Outcomes
Our study includes provider productivity, wait times, and patient satisfaction outcomes as mandated by the MISSION Act. We included three clinic-pay period level measures of provider productivity—(1) relative value units (RVUs) per full-time equivalent (FTE) per pay period, (2) visits per FTE per pay period, and (3) patients per day per pay period, which included the workload of both physicians and other advanced practice providers (e.g., physician assistants, nurse practitioners). For each provider in our included specialty clinics, we obtained patient visits and associated RVUs from the CDW and their clinical workload on an FTE basis for each pay period from the Specialty Productivity Report and Quadrant Tool (SPARQ) maintained by the Office of Productivity, Efficiency, and Staffing (OPES). Providers with scribe and non-scribe visits in the intervention sites were included to account for the potential site-wide spillover effect from scribe intervention.We also included three clinic-pay period wait times measures—(1) request to appointment day (total wait time), (2) request to appointment made (time between request for an appointment and appointment creation, the administrative time to make the appointment), and (3) appointment made to appointment day (time between appointment creation and appointment day). Appointments that were cancelled, a no-show, or created on the same day as the visit (e-referrals, and text/email messages between providersFinally, we included six patient satisfaction outcomes measured using survey data from Veterans Signals (V-Signals), a nationally administered email-based survey used to understand the veteran experience and satisfaction with the care received at VAMCs (approximately 18% response rate).