1. Describe the study design you will employ in order to determine if your intervention has had an effect on the outcome variable of interest.
The primary outcome of this implementation project will be patient satisfaction after the outpatient encounter. In order to measure this, I would employ a pre- post- design. The surgical clinics at UCSF currently use a Press-Ganey survey that it sends to patients after their outpatient visit. This will be particularly useful because an increasing emphasis is being put on these patient satisfaction scores at the institutional level. I am in contact with patient relations to learn more about what the survey asks and how exactly it is administered. Ideally, I would use the baseline scores on this survey and compare them to the scores after implementation.
I could consider a randomized trial, which would be feasible if we randomized at the level of the surgical clinics, however, I would be concerned about confounding given that any changes in patient satisfaction could be attributable to changes that occurred in a given surgical clinic during the study period that did not occur at the others. Further, randomizing at the level of the individual patient would not be possible because it is not possible to randomize the EMR interface (which is how the tools will be delivered) and I think it will be difficult for physicians to change their preoperative discussion so dramatically between patients.
2. Define the unit-of-analysis for your main outcome evaluation, the minimum meaningful effect size, and the sample size necessary to detect this effect size.
Unfortunately the surveys are not available publicly. My planning her will largely rest on the information I get from patient relations regarding scoring, normal variance, etc. It seems that Press Ganey (the company that sells and scores the survey) has a rich database of our previous patient satisfaction scores at the individual clinic- and physician-level, as well as changes over time, so I anticipate that this will be very useful in terms of defining a meaningful effect size and estimates of variance.