Fig. 1

a Multilevel enrollment: study A231701CD. a Presents the hierarchical enrollment to study A231701CD prior to the OPEN enhancement that permitted multilevel enrollment. Patients are nested within clinic surgeons, who are nested within clinics. Each clinic enrolled patients, and the patients were enrolled in OPEN. The study also enrolled the clinic and clinic surgeons with manual enrollment, attaching clinic-level data with the first surgeon enrolled at the clinic. Here we assume c clinics such that clinic stakeholders are at Clinic 1, clinic stakeholders are at Clinic 2, and so on up to clinic stakeholders at Clinic c. Patients are nested within clinic stakeholders such that the first clinic stakeholder at Clinic 1 sees 1, 2, …, patients, the second clinic stakeholder at Clinic 1 sees 1, 2, …, patients, and so on. b Summary of data flow between the research enrollment application, rave, and statistical analysis files. c Distributing the randomly assigned study intervention