• Denise D Quigley, Marc N Elliott, Mary E Slaughter, Efrain Talamantes, and Ron D Hays.
• RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. quigley@rand.org.
• J Gen Intern Med. 2023 Jan 1; 38 (1): 221227221-227.

IntroductionShadow coaching improves provider-patient interactions, as measured by CG-CAHPS® overall provider rating (OPR) and provider communication (PC). However, these improvements erode over time.AimExamine whether a second coaching session (re-coaching) improves and sustains patient experience.SettingLarge, urban Federally Qualified Health Center PROGRAM: Trained providers observed patient care by colleagues and provided suggestions for improvement. Providers with OPRs<90 (0-100-point scale) were eligible.EvaluationWe used stratified randomization based on provider type and OPR to assign half of the 40 eligible providers to re-coaching. For OPR and PC, we fit mixed-effects regression models with random-effects for provider (level of treatment assignment) and fixed-effects for time (linear spline with knots and possible "jump" at initial coaching and re-coaching), previous OPR, patient characteristics, and sites. We observed a statistically significant medium jump among re-coached providers after re-coaching on OPR (3.7 points) and PC (3.5 points); differences of 1, 3, and ≥5-points for CAHPS measures are considered small, medium, and large. Improvements from re-coaching persisted for 12 months for OPR and 8 months for PC.DiscussionRe-coaching improved patient experience more than initial coaching, suggesting the reactivation of knowledge from initial coaching. However, re-coaching gains also eroded. Coaching should occur every 6 to 12 months to maintain behaviors and scores.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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