Form 414 ePSS Questionn 414 ePSS Questionn 414 ePSS Questionnaire Wave 1 Revised

#REF!			red & strike-through: DELETE
#REF!			underlined & italicized: RE-ORDER
MID: 49ERl4MBQAYAgh85YVh5lg==			pink: ADDITION
Date:	2/25/2011		blue + -->: REWORDING
#REF!
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
EDO10269		Which of the following best describes your position or situation?	Physician		Radio button, one-up vertical	Single	Y	OPS Group	Role
			Physician Assistant
			Nurse
			Nurse Practitioner
			Medical Student
			Other clinician
			Medical assistant/ Medical office staff
			Patient or consumer
			Educator
			Policy maker
			Researcher
			Other (please specify)
EDO10270		What is your position or situation?			Text field, <100 char			OPS Group	Other Role
EDO10271		Have you ever searched or browed USPSTF recommendations on the ePSS before?	Yes		Radio button, one-up vertical	Single	Y		First time
			No
EDO10272		How often in the last six months have you gone to www.epss.ahrq.gov to use the ePSS?	This is my first time visiting it		Radio button, one-up vertical	Single	Y		How often
			Daily or almost daily
			About once a week
			About two or three times a month
			About once a month
			Every few months or less often
EDO10273		How often do you use the ePSS on a mobile device other than a laptop computer (PDA, Blackberry, iPhone/iPad, Android, smart phone,?	Never		Radio button, one-up vertical	Single	Y		Mobile
			Daily or almost daily
			About once a week
			About two or three times a month
			About once a month
			Every few months or less often
EDO10274		How often do you use the ePSS to learn more about a specific U.S. Preventive Services Task Force (USPSTF) recommendation?	This is my first time visiting	A, B	Radio button, one-up vertical	Single	Y	Skip Logic Group	Specific Rec
			Daily or almost daily	A, B
			About once a week	A, B
			About two or three times a month	A, B
			About once a month	A, B
			Every few months or less often	A, B
			Never	A
EDO10275	B	When searching for USPSTF recommendations based on a patient’s characteristics (e.g. age, sex, tobacco use, etc) the search results provide __________.	The right amount of information		Radio button, one-up vertical	Single	Y	Skip Logic Group	Information
			Too much information
			Not enough information
			Not sure
EDO10276	B	When you or a member of your care team searches for preventive service recommendations specific to a patient, at what point do you usually do this? (Check all that apply)	Prior to seeing the patient			Multi	Y	Skip Logic Group	When search
			With the patient
			After seeing the patient
			Other (please specify)	C
EDO10277	C	When do you search for recommendations?			Text field, <100 char		N	Skip Logic Group	Other when search
EDO10278	B	Have you ever used the search function for identifying patient specific recommendations?	Yes	D	Radio button, one-up vertical	Single	Y	Skip Logic Group	Used search
			No
EDO10279	D	How could the search feature be improved?			Text area, no char limit		N		Imp Search
EDO10280	A	Have you ever used the browsing (by topic) capabilities in the ePSS?	Yes	E			Y	Skip Logic Group	Used Browse
			No
EDO10281	E	How could the browse feature be improved?			Text area, no char limit		N	Skip Logic Group	Imp Browse
EDO10282		When discussing preventive services with patients, how often do you actually show the patient the results from the ePSS?	Every time		Radio button, one-up vertical	Single	Y
			Most of the time
			Some of the time
			Never
EDO10283		How often do you or someone else in the office provide patients with any kind of take-home information on preventive health services, such as printed materials or web site addresses?	Every time		Radio button, one-up vertical	Single	Y		Take home
			Most of the time
			Some of the time
			Never
EDO10284		What other suggestions do you have for improving the ePSS application?			Text area, no char limit		N		Improvement