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2005 Telephone Interview Protocol

NHSC Chiropractors

Draft

May 9, 2005

Scope of Services
I would like to start by discussing the types of services you provide at the clinic.
1.	What types of services do you provide on a routine basis (at least once a week)? [Check off services mentioned by respondent and probe for the services not mentioned. Make sure to emphasize these are only services they provide at least once a week.]
		Provide on Routine Basis
a.	Do you provide therapeutic treatments? Manipulation adjustments Application of surface neurostimulator Mechanical traction Gait training Massage Acupuncture Acupressure Other	___ ___ ___ ___ ___ ___ ___ ___
b.	Do you conduct evaluations and assessments? Assessment of the necessity for care Complete or focused physician examination Complete or focused personal/family health history Focused examination for management of acute or chronic condition Documenting final medical assessment Triaging Other	___ ___ ___ ___ ___ ___ ___
c.	Do you conduct or order diagnostic procedures? Muscle testing Range of motion measurement Needle electromyography Nerve conduction X-ray (order, review, and interpret) MRI (order, review, and interpret) Laboratory tests (order, review, and interpret) Ergonomics and workplace safety Other	___ ___ ___ ___ ___ ___ ___ ___ ___
d.	Do you provide counseling and education services? Diet and nutrition Stress management Health insurance/plan rules and guidelines Helping patients make choices Compliance counseling Disease education Fitness and exercise Other	___ ___ ___ ___ ___ ___ ___ ___
e.	Do you manage acute and chronic illnesses? Injuries/trauma Minor trauma Sprains/strains Musculoskeletal Tendinitis Back and neck pain/strain Disc herniation Osteoarthritis Scoliosis Repetitive stress injury Cardiovascular Chest pain Gastrointestinal Constipation Neurologic Headache Paresthesia (numbness and tingling in an extremity) Pain Trauma Behavioral Anxiety Other	___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
f.	Do you provide targeted services for special populations? Functional/support assessment for the frail elderly Other	___ ___
g.	Do you provide any other types of services on a routine basis? [If yes, please describe] _________________________________ _________________________________	___ ___
2.	Is your provision of care limited by scope of practice restrictions? [If yes] How? ___________________________________
3.	Are there any types of services that you wish you could provide, but do not? [If yes] What are they? ___________________________________ [If yes] What prevents you from providing these services? ___________________________________
4.	During a typical week, how many hours per week do you work at this clinic? _______
5.	How many patients do you see during an “average” day? _______
6.	Please describe your typical patient in terms of demographic characteristics and health conditions. _________________________________________
7.	What proportion of your practice is devoted to the treatment of neck and back pain? _________________________________________
8.	When treating neck and back pain, how many visits are included in one episode of treatment? _______
9.	Do you represent chiropractic care on any type of planning committee? [If yes] Please tell me about this committee. ___________________________________

Contributions to the Site
10.	Has your presence at the clinic resulted in the addition of new services? [If yes] What are those new services? ___________________________________
11.	Has your presence at the clinic resulted in the expansion of preexisting services to clinic users? [If yes] Which services did you expand? ___________________________________
12.	Have you implemented any quality of care initiatives since you started working at this clinic? [If yes] Please describe. ___________________________________
13.	Have you introduced any type of primary care program for clinic patients or the community? [If yes] Please describe. ___________________________________

Process of Care
Next, I would like to talk about how you are integrated into the process of care at this clinic.
14.	Do you ever co-manage patients with other clinical staff? [If yes] What types of patients do you co-manage? ___________________________________ [If yes] What proportion of your patients do you co-manage? ___________________________________
15.	What proportion of your patients come from each of the following sources? Referrals from clinic staff Referrals from other clinics within the same network of clinics Referrals from providers outside of your clinic’s network Self referrals
16.	How frequently do you refer your patients? To other physicians at this site ________ To other physicians at other clinics ________ To other pain specialist ________
17.	[If the chiropractor refers patients to other physicians] What types of patients do you typically refer? ___________________________________
18.	Do you ever participate in an interdisciplinary care team? [If yes] What is the purpose or goal of the team? ___________________________________ What other types of providers are included in the team [probe for physicians]? ___________________________________ How frequently does the team meet? ___________________________________

Recruitment
I would now like to discuss what motivated you to work in a medically needy area.
19.	How did you learn about the NHSC? ____________________________________
20.	Why did you decide to apply for a NHSC loan repayment award? ____________________________________
21.	Were you already working at the clinic at the time you applied for the NHSC loan repayment award? [If yes] When did you start working at this clinic? ____________________________________
22.	Did you have experience serving medically underserved populations prior to your NHSC obligation? [If yes, probe for when this experience occurred] School Internship Residency rotation Preceptorship
23.	Why did you decide to work at this clinic? ____________________________________ [If chiropractor does not mention the role of the loan repayment award] What role did the NHSC loan repayment award play in your decision to accept the position at this clinic? ____________________________________
24.	Would you have [worked/continued to work] at this clinic if you had not received the loan repayment award from the NHSC? ____________________________________

Retention
Next, I would like to discuss your future plans.
25.	Do you plan to continue to work at this clinic after your NHSC obligation ends? [If yes] How long do you plan to continue working at this clinic? ____________________________________ [If no] Do you expect to continue working in a medically needy area? ____________________________________
26.	Do you think clinics in underserved areas have a hard time retaining chiropractors? [If yes] What factors make it difficult? ____________________________________ [If yes] What kinds of strategies do you think clinics in underserved areas should use to retain chiropractors? ____________________________________
27.	Do you think your presence has helped this clinic retain other clinical staff, such as: Physicians Physician assistants/nurse practitioners Mental health providers Other [If yes to any of the disciplines] Why? ____________________________________

Chiropractor Satisfaction
Now, I’d like to discuss your satisfaction with your work environment and the NHSC.
28.	Using any number from 0 to 10 where 0 is the worst working environment possible and 10 is the best work environment possible, what number would you use to rate the working environment at this clinic? [Probe for reasons behind the rating.]
29.	How satisfied are you with your NHSC experience? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
30.	Is your experience with the NHSC loan repayment program what you expected? [If no] How does your experience differ from your expectations? ____________________________________
31.	Would you recommend the NHSC loan repayment program to other chiropractors? [If yes] Why? ____________________________________

Background Information
To conclude, I need to get a little bit of information about you.
32.	What is your age? ____________________________________
33.	Are you male or female? ____________________________________
34.	Are you of Hispanic or Latino origin or descent?
35.	What is your race? [Mark all that apply] White Black or African-American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native Other
36.	Where did you grow up? Town (or City) name: __________________ County name: __________________ State name (or Foreign country): __________________ Is this a(n): Rural area Small town Inner-city area Suburban area
37.	What type of education/training have you completed? ____________________________________

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