administrative | Binary |
| Provider Tenure at Essentia | Number of years a provider has been affiliated with Essentia Health | Administrative | Interval |
| Protocol for implementation metrics using the RE-AIM framework | |||
| Domain | Measure | Data Source | |
| Reach | Identification rate among patients –Number and proportion of patients identified as needing cancer prevention interventions. | EHR prescription, patient surveys, & Smart Form data [Intervention only]) | |
| Representativeness of patients –age, gender and clinical characteristics of CDS clinic patients exposed and not exposed to the CP-CDS intervention | EHR data | ||
| Effectiveness | Proportion who received a cancer prevention intervention (includes SA #1, H1 & H2) | EHR data | |
| 12-month adherence to a cancer prevention intervention (SA #1, H1 & H2) | EHR data | ||
| Proportion of physician practice patterns meeting evidence-based recommendations of the CP-CDS | EHR data (CPW-CDS & UC clinics), CPW-CDS Smart Form use | ||
| Proportion of patients reporting participation in weight or smoking counseling or programs | Patient surveys | ||
| Adoption (Intervention Clinics) | Proportion of primary care clinics agreeing to participate and, within clinics, proportion of primary care providers consenting to participate | Meeting minutes, consent forms | |
| Representativeness of settings – Proportion of potential clinics and providers who participate; differences in their urban/rural location, size, specialty, etc. | Essentia clinic & provider data | ||
| Implementation (Intervention Clinics) | Proportion of patients needing cancer prevention identified with the ‘Best Practice Alert’ (BPA’s) among all identified patients CPW-CDS rates of use, defined as number of times used in eligible patient visits, divided by number of eligible patient visits | EHR data Web-service data | |
| Print use of CPW-CDS interface | Web-service print data, provider & patient surveys | ||
| Use rates of CPW-CDS Smart Form | EHR and Web-service data | ||
| Maintenance | Percent Intervention clinics continue using CPW-CDS at 12 months | Meeting minutes, webservice data | |
| Percent primary care providers using the CPW-CDS at 12 months | Web-service data | ||
| Organizational commitment to sustaining the CPW-CDS | Provider focus groups, key informant interviews of leaders | ||
| Implementation of CPW-CDS in non-Intervention primary care clinics, including spread beyond usual care clinics | Key informant interviews with organizational leaders, training of nonintervention clinics | ||
***
denotes CFIR related metrics