Attachment 4 - Letters and Materials for grantees, sites and patients

Introductory Letters/Materials for Grantees,
Sites, and Patients

1

RTI LEAD LETTER TO GRANTEES
DATE
DIRECTOR
ADDRESS
CITY, STATE ZIP
Dear [DIRECTOR],
On behalf of RTI (Research Triangle Institute) and the Health Resources and Services Administration’s
Bureau of Primary Health Care, we would like to request your participation in the Primary Health Care
Patient Surveys. These surveys aim to collect data on patients who use health centers funded under
Section 330 of the Public Health Service Act, to support the Bureau’s mission to improve the health of the
nation’s medically underserved communities and populations and ensure their access to high-quality
primary health care services.
Your organization is one of a stratified sample of only 115 grantees selected to participate in this study.
Therefore, your assistance is essential. We would like to involve some of your health center sites in these
surveys, which will be conducted sometime between [MONTH] and [MONTH] 2010. Data collection
activities will be scheduled at your convenience. Your sites would be asked to participate in the following
activity:
•

Allowing RTI to conduct one-on-one private, personal interviews with a sample of patients who have
received services at your health center in the previous year. Copies of the instrument are available for
your review.

All information obtained during the patient surveys will be kept private and without personal identifiers,
and will be used for research purposes only. We will work with you and the site staff to ensure that the
data collection activities adhere to the research requirements of your facilities. We also assure you and the
site staff that the findings from the patient surveys will not be used to assess the performance of the
individual site or grantee.
In the next week, NAME OF GRANTEE RECRUITER, a member of the RTI research team, will contact
you to discuss this request in more detail, to obtain site-related information necessary for conducting the
surveys, and to answer any questions or concerns that you may have. If you prefer, you may contact
him/her by calling toll free (800)XXX-XXXX, extension _____. We recognize that participation may
present a variety of challenges, but our hope is that you will permit us to work with you and your site staff
to develop a plan that will effectively address any concerns and enable your participation.
Thank you in advance for your time and thoughtful consideration.
Sincerely,

Kristine Fahrney
RTI Project Director for the
Community Health Center Patient Survey

Jody Greene
RTI Project Director for the
Special Populations Patient Survey

Enclosures: BPHC Letter of Support and RTI Brochure
2

RTI LEAD LETTER TO SITES
DATE
DIRECTOR
ADDRESS
CITY, STATE ZIP
Dear [DIRECTOR],
On behalf of RTI (Research Triangle Institute) and the Health Resources and Services Administration’s
Bureau of Primary Health Care, we would like to request your participation in the Primary Health Care
Patient Surveys. These surveys aim to collect data on patients who use health centers funded under
Section 330 of the Public Health Service Act, to support the Bureau’s mission to improve the health of the
nation’s medically underserved communities and populations and ensure their access to high-quality
primary health care services.
Your grantee was one of 115 randomly selected from across the country for participation in this study,
and your site was selected within your grantee. Therefore, your assistance is essential. This study will be
conducted sometime between [MONTH] and [MONTH] 2010 and will be scheduled at your convenience.
Your participation will involve the following activities:
•

Allowing RTI to conduct one-on-one private, personal interviews with a sample of patients who have
received services at your health center in the previous year. Copies of the instrument are available for
your review.

All information obtained during the patient surveys will be kept private and without personal identifiers,
and will be used for research purposes only. We will work with you and your staff to ensure that the data
collection activities adhere to the research requirements of your facilities. We also assure you and the site
staff that the findings from the patient surveys will not be used to assess the performance of the individual
site or grantee.
In the next week, NAME OF GRANTEE RECRUITER, a member of the RTI research team, will contact
you to discuss this request in more detail, to obtain site-related information necessary for conducting the
surveys, and to answer any questions or concerns that you may have. If you prefer, you may contact
him/her by calling toll free (800)XXX-XXXX, extension _____. We recognize that participation may
present a variety of challenges, but our hope is that you will permit us to work with you and your staff to
develop a plan that will effectively address any concerns and enable your participation.
Thank you in advance for your time and thoughtful consideration.
Sincerely,

Kristine Fahrney
RTI Project Director for the
Community Health Center Patient Survey

Jody Greene
RTI Project Director for the
Special Populations Patient Survey

Enclosures: BPHC Letter of Support and RTI Brochure
3

BPHC Lead Letter to Grantees and Sites
BPHC LETTERHEAD

BPHC LEAD LETTER TO GRANTEES AND SITES
DATE
Dear Colleague:
The Health Resources and Services Administration (HRSA)’s Bureau of Primary Health Care (BPHC) is sponsoring
the Primary Health Care Patient Surveys to be conducted by RTI International, a not-for-profit research firm. The
Patient Surveys aim to collect data on patients who use health centers funded under Section 330 of the Public Health
Service Act, to support the Bureau’s mission to improve the health of the nation’s underserved communities and
populations, and to ensure their access to high-quality primary health care services.
The BPHC has selected your program to assist us in this important work, and we would very much appreciate your
support and cooperation. RTI International, our contractor, will ask your program to assist by allowing RTI to
conduct patient interviews at your program. Specifically, your staff will be asked to help identify clients willing to
be interviewed for the Patient Survey and allow RTI staff to conduct personal interviews with the selected clients.
The study will involve the selection of a specific number of clients to participate in a personal interview with an RTI
representative. We will treat all information obtained during the study as private, and it will be used for research
purposes only. Furthermore, we will work with you and your staff to ensure that the data collection activities adhere
to the research requirements of your facility.

For more detailed information on this study, please read the enclosed materials from RTI, and let them know if you
are able to participate. If you have any questions, please feel free to contact me at the e-mail address or phone
number below.
Thank you in advance for your time and consideration.
Sincerely,

Anne Pope, MPH
Project Officer, BPHC Patient Surveys
Office of Quality and Data
Bureau of Primary Health Care
Health Resources and Services Administration
Parklawn Building, Room 15C-26
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 594-4284
e-mail: [email protected]

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INFORMATION TO BE INCLUDED AS PART OF A TRIFOLD BROCHURE

Frequently Asked Questions About the Primary Health Care
Patient Surveys
What are the surveys about? What is the purpose?
RTI (Research Triangle Institute) International is conducting the Primary Health Care Patient Surveys.
The surveys are sponsored by the Bureau of Primary Health Care within the Health Resources and
Services Administration (HRSA). These surveys are about people who receive health care at health
centers like this one. The surveys will try to find out what kinds of health issues people who use the
health centers have and how well their needs are met. The surveys are not associated with any
immigration laws and the agency sponsoring the study is not associated with an immigration agency.

What is involved and how long will it take?
If you agree to participate, you will take part in an in person interview conducted by one of our
interviewers. We will conduct the interview in private at the health center or another convenient location.
All responses will be kept private. You may refuse to answer any question and you may also stop the
interview at any time.

What types of questions will be asked?
Questions about health care received, medical conditions, alcohol and drug use and health insurance will
be asked.

How long are the interviews?
The time varies, but interviews generally take 1 hour.

Will I be paid?
You will receive $25 cash or a $25 gift card for your participation. The form of payment has been
selected by this health center.

What about my privacy?
The information you provide will be private. We will create and use a number instead of your name to
identify your interview in the computer. This will prevent anyone from finding out what your answers
were. After you complete the interview, the interviewer will not be able to look at your answers again.
We will combine your information with information from all of the other participants to create group
statistics.

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Why was I selected for this study?
RTI requested the cooperation of about 600 health centers to conduct this study. This health center has
agreed to participate. You have been randomly selected from this health centers’ patients to participate.

Why should I participate?
Your opinions and experiences are valuable. You represent thousands of others who receive similar care
and services. Information we gather through these surveys will provide policy makers and health centers
with a better understanding of how patients are being served and how to better serve patients at these
health centers.

Do I have to participate?
You do not have to participate in this survey or respond to any questions you do not want to answer. If
you choose not to participate it will not affect any services you or your family may receive at the health
center or any other programs.

What is the RTI International?
RTI International is a nonprofit company in Research Triangle Park, North Carolina. RTI conducts
research and provides services to local, state, and federal agencies.

I have more questions. Who can answer them?
If you have any questions about these studies, you may call FIELD DIRECTOR 1 NAME at
(XXX)XXX-XXXX or FIELD DIRECTOR 2 NAME at (XXX)XXX-XXXX. If you have any questions
about your rights as a study participant, you may call RTI’s Office of Research Protections toll-free at (1866-214-2043).

6

GRANTEE RECRUITMENT GUIDELINES
SUGGESTED INTRODUCTION SCRIPT:
[ASK FOR CONTACT PERSON IDENTIFIED IN VERIFICATION CALL]
Hello, my name is ________________ and I’m calling on behalf of the United States
Department of Health and Human Services about the Primary Health Care Patient Surveys
which are sponsored by the Bureau of Primary Health Care within the Health Resources and
Services Administration (HRSA). I’m calling from Research Triangle Institute International,
which has been contracted to conduct the patient surveys. I was given your name as the person
in your office that is the most knowledgeable about the health center sites that your organization
funds via Section 330 funding. I recently mailed study information to you. I am calling today to
discuss the surveys in more detail and answer any questions that you may have regarding
participation. Do you have time to talk with me now? [THE FIRST CALL MAY LAST 10
MINUTES]. [IF NO]…I will be happy to call back at a time that is more convenient for you. [SET
UP APPOINTMENT DATE AND TIME]

THE FOLLOWING MUST BE DISCUSSED DURING THIS CALL OR DURING SUBSEQUENT
CALLS:
1.

Give summary of the patient surveys. Include purpose and major tasks.
The purpose of these surveys is to obtain data about the health and health care needs of
patients who received services at Section 330 funded health centers. The national
studies will provide policy makers and service providers with a better understanding of
the health problems and needs of these patients, their health care utilization, and met
and unmet needs.

2.

Clarify our request.
We are seeking permission from the grantees to collect data at a sample of their sites.
We are requesting information on their sites so that our statistician can select the
sample of sites. Each selected site will be asked to allow RTI to conduct one-on-one
private, personal interviews with patients who have used the site in the previous year
(approx XX interviews per grantee, X or X per site). Copies of the interview questions
are available for grantee review.

3.

Identify any perceived barriers to participation and work out plans to alleviate such
barriers.

4.

Discuss the approval process that is required at the Grantee level. Do they have an
IRB and/or Board of Governance? If so, when is their next meeting? Offer assistance in
obtaining study approval and/or gaining their cooperation. RTI must receive written
notification of approval, if applicable. Discuss and document local requirements for
obtaining informed consent from minors and proxies.

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5.
•
•
•
•
•
•
•
6.

Address concerns about patient protection. Protective measures for the patient
surveys include:
informing respondents up front that some of the questions may be sensitive in nature
and that they have the right to refuse to answer any questions;
reassuring all subjects that they are under no obligation to respond to the interview and
may terminate their participation at any time;
informing participants that their answers are private, and that their names will not be
associated with responses provided;
conducting the interviews in a private location;
reporting information obtained from the interviews only in summary form;
maintaining hard copies of the consent forms in a locked storage cabinet;
destroying hard copies of consent forms after they are no longer needed;
Obtain the following information for each eligible site associated with the Grantee.
Eligible sites are defined as those that are within the scope of project of the 330-funded
program.
Name of site__________________________________
Contact Information
Name_________________________________
Title___________________________________
Address________________________________
Phone_________________________________
Email__________________________________
Fax___________________________________
Number or Percent of users by ethnicity during 2008: (CIRCLE NUMBER OR PERCENT AND INSERT
FIGURES BELOW)

___Hispanic or Latino
___All others
Number or Percent of users by race during 2009:

(CIRCLE NUMBER OR PERCENT AND INSERT

FIGURES BELOW)

___American Indian/Alaskan Native
___Asian
___Black/African American
___Native Hawaiian/Other Pacific Islander
___White
___More than one race
___Other/Unknown
Number or Percent of users by gender during 2009:
FIGURES BELOW)

8

(CIRCLE NUMBER OR PERCENT AND INSERT

___Male
___Female
Number or Percent of users by age during 2009:

(CIRCLE NUMBER OR PERCENT AND INSERT

FIGURES BELOW)

___0-12
___13-19
___20-44
___45-64
___65+
Populations served (Circle Yes or No)
Migrant or seasonal farmworkers
Homeless

Yes / No

Public Housing

Yes / No

Other (Community health)

Yes / No

Yes / No

Type of site (select one for Homeless Site only)
Fixed serving homeless and general population
Fixed serving homeless only
Mobile serving homeless and general population
Mobile serving homeless only
Eligibility
Number of years in operation (allow decimal points)
Receives at least partial section 330 funding (yes/no)
Types of services
Conducts intake (yes/no)
Face-to-face contact with clients (yes/no)
Language
___% Clients speaking Spanish only
___% Clients speaking other language; SPECIFY LANGUAGE______________
7.

After grantee agrees to participate, ask this contact for suggested sequence for other
approvals/permissions. Specifically, are there approvals that must be acquired before
contacting the site or can we immediately make contact with the site?

8.

Discuss Letter of Agreement, if applicable.

9

SITE RECRUITMENT GUIDELINES
EXAMPLE SCRIPT OF INTRODUCTION:
[ASK FOR PERSON THAT SHOULD HAVE RECEIVED THE ADVANCE PACKAGE]
Hello, my name is ________________ and I’m calling on behalf of the United States
Department of Health and Human Services about the Primary Health Care Patient Surveys
which are sponsored by the Bureau of Primary Health Care within the Health Resources and
Services Administration (HRSA). I’m calling from Research Triangle Institute International,
which has been contracted to conduct the patient surveys. I have already spoken with [GIVE
NAME OF CONTACT AT THE GRANTEE ORGANIZATION] and he/she has given me
permission to contact you about the surveys. I sent you some materials in the mail about the
surveys. I am calling today to discuss the surveys in more detail and answer any questions that
you may have regarding participation.
Do you have time to talk with me now? [THE FIRST CALL MAY LAST 10 MINUTES]. [IF NO]…I
will be happy to call back at a time that is more convenient for you. [SET UP APPOITMENT
DATE AND TIME]
Have you had a chance to look over those materials? [IF NO]…. I will be happy to call back after
you’ve had a chance to do so. [SET UP APPOINTMENT DATE AND TIME]

THE FOLLOWING MUST BE DISCUSSED DURING THIS CALL OR DURING SUBSEQUENT
CALLS:
Give summary of the patient surveys. Include purpose and major tasks.
The purpose of these surveys is to obtain data about the health and health care needs of
patients who received services at Section 330 funded health centers. These national
surveys will provide policy makers and service providers with a better understanding of
the health problems and needs of these patients, their health care utilization, and met
and unmet needs.
Verify information obtained from grantee concerning contact information, users by ethnicity,
users by race, users by age, users by gender, % requiring a translator, type of site and
eligibility criteria.
Clarify our request.
Each selected site will be asked to allow RTI to conduct one-on-one private, personal
interviews with people who have used the site in the previous year (approx XX
interviews per grantee, X or X per site). Copies of the instruments are available for
grantee review.

10

Discuss the schedule for data collection: [Month] – [Month] 2010. We will schedule the data
collection at their convenience, but it must be conducted within this time frame. Let site
know that an RTI interviewer will be conducting the interviews.
What are the days and hours of operation?
Assist in developing the site-specific protocol for reporting situations of distress/abuse or
harm to participants or others. Also, develop referral protocol for respondents
requesting services or assistance. Obtain the name of an appropriate person at the
site or grantee organization for referrals, if applicable and appropriate.
Address concerns of patient protection. Protective measures for the patient surveys include:
•
•
•
•
•
•
•

informing respondents up front that some of the questions may be sensitive in nature and that
they have the right to refuse to answer any questions;
reassuring all subjects that they are under no obligation to respond to the interview and may
terminate their participation at any time;
informing participants that their answers are private, and that their names will not be associated
with responses provided;
conducting the interviews in a private location;
reporting information obtained from the interviews only in summary form;
maintaining hard copies of the consent forms in a locked storage cabinet;
destroying hard copies of consent forms after they are no longer needed;

Discuss study logistics.
Number of clients per day:
Migrant and seasonal farmworkers (if any)
Homeless (if any)
Public Housing (if any)
All other (Community Health)
Best time to interview clients (select one)
While awaiting receipt of services
After receiving services
Special appointment
Preference for respondent incentive (Mark all that apply)
Cash
Visa gift card
Food voucher
Telephone card
Movie tickets
Hygiene bag
Other (Specify)
Discuss the Letter of Agreement, if applicable.

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LETTER OF AGREEMENT FOR A PARTICIPATING SITE

Dear
This letter will serve as an agreement between you and Research Triangle Institute International
regarding your facility’s participation in the Primary Health Care Patient Surveys. As you know, the
patient surveys, sponsored by the Bureau for Primary Health Care within the Health Resources and
Services Administration (HRSA) are being conducted by RTI, a not-for-profit organization based in
North Carolina.
The purpose of these surveys is to collect data on patients who use health centers funded under
Section 330 of the Public Health Service Act, to support the Bureau’s mission to improve the health of the
nation’s medically underserved communities and populations, and to ensure access to high-quality
primary health care services.
Please review the following information for accuracy:
1.

Your site’s administration has agreed to allow the facility to participate. The specific elements of
participation were outlined in the patient surveys overview that you received previously. The
surveys involve in-person interviews with patients aged 13 and older and in-person interviews
with the parents/guardians of patients who are under age 12. (For all interviews conducted with
13-17 year olds, parental consent and minor assent will be obtained.) All data collected will be
strictly private and will be used for research purposes only.

2.

Your internal review process is complete and the research is approved for implementation at your
site. No exceptions or stipulations were noted.

3.

The designated contact person from your site is .

4.

Your staff and RTI have determined the protocol for addressing subjects that may display
significant emotional distress or volunteer other information that requires intervention or
reporting.

5.

Data collection for the visit survey will be conducted between [MONTH] and [MONTH] 2010.
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Your signature below indicates that you confirm/agree with the contents of this letter and that the
Primary Health Care Patient Surveys can be initiated at your site.

_____________________________

___________________
Date

Please make a copy of this letter for your records. Please fax this signed letter to [RECRUITER]
at 919 XXX-XXXX). After faxing the letter, please return the original to RTI in the enclosed selfaddressed stamped envelope.
If you have any questions now, or at any time during the study, please do not hesitate to call
either Jody Greene at 1-800-XXX-XXXX, ext 2710 or Kristine Fahrney at 1-800-XXX-XXXX, ext.
5531. We look forward to working with you and your staff. Again, thank you for participating in this
study.
Sincerely,

Kristine Fahrney
RTI Project Director for the
Community Health Center Patient Survey

Jody Greene
RTI Project Director for the
Special Populations Patient Survey

cc:

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Primary Health Care Patient Surveys
Respondent Recruitment Script

You have been invited to participate in an interview as part of an important research effort being
conducted by Research Triangle Institute and sponsored by the Bureau of Primary Health Care.
The interview asks about your health care experiences and some other topics.
You will receive $25 in either CASH or CASH EQUIVALENCY as thanks for your
participation.
Here is a brochure that provides information about the study.
If you are interested in participating, or have any questions, please read the brochure and speak
with the on-site RTI representative, _______________________________.
If the on-site RTI representative is not available and you would like to find out more
information about the study, I can set an appointment for you to speak with her/him.
We hope you will choose to participate.
Thank you!

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Primary Health Care Patient Survey
Contact Summary Report Form
Case ID:___________________________

FI Name:__________________________

FS Name:______________________________

Grantee Number:____________________

Grantee Name:__________________________

Site Number:_______________________

Site Name:_____________________________

RECORD OF CONTACTS

DATE

TIME

TYPE OF
INTERVIEW

STATUS*

COMMENTS

* IF AN APPOINTMENT IS SET FOR A LATER TIME, DOCUMENT THE RESPONDENT’S FIRST NAME, CONTACT NUMBER, THE
LOCATION AND TIME OF THE APPOINTMENT, AND THE PARENT/GUARDIAN NAME (IF APPLICABLE) IN THE COMMENTS
SECTION.

Interviewer Notes:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Status Codes: (To be finalized and inserted)

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Patient Screening Form
Primary Health Care Patient Surveys
S1.

Have (you/child’s name) received services from a health care professional such as a doctor, nurse, drug
counselor, mental health counselor, or dentist at [NAME OF HEALTH CARE CENTER SITE] in the last
12 months?
YES.................................... 1
NO...................................... 2 (TERMINATE INTERVIEW)
REFUSED.......................... 7 (TERMINATE INTERVIEW)
DON’T KNOW.................. 9 (TERMINATE INTERVIEW)

S2.

Do any of the following apply to you?
Have you worked as a farmworker in the past 24 months or have you or has anyone in your family been
supported by someone who worked as a farmworker in the past 24 months?
YES.................................... 1 IF YOUR QUOTA IS ALREADY MET, THANK THE
RESONDENT FOR THEIR TIME. IF NOT, USE AN M
CASE ID AND SKIP TO S3
NO...................................... 2
In the past 12 months, has there been a period in which you have been without regular housing or
homeless? To clarify, that is not living in your own house, apartment, or room on a regular basis and not in
a hospital or jail/prison. For example, living in a shelter, on the street/campsite/car/etc. or in temporary or
transitional housing where services are provided.
YES.................................... 1 IF YOUR QUOTA IS ALREADY MET, THANK THE
RESONDENT FOR THEIR TIME. IF NOT, USE AN H
CASE ID AND SKIP TO S3
NO...................................... 2
Are you currently living in a public housing unit? Do not count Section 8 housing as public housing.
YES.................................... 1 IF YOUR QUOTA IS ALREADY MET, THANK THE
RESONDENT FOR THEIR TIME. IF NOT, USE A P CASE
ID AND SKIP TO S3
NO...................................... 2
NONE OF THE ABOVENONE ................................ 3 IF YOUR QUOTA IS ALREADY MET, THANK THE
RESONDENT FOR THEIR TIME. IF NOT, USE A C CASE
ID AND SKIP TO S3

S3.

What is your age?
•
•
•

____ YEARS
IF RESPONDENT IS 18 OR OLDER, THEN CONTINUE WITH INFORMED CONSENT AND
CONDUCT INTERVIEW OR SCHEDULE AN INTERVIEW FOR A LATER DATE IF R IS
INTERESTED BUT UNAVAILABLE.
IF PROXY RESPONDENT FOR CHILD AGE 12 OR YOUNGER, THEN CONTINUE WITH
INFORMED CONSENT AND CONDUCT INTERVIEW OR SCHEDULE AN INTERVIEW FOR
A LATER DATE IF R IS INTERESTED BUT UNAVAILABLE.
IF RESPONDENT IS 13-17, THEN GO TO S4.

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S4.

Is a parent or guardian with you?
YES........................................1 (FIND PARENT, AND PROCEED WITH PARENTAL
INFORMED CONSENT PROCEDURES, ASSENT
PROCEDURES AND CONDUCT OR SCHEDULE
INTERVIEW.)
NO...................................... 2 (THANK POTENTIAL R, TERMINATE INTERVIEW)
REFUSED.......................... 7 (THANK POTENTIAL R, TERMINATE INTERVIEW)
DON’T KNOW.................. 9 (THANKS POTENTIAL R, TERMINATE INTERVIEW)

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Resource List

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