Practice Readiness. A major driver for this proposal is the recognition that some of the highest need populations in terms of uncontrolled HTN and CVD risk receive their healthcare in a wide variety of practices, ranging from single physician practices still using paper records to more sophisticated health center networks actively working on practice transformation. Some variety in practice structure and process is desirable in this implementation context, but too much variation can also create threats to validity. Therefore, based on the NC team’s extensive experience with practice facilitation and practice transformation, we have developed practice readiness criteria to assure that a minimum standard is met prior to moving a practice forward to randomization. We have devised a ‘speed to readiness program’ for those practices committing to participating but not deemed ready by the study team (see below). Furthermore, it is likely that some practices that express commitment initially may experience changes over time. Because the study design calls for waves of practices being engaged over a 2-year period, it is likely that some practices may not be approached for randomization until several months after they signed. Therefore, we will assess readiness on signing the Letter of Agreement, and again just prior to randomization. In brief, the readiness criteria include: • Financial stability over the study period and no plans to close the practice in the next 3 years for reasons such as retirement • Engagement and commitment by the leadership of the practice to support change • No major disruptions over the study period (e.g., key staff position vacant, key staff member going out on family leave, new EHR being implemented) The assessment of practice readiness for making structural practice changes is a very new concept and the validation of instruments used to assess various domains of capacity for change is limited. The practice readiness assessment includes items from the Organizational Readiness for Implementing Change (ORIC) scale,45 which includes two subscales assessing change commitment and change efficacy. The ORIC has acceptable psychometric properties in practices similar to those that will be engaged in the proposed study. A copy of the practice readiness survey (along with the survey of practice characteristics) is provided in Appendix 2. Readiness is assessed by the Recruitment and Retention Committee, led by Drs. Shikany and Xxxxxxxx. The data that are considered in...
