Intervention
The E2C2 intervention includes patient- and clinician-directed elements that are designed to increase the frequency with which patients receive individualized, preference-concordant, and guideline-based care for their symptoms and to increase rates of symptom control. All patients treated by clinicians in clusters in the control state will receive usual care. Additional details of the intervention are previously published [One critical and relevant feature of the intervention is the EHR Triage and Decision Support Algorithms. Patients’ responses to questionnaires will initially assign symptomatic patients to one of 2 incremental levels of stepped care. Patients reporting symptoms 0–3 will be given usual care; those reporting any symptoms 4–6 will be triaged to level 1 intervention (moderate symptoms); and those reporting any symptoms 7–10 will be triaged to level 2 (severe symptoms). We define an “elevated” symptom score as any score greater than 3. Though other criteria also trigger enhanced intervention (non-response to treatment; patient preference for SCM contact; or clinician referral), it is notable that the SPPADE symptom scores used to triage patients are also outcomes, as noted below. It is also notable that patients who never report moderate or severe symptoms will not receive key elements of the intervention.