Attachment R -- Invitation to Participate in Patient Survey 020411

Patient Survey – Pre- and post-implementation

Invitation Text

Dear Patient,

We are writing to ask you to participate in a Patient Feedback Survey for [INSERT HOSPITAL NAME] patients. The purpose of the survey is to obtain feedback about your recent hospital stay. This survey is being conducted by the American Institutes for Research and funded by the Agency for Healthcare Research and Quality as part of a project to develop and evaluate a Guide to Patient and Family Engagement.

We have included a copy of the Patient Feedback Survey with this letter. The survey asks about your experiences in the hospital during your recent stay and the care you received. Your answers to these questions will help us understand how the Guide works, how it affects patients and family members, and what we can do to improve it. .

To respond to this survey, please complete the enclosed questionnaire. When you are finished, please place the completed questionnaire in the stamped envelope and send it to AIR. You do not need to add additional stamps to this envelope.

To say thank you, we have attached a two dollar bill to this survey. This is yours to keep whether you send the survey or not. But, we thank you for participating!

This survey should take about 30 minutes to complete. Participation in this survey is voluntary. You can decide not to complete the survey or to stop completing the survey at any time without penalty. The survey is being administered by Dr. Kristin Carman of the American Institutes for Research (AIR). She can be reached at 202-403-5090 or [email protected] with any questions or concerns.

Your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). Results from this survey will only be presented in a large group. If you have any concerns or questions about your rights as a participant in this survey, contact AIR’s Institutional Review Board (which is responsible for the protection of project participants) at [email protected] or toll free at 1-800-634-0797.

Sincerely,

Kristin Carman, Ph.D.

Frequently Asked Questions

What is this survey about?

This survey is about your recent stay at [INSERT HOSPITAL NAME]. The survey asks about your experiences during your stay, including the care you received from doctors or nurses and whether or not certain things happened during your stay.

Who is sponsoring this survey?

This survey is being sponsored by the Agency for Healthcare Research and Quality (AHRQ), the federal government agency in charge of improving the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ has asked the American Institutes for Research (AIR), a non-profit research organization, to conduct this survey.

Who should answer the questions?

We are asking the person who was just hospitalized at [INSERT HOSPITAL NAME] to complete this survey.

What do I have to do?

A copy of the survey is enclosed with this letter. All you have to do is complete the survey, which should take about 30 minutes of your time. Once you have completed the survey, please place it in the postage-paid envelope and mail it back to us.

Why should I participate?

Your answers to this survey will help AIR and AHRQ develop and evaluate a Guide to Patient and Family Engagement that will be used in hospitals. The purpose of the Guide is to provide support for patients and family members by helping them become engaged in the quality and safety of care they receive.

Will you keep my information confidential?

Yes, we respect your privacy. We will not ask for your name, and your responses will be kept confidential to the extent permitted by law, including AHRQ’s confidentiality statute, 42 USC 299c-3(c). That law requires that information collected for research conducted or supported by AHRQ be used only for the purpose for which it was supplied unless you consent to the use of the information for another purpose.