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| # | Location | File | Last Modified |
|---|---|---|---|
| 1 | HTRE_P3_v14.5_iter_4_build_14.zip\webapp\docs | PatSatSurveyV1.doc | Wed May 29 15:26:14 2019 UTC |
| 2 | HTRE_P3_v14.5_iter_4_build_14.zip\webapp\docs | PatSatSurveyV1.doc | Tue Jun 11 11:52:28 2019 UTC |
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| 2 | “It is imp ortant tha t we know what you t hink about the value of our Ca re Coordin ation prog ram. It wi ll help us learn how we can im prove care to all ve terans. We would gre atly appre ciate your taking a few minute s to answe r eight qu estions. | |
| 3 | Before you get start ed on the survey, we would lik e to clear up a few things: | |
| 4 | You may kn ow the Car e Coordina tion progr am as the Home Teleh ealth prog ram. It is the progr am that pr ovided you with this device. | |
| 5 | The Care C oordinator is the pe rson that calls you as follow- up to your answers o n this dev ice. | |
| 6 | Now let’s begin the survey. Pl ease enter ‘continue ’.” | |
| 7 | **Notes: | |
| 8 | All of the following questions and answe rs are on the OMB ap proved que stions lis t. | |
| 9 | The number s in paren theses are how the r esponse wi ll be scor ed in the database. | |
| 10 | Questionna ire Conten t | |
| 11 | 1. The fol lowing sta tement is related to your feel ings about the Care Coordinati on staff. The staff is helpful . | |
| 12 | Strongly a gree | |
| 13 | (5) | |
| 14 | Agree | |
| 15 | ||
| 16 | (4) | |
| 17 | No opinion | |
| 18 | (3) | |
| 19 | Disagree | |
| 20 | ||
| 21 | (2) | |
| 22 | Strongly d isagree (1) | |
| 23 | No experie nce | |
| 24 | 2. The fol lowing sta tement ref ers to the health ca re you rec eive from the Care C oordinatio n program. Informati on given t o me about my health is clear and adequa te. | |
| 25 | Strongly a gree | |
| 26 | (5) | |
| 27 | Agree | |
| 28 | ||
| 29 | (4) | |
| 30 | No opinion | |
| 31 | (3) | |
| 32 | Disagree | |
| 33 | ||
| 34 | (2) | |
| 35 | Strongly d isagree ( 1) | |
| 36 | No experie nce | |
| 37 | 3. Your Ca re Coordin ator has a thorough understand ing of the things th at are wro ng with yo u. | |
| 38 | Strongly a gree | |
| 39 | (5) | |
| 40 | Agree | |
| 41 | ||
| 42 | (4) | |
| 43 | No opinion | |
| 44 | (3) | |
| 45 | Disagree | |
| 46 | ||
| 47 | (2) | |
| 48 | Strongly d isagree ( 1) | |
| 49 | No experie nce | |
| 50 | 4. Please rate the f ollowing a spects of the health care you received f rom Care C oordinator s in the p ast 12 mon ths. Advic e the Care Coordinat or gives y ou about w ays to avo id illness and stay healthy. | |
| 51 | Excellent | |
| 52 | ||
| 53 | (5) | |
| 54 | Very Good | |
| 55 | (4) | |
| 56 | Good | |
| 57 | ||
| 58 | (3) | |
| 59 | Fair) | |
| 60 | ||
| 61 | (2) | |
| 62 | Poor | |
| 63 | ||
| 64 | (1) | |
| 65 | No experi ence | |
| 66 | 5. How muc h do you a gree or di sagree wit h the foll owing stat ement abou t the Care Coordinat ion care y ou have re ceived in the past 1 2 months? I would re commend th is type of care to m y family o r friends who have c hronic dis eases. | |
| 67 | Strongly a gree | |
| 68 | (5) | |
| 69 | Agree | |
| 70 | ||
| 71 | (4) | |
| 72 | No opinion | |
| 73 | (3) | |
| 74 | Disagree | |
| 75 | ||
| 76 | (2) | |
| 77 | Strongly d isagree ( 1) | |
| 78 | No experie nce | |
| 79 | 6. Think a bout the c are you re ceive from your Care Coordinat or. You of ten have h ealth prob lems that should be discussed but are no t. | |
| 80 | Strongly a gree | |
| 81 | (1) | |
| 82 | Agree | |
| 83 | ||
| 84 | (2) | |
| 85 | No opinion | |
| 86 | (3) | |
| 87 | Disagree | |
| 88 | ||
| 89 | (4) | |
| 90 | Strongly d isagree (5 ) | |
| 91 | No experie nce | |
| 92 | 7. The fol lowing sta tement ref ers to you r Care Coo rdinator. It is easy to unders tand what the Care C oordinator is talkin g about. | |
| 93 | Strongly a gree | |
| 94 | (5) | |
| 95 | Agree | |
| 96 | ||
| 97 | (4) | |
| 98 | No opinion | |
| 99 | (3) | |
| 100 | Disagree | |
| 101 | ||
| 102 | (2) | |
| 103 | Strongly d isagree | |
| 104 | (1) | |
| 105 | No experie nce | |
| 106 | 8. The inf ormation g iven by th e Care Coo rdinator a bout my me dical prob lems helps me to adj ust to my condition. | |
| 107 | Strongly a gree | |
| 108 | (5) | |
| 109 | Agree | |
| 110 | ||
| 111 | (4) | |
| 112 | No opinion | |
| 113 | (3) | |
| 114 | Disagree | |
| 115 | ||
| 116 | (2) | |
| 117 | Strongly d isagree | |
| 118 | (1) | |
| 119 | No experie nce |
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