2 Attachment B: Structural Assessment_Antibiotic Stewardsh

STRUCTURAL ASSESSMENT

1. How many of the following clinicians work in your practice?

MDs/DOs

NPs/PAs

Registered Nurses

Medical Assistants

Pharmacists

Other (please describe)

2. Approximately how many patients does your practice see in an average week?

3. Does your practice use an electronic health record system? Yes No

3a. If yes, has your practice implemented any prompts in the EHR to assist with antibiotic decision-making? Yes No Not sure

4. Has your practice used a team-based safety program (e.g., comprehensive unit-based safety program) to drive improvement activities in the practice in the past? Yes No Not sure

4a. If yes, please describe previous initiatives that have used a team-based safety approach.

5. Do any clinicians in your practice receive any protected time or salary designated specifically for antibiotic stewardship related activities? Yes No Not sure

5a. If yes, please describe.

6. Have clinicians in your practice developed local guidelines covering conditions for which antibiotics are commonly prescribed? Yes No Not sure

6a. If yes, please describe.

7. Does your practice use any other tools to assist with antibiotic decision-making?

Yes No Not sure

7a. If yes, please describe.

8. Have clinicians in your practice developed a list of conditions for which antibiotic prescriptions are discouraged?

Yes No Not sure

8a. If yes, please describe.

9. Does your practice formally review data on rates of antibiotic prescriptions periodically?

Yes No Not sure

10. Approximately what proportion of visits in your practice are via telemedicine, as defined by use of synchronous video visits?

• 1% to 24%

• 25% to 49%

• 50% to 74%

• 75% to 99%

• All (100%)

11. Approximately what proportion of telemedicine visits in your practice are via telephone?

• 0%

• 1%-24%

• 25%-49%

• 50%-74%

• 75%-100%

12. Is your practice considered any of the following? (Select all that apply)

• primary care

• urgent care

• direct to consumer

• other (please specify) _______________

13. Do patient satisfaction scores impact provider compensation in your practice? Yes No Not sure

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