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SAMPLE MEMORANDUM of UNDERSTANDING BETWEEN LA Net, a Project of Community Partners AND CLINIC The purpose of the Memorandum is to document agreement between the LA Net, a Project of Community Partners (LA Net) and CLINIC with regard to key elements involved in executing AHRQ Task Order 13 (TO13) Practice Coaching and Implementing the Chronic Care Model and Patient Centered Medical Home in the Safety Net (T.O.13).

(1) Decision-making about T.O.13 Operations and Resource Allocation.

LA Net is led by the CEO Lyndee Knox, PhD, who will have final responsibility and accountability for key administrative, financial, and planning functions. The director or her designee will work closely with clinic directors and the medical directors from the organizations participating in T.O.13 via monthly conference calls and on an as needed basis.

(2) CLINIC Responsibilities and Agreements

2A Clinical 2A.1 CLINIC agrees to participate in 40 on-site coaching sessions that will take place weekly for 10 months and last an average of 4 hours each. 2A. 2 CLINIC agrees that its medical director will serve as the coaching contact for the practice coaching intervention and the primary point of contact for the LA Net practice coach. The coaching contact agrees to meet with the practice coach as needed for up to 60 minutes each month over the course of the coaching intervention to discuss progress, problems, and process of the coaching intervention. CLINIC may appoint a designee to stand in for the medical director with the agreement of LA Net CEO. 2A.3 CLINIC agrees to undertake at least one practice change project selected in collaboration with the practice coach that is aimed at increasing implementation of the Chronic Care Model (CCM) or components of the Patient Centered Medical Home (PCMH) at CLINIC 2A.4 Sign a business agreement to assure confidentiality and privacy of both medical records and any data collected. Document is attached 2B Research 2B.1 CLINIC agrees to participate in the evaluation of the coaching intervention for AHRQ and participate in 3 planned assessments (pre, post and 3-month follow-up) that will each include: 1) Forty five minute paper surveys for up to 10 providers and staff; 2) One hour interviews either in-person or telephonic with up to 5 providers and staff; 3) Access for LANet to conduct 30 minute post-visit surveys of 50 patients taking place at the visit; and 4) provide medical records for an random audit of CLINIC identified process indicators conducted by LA Net staff.

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2B.2 Sign a Federal Wide Assurance (FWA) agreement between the CLINIC and LA Net. (FWA is a temporary agreement between the CLINIC and the federal government that for this project the CLINIC will use LA-Nets Institutional Review Board (IRB) The University of Minnesota). 2B.3 CLINIC agrees to publication of de-identified, summaries of collected data in reports to AHRQ and manuscripts submitted to professional journals. 2B.4 CLINIC understands that they will not receive compensation from LA Net for participating in the AHRQ practice coaching intervention and evaluation. (3) LA Net Responsibilities 3A Clinical 3A.1 The 40 practice coaching sessions and evaluation data and summaries will be provided to CLINIC at no charge. 3A.2 Practice coaches trained in the AHRQ Chronic Care Model (CCM) and Practice Centered Medical Home (PCMH) practice coaching intervention 3A.3 The 10 month day a week practice coaching intervention 3A.4 Resources that might helpful to the practice 3B Research 3B.1 Staff to conduct data collection activities for each of the 3 assessment periods 3B.2 A report at the start of the intervention summarizing results of the 1st assessment 3B.3 A report at the 3-month follow-up summarizing the results of all 3 assessment periods 3B.4 Copies of the final report to AHRQ on the project and any manuscripts submitted 3C.5 Prepare, submits, and maintains IRB approval, including: Submission of institutional review board protocol(s), including the coordination of multiple submissions, if necessary Delineation of setting and responsible parties for consent procedures, as needed (4) Data sharing/ownership LA Net and the CLINIC will establish data sharing processes consistent with the final NIH statement on sharing research data. (http://grants1.nih.gov/grants/policy/data_sharing/). The statement is attached.

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(5) Research Publications and Presentations LA Net and the CLINIC will adhere to International Committee of Medical Journal Editors Uniform Requirements for Manuscripts Submitted to Biomedical Journals regarding criteria for authorship and publication. (http://www.icmje.org/#author) Specifically: Authorship credit should be based on 1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3. When a large, multi-center group has conducted the work, the group should identify the individuals who accept direct responsibility for the manuscript. These individuals should fully meet the criteria for authorship defined above and editors will ask these individuals to complete journal-specific author and conflict of interest disclosure forms. When submitting a group author manuscript, the corresponding author should clearly indicate the preferred citation and should clearly identify all individual authors as well as the group name. Journals will generally list other members of the group in the acknowledgements. The National Library of Medicine indexes the group name and the names of individuals the group has identified as being directly responsible for the manuscript. Acquisition of funding, collection of data, or general supervision of the research group, alone, does not justify authorship. All persons designated as authors should qualify for authorship, and all those who qualify should be listed. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content Signed, FOR LA Net, a Project of Community Partners FOR CLINIC

Lyndee Knox, CEO LA Net

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Clinic CEO - Name and title

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Community Partners Representative

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