Form #5 Form #5 Online Survey

Attachment E: Online Survey Questionnaire

Online Survey Questionnaire

Number	Follow-Up (Yes/No)	Question	Potential Answers
Form Approved OMB No. 0935-XXXX Exp. Date XX/XX/20XX The Effective Health Care Program (EHC) at the Agency for Healthcare Research and Quality (AHRQ) is undertaking an evaluation of the program’s governance process and outcomes. There are various components to this analysis. This survey will solicit feedback about the EHC program’s governance from a broad and diverse group of individuals. The goal of the survey is to capture a robust view of the EHC program governance system from the vantage point of all stakeholders and within certain stakeholder groups, particularly related to the following topics: • EHC program Goals • Research Topic Selection Process • Priority Conditions and Populations • EHC program Research Impact • Engaging Stakeholders Your participation is extremely valuable to this evaluation and is greatly appreciated. Public reporting burden for this collection of information is estimated to 10-15 minutes per response on average, the estimated time required to complete the survey. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer. Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.
		Which best describes your affiliated organization? [check all that apply]	The EHC program Stakeholder Group Employer or Health Related Business Group Federal Partner Healthcare Industry Healthcare Provider Patient/ Consumer/ Advocacy Organization Pharmacy & Therapeutic Policy Maker Professional Organization Researcher Third Party Healthcare Payer Other (please specify)
		Does your organization have a vested interest in research on any of the following specific conditions? [ check all that apply]	Muscle, bone, and joint conditions Cancer Heart and blood vessel conditions Brain and nerve conditions Mental health Developmental delays, ADHD, autism Diabetes Functional limitations and physical disabilities Infectious diseases and HIV/AIDS Obesity Digestive system conditions Pregnancy and childbirth Breathing conditions Alcohol and drug abuse None of the above
		EHC PROGRAM GOALS
		The EHC program was established as a part of a mandate to provide objective, timely, and rigorous assessments of therapeutics and other health care interventions. Do you agree that the EHC program is providing objective assessment of therapeutics and other interventions?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
		Please, elaborate on your response.	Open ended
		Do you agree that the EHC program is providing timely assessment of therapeutics and other interventions?
		Please, elaborate on your response.	Open ended
		Do you agree that the EHC program is providing rigorous assessment of therapeutics and other interventions?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
		Please, elaborate on your response.	Open ended
8b		Do you agree that the EHC program assessment of therapeutics and other intervention is useful?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
8c		Please elaborate on your response.	Open ended
		Do you agree that the EHC program provides effective translations of complex research findings into publications for policymakers?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
10		Please, elaborate on your opinion.	Open ended response requested
11.		Do you agree that the EHC program provides effective translations of complex research findings into publications for health care providers?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
12.		Please, elaborate on your opinion.	Open ended
13.		Do you agree that the EHC program provides effective translations of complex research findings into publications for consumers/patients?	Strongly Agree Agree Neither agree or disagree Disagree Strongly Disagree
14.		Please, elaborate on your opinion.	Open ended
		RESEARCH SELECTION PROCESS
15.		What has been your role in suggesting topics for research? [check all that apply]	Solicited by the EHC program to nominate a research topic Collaborated with the EHC program to nominate a research topic Nominated, without solicitation from the EHC program, a research topic Other – please specify No role
16.	15(e)	Do you have any interest in suggesting topics for research?	Very interested Interested Moderately Interested Of Little Interest Uninterested
17.	15(e)	Do you know how to nominate a research topic?	Yes No
18.		In your opinion, can the transparency of the EHC program’s selection of research topics be improved?	Strong Need for Improvement Some Need for Improvement No Need for Improvement No Opinion
19.	18(a), 18(b)	What improvements would you recommend to make the selection process more transparent?	Open-ended
20.		The mandated criteria for prioritizing research topics in the EHC program are “health care items or services that: impose high costs on Medicare, Medicaid, or SCHIP programs may be over or underutilized, and those which may significantly improve the prevention, treatment, or cure of diseases and conditions which impose high direct or indirect costs on patients or society. Do you think the EHC program research selection process has been guided by these criteria?	Always Usually Occasionally Usually Not Never No opinion
21.		Beyond the mandated criteria what do you feel significantly affects the selection of research topics?	Open ended
22.		Beyond the mandated criteria what do you feel should affect the selection of research topics?	Open ended
22b		I believe/think that my center has been appropriately engaged by the EHC stakeholders in the topic nomination and selection process.	Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
22c		Please, elaborate on your response.	Open ended
		PRIORITY CONDITIONS & POPULATIONS
23.		Which of the following EHC program priority conditions MOST warrant additional research by the EHC program? [you may check up to 3 boxes]	Muscle, bone, and joint conditions Cancer Heart and blood vessel conditions Brain and nerve conditions Mental health Developmental delays, ADHD, autism Diabetes Functional limitations and physical disabilities Infectious diseases and HIV/AIDS Obesity Digestive system conditions Pregnancy and childbirth Breathing conditions Alcohol and drug abuse None
24.		Please, explain further what specific research is needed.	Open ended
25.		Which of the following priority populations have the most pressing needs/issues that have not been sufficiently addressed by the research of the EHC program? [you may check up to 3 boxes]	Medicare – elderly population Medicare – disabled population Medicaid – children Medicaid – adults SCHIP Other None
26.		Please, explain further what specific research is needed.	Open ended
27.		Which of the following priority populations have needs/issues that have not been MOST sufficiently addressed by the research of the EHC program? [you may check up to 3 boxes]	Low Income Groups Minority Groups Women Children Elderly Individuals with Special Needs Rural populations None
28.		Please, explain further what specific research is needed and why.	Open ended
		EHC PROGRAM RESEARCH IMPACT
29.		For what purposes have you or your organization used EHC program research publications? [check all that apply]	Aide clinical decision-making Change practice guidelines Change formularies Inform regulation Inform legislation Assist with personal health care decisions Other (please specify) Have not used publications
30.		For what other purpose(s)?	Open ended
31.		What have you observed as the impact of the EHC program publications? [check all that apply]	Provided new research Aided clinical decision-making Changes in practice guidelines Changes in formularies Influence on regulation Influence on legislation Changes to effective clinical practice Changes in patient behavior Improved clinical outcomes Improved communication between patients/consumers and clinicians Improved economic outcomes Improved quality of life Other (please specify) No impact
32.		What other impact(s)?	Open ended
33.		Overall, how significant/influential was this impact(s) for your organization?	Very Significant Significant Moderately Significant Of Little Significance Insignificant No opinion
34.		What type of EHC program research/publications have you found to be the most useful? [check all that apply]	Effectiveness or comparative effectiveness review Technical brief New research report Summary guide for clinicians Summary guide for consumers Summary guide for policymakers Research method publication Other (please specify)
35.		What other publication(s)?	Open ended
36.		How would you rate the general awareness of the EHC program’s research and publications among your professional colleagues?	Completely aware Mostly aware Slightly aware Slightly unaware Mostly unaware Mostly unaware Completely unaware Don’t know
		ENGAGING STAKEHOLDERS
37.		How would you change the representative range of stakeholders (patients, providers, policy makers) involved in the EHC program?	Increase Leave the same Decrease No opinion
38.	37(a)	Which type(s) of stakeholders would you add?	Open ended
39.	37(c)	Which type(s) of stakeholders would you remove?	Open ended
40.		The involvement of outside stakeholders in the nomination of research topics should be:	Greater than current level Current level Less than current level No opinion
41.		How would you change their involvement?	Open ended
42.		The involvement of outside stakeholders in the selection of research topics should be:	Greater than current level Current level Less than current level No opinion
43.		How would you change their involvement?	Open ended
44.		The involvement of outside stakeholders in conducting research should be:	Greater than current level Current level Less than current level No opinion
45.		How would you change their involvement?	Open ended
46.		The involvement of outside stakeholders in the translation of research results into tools and publications for the general public should be:	Greater than current level Current level Less than current level Don’t Know
47.		How would you change their involvement?	Open ended
48.		The involvement of outside stakeholders in the distribution of publications should be:	Greater than current level Current level Less than current level Don’t Know
49.		How would you change their involvement?	Open ended
50.		The involvement of outside stakeholders in the implementation of research results should be:	Greater than current level Current level Less than current level Don’t Know
51.		How would you change their involvement?	Open ended
52.		How else could the EHC program involve outside stakeholder groups in order to meet its mandate?	open text
The following set of questions focus on stakeholders. There are two distinct groups of stakeholders in which we are interested. “EHC program Stakeholder Group” refers to an official group of selected members from whom the EHC program seeks input, guidance, and advice. “Outside stakeholders” refers to community members who have an interest in the work of the EHC program but are not members of the EHC program Stakeholder Group.
53.		Are you familiar with the EHC program Stakeholder Group that provides guidance to the EHC program?	Yes Somewhat No
54.	53(a), 53(b)	The issues on which the EHC program seeks the consultation of the EHC program Stakeholder Group should be:	Expanded Remain the Same Reduced Expanded and Reduced No opinion
55.	53(a), 53(b)	Which issue(s)?	Open ended
56.	53(a), 53(b)	Are you aware of the process by which members are selected for the EHC program Stakeholder Group?	Yes No
57.	56(a)	I feel the selection process is:	Very Fair Fair Unfair Very Unfair No Opinion
58.	53(a), 53(b)	Do you feel that the composition of EHC program Stakeholder Group fairly reflects the various types of EHC program stakeholders?	Completely Somewhat Not at all No opinion
59.	58(b), 58(c)	Which essential stakeholders are unrepresented or underrepresented on the EHC program Stakeholder Group?	Open ended
60.		Do the opinions of and/or the guidance provided by the EHC program Stakeholder Group align with those of outside stakeholders in general?	Completely Somewhat Not at all No Opinion
61.	60(b), 60(c)	Where do the opinions differ?	Open ended
62.		Overall, how would you rate your experience as a stakeholder of the EHC program?	Excellent Good Satisfactory Needs Improvement Poor
63.		Please explain/elaborate on your rating
Thank you for sharing your experiences and thoughts about the Effective Health Care (EHC) program at the Agency for Healthcare Research and Quality (AHRQ).  Your input and responses will help us build a better, more efficient structure and program.  We appreciate your valuable time and feedback.  Should you have any thoughts, questions or concerns, please do not hesitate to contact me at [email protected]. Ying Wang, PhD Project Director, Evaluation of AHRQ EHC Program Governance and Priority Setting IMPAQ International