Form #1 Form #1 Guide to Clinical Preventive Services Feedback Questionn

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Form Approved
OMB No. 0935-0179
Exp. Date 7/31/2014

ell Us What You Think About the 2012 Guide to Clinical Preventive Services

Please provide feedback on the Guide to Clinical Preventive Services so we can better meet your information needs.

Do you primarily consider yourself a:

___Clinician

___Health Professions Educator

___Policymaker

___Health Care System Administrator

___Student or Resident

___Other ________________________

How do you/will you use the 2012 Guide to Clinical Preventive Services?

___As a teaching tool for clinical students

___As a direct patient care resource

___Staying up-to-date/background information

___As a self-study tool in a clinical curriculum or for board exam preparation

___To inform policy discussions

___As a patient education tool

___ Other____________________________________________________________________

How frequently do you refer to the print format of the Guide?

___Daily

___Weekly

___Monthly

___Every couple of months

___Never

Do you use any of the following electronic formats of the USPSTF recommendations?

___Electronic Preventive Services Selector (ePSS) on handheld device (phone, tablet)

___ePSS on personal computer

___Recommendations at USPreventiveServicesTaskForce.org

___None

If you use an electronic format, do you refer to it more or less frequently than the print version of the Guide?

___More frequently

___Less frequently

___Same

Public reporting burden for this collection of information is estimated to average 2 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. 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 (0935-0179) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Have you used previous print editions of the Guide? ___Yes ___No

How satisfied are you with this print format of the 2012 Guide?

___Very satisfied ___Satisfied ___Neutral ___Dissatisfied ___Very dissatisfied

Please indicate the usefulness of the following sections of the 2012 Guide from very useful (1) to not at all useful (5):

___ Table of ‘A’ and ‘B’ recommendations (How the U.S. Preventive Services Task Force Grades Its Recommendations)

___ Clinical summaries of recommendations (Recommendations for Adults/Children and Adolescents)

___ Topics in Progress

___ Definitions of grades assigned to recommendations (Appendix A)

___ About the U.S. Preventive Services Task Force (Appendix D)

___ More Resources (Appendix E)

Is there any other information about clinical preventive services that you feel should be included in the print format of the Guide to Clinical Preventive Services? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other Suggestions/Comments ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________