Adaptive reserve at community health centers: The cancer prevention and control research network (CPCRN) multi-state survey

Background: Community health centers (CHCs) are vanguard providers of primary care for vulnerable populations. With healthcare reform, understanding facilitators to change at CHCs will be important to expanding the delivery of primary care to the estimated 32 million Americans who will be newly insured. The Practice Change and Development Model identifies attributes of high improvement practices compared with low improvement practices. Within this model, the Adaptive Reserve construct comprises of intangible elements that make an organization both stable and flexible during times of change.

Objective: Determine the Adaptive Reserve, as measured by the Practice Adaptive Reserve (PAR) Scale, of CHCs in 7 states (California, Colorado, Georgia, Missouri, South Carolina, Texas, and Washington).

Methods: We engaged national, regional and local stakeholders to develop and conduct an online survey with CHCs. To guide the survey, we selected the Patient Centered Medical Home and the Consolidated Framework for Implementation Research (CFIR) and included questions adapted from the National Demonstration Project's Clinician Staff Questionnaire to examine the Adaptive Reserve of participating CHC clinics. PAR scores will be scaled from 0.00 to 1.00, with higher scores representing greater agreement with PAR items.

Working with Primary Care Associations and CHCs, we recruited a convenience sample of CHC clinics and invited their providers, nurses and medical assistants to participate in our CPCRN Community Health Center Survey. The survey currently is in the field and to date, 33 CHC clinics in three states have participated. A Clinic Characteristics survey is also being completed by each CHC for their participating clinics.

Results: Data collection will conclude by the end of March 2013 and analyses completed by the end of June.

We will report the PAR composite scores with clinic-level summary characteristics as reported in the Clinic Characteristics Survey (i.e., total patients served, provider FTE, nurses FTE, medical assistants FTE, electronic medical records, etc). We will also report the PAR composite scores with individual-level demographic responses from our Community Health Center survey: age, gender, position type, number of years worked at their current clinic.

Comparisons in mean PAR scores among clinics and with clinic characteristics will be performed using mixed effects regression models.

Summary: Evidence from primary care transformation indicates that practices with strong Adaptive Reserve are more successful at incorporating change. With the Affordable Care Act, understanding the Adaptive Reserve of CHC clinics will be timely for the many changes needed to successfully expand primary care at CHCs.