686 2013 686 VHA Medical Centers Questionnaire Redesign Ques

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Overview

Current Model Qsts
Current Custom Qsts

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Sheet 1: Current Model Qsts

VHA Medical Centers
MID:	4E989k41otEAc5w1UI9opw==
Date:	Fill In Date
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Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Content (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Return (1=Very Unlikely, 10=Very Likely)
	Please rate the accuracy of information on this site.		What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		How likely are you to return to this site?
	Please rate the quality of information on this site.		How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
	Please rate the freshness of content on this site.		How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		How likely are you to recommend this site to someone else?
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
	Please rate the visual appeal of this site.
	Please rate the balance of graphics and text on this site.
	Please rate the readability of the pages on this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
	Please rate how well the site is organized.
	Please rate the options available for navigating this site.
	Please rate how well the site layout helps you find what you are looking for.
	Please rate the number of clicks to get where you want on this site.
	Search (1=Poor, 10=Excellent, Don't Know)
	Please rate the relevance of search results on this site.
	Please rate the organization of search results on this site.
	Please rate how well the search results help you decide what to select.
	Please rate how well the search feature helps you to narrow the results to find what you want.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
	Please rate how quickly pages load on this site.
	Please rate the consistency of speed from page to page on this site.
	Please rate the ability to load pages without getting error messages on this site.

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Sheet 2: Current Custom Qsts

Model Instance Name: VHA Medical Centers			red & strike-through: DELETE
			underlined & italicized: RE-ORDER
MID: 4E989k41otEAc5w1UI9opw==			pink: ADDITION
			blue + -->: REWORDING
CUSTOM QUESTION LIST
QID (Group ID)	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
EDO03866		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Visit Frequency
			Frequently (about once a month or more often)	A, B
			Infrequently (Every few months or less often)	A,B
ACQinh0025396	A	We’ve recently redesigned our VA Medical Center websites. Please select the statement which best describes your experience with the redesign.	It is easier to find what I am looking for		Radio button, one-up vertical	Single	Y	Skip Logic	Redesign Ability to find
			It is harder to find what I am looking for
			My experience is no different when looking for information on the new site
			Don't Know
ACQinh0025397	B	Do you like the new layout of the medical center pages?	Yes		Radio button, one-up vertical	Single	Yes	Skip Logic	Opinion of Redesign
			No	BB
			No Opinion
ACQinh0025398	BB	What didn't you like about the new medical center pages?			Test area, no character limit		N	Skip Logic	OE_Redesign
EDO03867		Please tell us who you are.	Veteran	B	Radio button, one-up vertical	Single	Y		Role
			Active Duty	B
			Family Member / Friend
			VA Employee
			Volunteer
			Healthcare Professional (MD, RN, etc.)
			Job Applicant
			Student / Healthcare Trainee
			Media
			Other, please specify:	A
EDO03868	A	Other, please specify:			Text area, no char limit				OE_Role
EDO03869	B	Please check the conflict(s) in which you served.	World War II		Checkbox, one-up vertical	Multi	Y		Conflict
			Korean Conflict
			Vietnam Era
			Persian Gulf War
			Operation Enduring Freedom
			Operation Iraqi Freedom
			Operation New Dawn
			No conflict / war service
EDO03870		Please select your age range:	17 or under		Radio button, one-up vertical	Single	Y		Age
			18-24
			25-34
			35-44
			45-54
			55-64
			65+
			Prefer not to answer
EDO03871		Please select your gender:	Male		Radio button, one-up vertical	Single	Y		Age
			Female
			Prefer not to answer
EDO03872		From which medical center do you get the majority of your care? (Choose State First) (If you receive most of your care at a community-based outpatient clinic, please select the medical center from which you would receive advanced care if needed).	Do not have a primary medical center		Drop down, select one	Single	Y		State
			Alaska	A
			Alabama	B
			Arkansas	C
			Arizona	D
			California	E
			Colorado	F
			Connecticut	G
			District of Columbia	H
			Delaware	I
			Florida	J
			Georgia	K
			Hawaii	L
			Iowa	M
			Idaho	N
			Illinois	O
			Indiana	P
			Kansas	Q
			Kentucky	R
			Louisiana	S
			Massachusetts	T
			Maryland	U
			Maine	V
			Michigan	W
			Minnesota	X
			Missouri	Y
			Mississippi	Z
			Montana	AA
			North Carolina	BB
			North Dakota	CC
			Nebraska	DD
			New Hampshire	EE
			New Jersey	FF
			New Mexico	GG
			Nevada	HH
			New York	II
			Ohio	JJ
			Oklahoma	KK
			Oregon	LL
			Pennsylvania	MM
			Puerto Rico	NN
			Rhode Island	OO
			South Carolina	PP
			South Dakota	QQ
			Tennessee	RR
			Texas	SS
			Utah	TT
			Virginia	UU
			Vermont	VV
			Washington	WW
			Wisconsin	XX
			West Virginia	YY
			Wyoming	ZZ
EDO03873	A	Which Medical Center in Alaska do you visit?	Anchorage - Alaska VA Healthcare System		Radio button, one-up vertical
EDO03874	B	Which Medical Center in Alabama do you visit?	Birmingham - Birmingham VA Medical Center		Radio button, one-up vertical
			Montgomery - Central Alabama Veterans Health Care System
			Tuscaloosa - Tuscaloosa VA Medical Center
			Tuskegee - Central Alabama Veterans Health Care System
EDO03875	C	Which Medical Center in Arkansas do you visit?	Fayetteville - Veterans Health Care System of the Ozarks		Radio button, one-up vertical
			Little Rock - Central Arkansas Veterans Healthcare System
			North Little Rock - Central Arkansas Veterans Healthcare System
EDO03876	D	Which Medical Center in Arizona do you visit?	Phoenix - Phoenix VA Health Care System		Radio button, one-up vertical
			Prescott - Northern Arizona VA Health Care System
			Tucson - Southern Arizona VA Health Care System
EDO03877	E	Which Medical Center in California do you visit?	Fresno - VA Central California Health Care System		Radio button, one-up vertical
			Livermore - VA Palo Alto Health Care System
			Loma Linda - VA Loma Linda Healthcare System
			Long Beach - VA Long Beach Healthcare System
			Los Angeles - VA Greater Los Angeles Healthcare System
			Mather - VA Northern California Health Care System
			Menlo Park - VA Palo Alto Health Care System
			Palo Alto - VA Palo Alto Health Care System
			San Diego - VA San Diego Healthcare System
			San Francisco - San Francisco VA Medical Center
EDO03878	F	Which Medical Center in Colorado do you visit?	Denver - VA Eastern Colorado Health Care System		Radio button, one-up vertical
			Grand Junction - Grand Junction VA Medical Center
EDO03879	G	Which Medical Center in Connecticut do you visit?	Newington - VA Connecticut Healthcare System		Radio button, one-up vertical
			West Haven - VA Connecticut Healthcare System
EDO03880	H	Which Medical Center in District of Columbia do you visit?	Washington DC - Washington DC VA Medical Center		Radio button, one-up vertical
EDO03881	I	Which Medical Center in Delaware do you visit?	Wilmington - Wilmington VA Medical Center		Radio button, one-up vertical
EDO03882	J	Which Medical Center in Florida do you visit?	Bay Pines - Bay Pines VA Healthcare System		Radio button, one-up vertical
			Miami - Miami VA Healthcare System
			Gainesville - North Florida / South Georgia VA Healthcare System
			Lake City - North Florida / South Georgia VA Healthcare System
			Orlando - Orlando VA Medical Center
			Tampa - James A. Haley Veterans' Hospital
			West Palm Beach - West Palm Beach VA Medical Center
EDO03883	K	Which Medical Center in Georgia do you visit?	Augusta - Charlie Norwood VA Medical Center		Radio button, one-up vertical
			Decatur - Atlanta VA Medical Center
			Dublin - Carl Vinson VA Medical Center
EDO03884	L	Which Medical Center in Hawaii do you visit?	Honolulu - VA Pacific Islands Health Care System		Radio button, one-up vertical
EDO03885	M	Which Medical Center in Iowa do you visit?	Des Moines - VA Central Iowa Health Care System		Radio button, one-up vertical
			Iowa City - Iowa City VA Medical Center
EDO03886	N	Which Medical Center in Idaho do you visit?	Boise VA Medical Center		Radio button, one-up vertical
EDO03887	O	Which Medical Center in Illinois do you visit?	Chicago - Jesse Brown VA Medical Center		Radio button, one-up vertical
			Danville - VA Illiana Health Care System
			Hines - Edward Hines Jr. VA Hospital
			Marion - Marion VA Medical Center
			North Chicago – Captain James A. Lovell Federal Healthcare Center
EDO03888	P	Which Medical Center in Indiana do you visit?	Fort Wayne - VA Northern Indiana Health Care System		Radio button, one-up vertical
			Indianapolis - Richard L. Roudebush VA Medical Center
			Marion - VA Northern Indiana Health Care System
EDO03889	Q	Which Medical Center in Kansas do you visit?	Leavenworth - VA Eastern Kansas Health Care System		Radio button, one-up vertical
			Topeka - VA Eastern Kansas Health Care System
			Wichita - Robert J. Dole VA Medical Center
EDO03890	R	Which Medical Center in Kentucky do you visit?	Lexington - Lexington VA Medical Center (Cooper Division)		Radio button, one-up vertical
			Lexington - Lexington VA Medical Center (Leestown Division)
			Louisville - Louisville VA Medical Center
EDO03891	S	Which Medical Center in Lousiana do you visit?	New Orleans - Southeast Louisiana Veterans Health Care System		Radio button, one-up vertical
			Pineville - Alexandria VA Medical Center
			Shreveport - Overton Brooks VA Medical Center
EDO03892	T	Which Medical Center in Massachusetts do you visit?	Bedford - Edith Nourse Rogers Memorial Veterans Hospital		Radio button, one-up vertical
			Brockton - VA Boston Healthcare System
			Jamaica Plain - VA Boston Healthcare System
			Leeds – Central Western Massachusetts Health Care System
			West Roxbury - VA Boston Healthcare System
EDO03893	U	Which Medical Center in Maryland do you visit?	Baltimore - VA Maryland Health Care System		Radio button, one-up vertical
			Perry Point - Perry Point VA Medical Center
EDO03894	V	Which Medical Center in Maine do you visit?	Augusta - Togus VA Medical Center		Radio button, one-up vertical
EDO03895	W	Which Medical Center in Michigan do you visit?	Ann Arbor - VA Ann Arbor Healthcare System		Radio button, one-up vertical
			Battle Creek - Battle Creek VA Medical Center
			Detroit - John D. Dingell VA Medical Center
			Iron Mountain - Oscar G. Johnson VA Medical Center
			Saginaw - Aleda E. Lutz VA Medical Center
EDO03896	X	Which Medical Center in Minnesota do you visit?	Minneapolis - Minneapolis VA Medical Center		Radio button, one-up vertical
			St. Cloud - St. Cloud VA Medical Center
EDO03897	Y	Which Medical Center in Missouri do you visit?	Columbia - Harry S. Truman Memorial VA Medical Center		Radio button, one-up vertical
			Kansas City - Kansas City VA Medical Center
			Poplar Bluff - John J. Pershing VA Medical Center
			St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division)
			St. Louis - St. Louis VA Medical Center (John Cochran Division)
EDO03898	Z	Which Medical Center in Mississippi do you visit?	Biloxi - VA Gulf Coast Veterans Health Care System		Radio button, one-up vertical
			Jackson - G.V. (Sonny) Montgomery VA Medical Center
EDO03899	AA	Which Medical Center in Montana do you visit?	Fort Harrison - VA Montana Health Care System		Radio button, one-up vertical
EDO03900	BB	Which Medical Center in North Carolina do you visit?	Asheville - Asheville VA Medical Center		Radio button, one-up vertical
			Durham - Durham VA Medical Center
			Fayetteville - Fayetteville VA Medical Center
			Salisbury - W.G. (Bill) Hefner VA Medical Center
EDO03901	CC	Which Medical Center in North Dakota do you visit?	Fargo - Fargo VA Medical Center		Radio button, one-up vertical
EDO03902	DD	Which Medical Center in Nebraska do you visit?	Omaha - VA Nebraska-Western Iowa Health Care System		Radio button, one-up vertical
EDO03903	EE	Which Medical Center in New Hampshire do you visit?	Manchester - Manchester VA Medical Center		Radio button, one-up vertical
EDO03904	FF	Which Medical Center in New Jersey do you visit?	East Orange - VA New Jersey Health Care System		Radio button, one-up vertical
			Lyons - VA New Jersey Health Care System
EDO03905	GG	Which Medical Center in New Mexico do you visit?	Albuquerque - New Mexico VA Health Care System		Radio button, one-up vertical
EDO03906	HH	Which Medical Center in Nevada do you visit?	Las Vegas - VA Southern Nevada Healthcare System		Radio button, one-up vertical
			Reno - VA Sierra Nevada Health Care System
EDO03907	II	Which Medical Center in New York do you visit?	Albany - Samuel S. Stratton VA Medical Center		Radio button, one-up vertical
			Batavia - VA Western New York Healthcare System
			Bath - Bath VA Medical Center
			Bronx - James J. Peters VA Medical Center
			Brooklyn - VA NY Harbor Healthcare System
			Buffalo - VA Western New York Healthcare System
			Canandaigua - Canandaigua VA Medical Center
			Castle Point - VA Hudson Valley Health Care System
			Montrose - VA Hudson Valley Health Care System
			New York - VA NY Harbor Healthcare System - Manhattan Campus
			Northport - Northport VA Medical Center
			Syracuse - Syracuse VA Medical Center
EDO03908	JJ	Which Medical Center in Ohio do you visit?	Chillicothe - Chillicothe VA Medical Center		Radio button, one-up vertical
			Cincinnati - Cincinnati VA Medical Center
			Cleveland - Louis Stokes VA Medical Center
			Columbus - Chalmbers P. Wylie Ambulatory Care Center
			Dayton - Dayton VA Medical Center
EDO03909	KK	Which Medical Center in Oklahoma do you visit?	Muskogee - Jack C. Montgomery VA Medical Center		Radio button, one-up vertical
			Oklahoma City - Oklahoma City VA Medical Center
EDO03910	LL	Which Medical Center in Oregon do you visit?	Roseburg - VA Roseburg Healthcare System		Radio button, one-up vertical
			Portland - Portland VA Medical Center
EDO03911	MM	Which Medical Center in Pennsylvania do you visit?	Altoona - James E. Van Zandt VA Medical Center		Radio button, one-up vertical
			Butler - VA Butler Healthcare System
			Coatesville - Coatesville VA Medical Center
			Erie - Erie VA Medical Center
			Lebanon - Lebanon VA Medical Center
			Philadelphia - Philadelphia VA Medical Center
			Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division)
			Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division)
			Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center)
			Wilkes-Barre - Wilkes-Barre VA Medical Center
EDO03912	NN	Which Medical Center in Puerto Rico do you visit?	San Juan - VA Caribbean Healthcare System		Radio button, one-up vertical
EDO03913	OO	Which Medical Center in Rhode Island do you visit?	Providence - Providence VA Medical Center		Radio button, one-up vertical
EDO03914	PP	Which Medical Center in South Carolina do you visit?	Charleston - Ralph H. Johnson VA Medical Center		Radio button, one-up vertical
			Columbia - Wm. Jennings Bryan Dorn VA Medical Center
EDO03915	QQ	Which Medical Center in South Dakota do you visit?	Fort Meade - VA Black Hills Health Care System		Radio button, one-up vertical
			Hot Springs - VA Black Hills Health Care System
			Sioux Falls - Sioux Falls VA Medical Center
EDO03916	RR	Which Medical Center in Tennessee do you visit?	Memphis - Memphis VA Medical Center		Radio button, one-up vertical
			Mountain Home - Mountain Home VA Medical Center
			Murfreesboro - Tennessee Valley Healthcare System
			Nashville - Tennessee Valley Healthcare System
EDO03917	SS	Which Medical Center in Texas do you visit?	Amarillo - Amarillo VA Health Care System		Radio button, one-up vertical
			Big Spring - West Texas VA Health Care System
			Dallas - VA North Texas Health Care System
			El Paso - El Paso VA Health Care System
			San Antonio - South Texas Veterans Health Care System
			Temple - Central Texas Veterans Health Care System
			Bonham - VA North Texas Health Care System
			Houston - Michael E. DeBakey VA Medical Center
			Kerrville - Kerrville VA Medical Center
			Waco - Central Texas Veterans Health Care System
EDO03918	TT	Which Medical Center in Utah do you visit?	Salt Lake City - VA Salt Lake City Health Care System		Radio button, one-up vertical
EDO03919	UU	Which Medical Center in Virginia do you visit?	Hampton - Hampton VA Medical Center		Radio button, one-up vertical
			Richmond - Hunter Holmes McGuire VA Medical Center
			Salem - Salem VA Medical Center
EDO03920	VV	Which Medical Center in Vermont do you visit?	White River Junction - White River Junction VA Medical Center		Radio button, one-up vertical
EDO03921	WW	Which Medical Center in Washington do you visit?	Seattle - VA Puget Sound Health Care System		Radio button, one-up vertical
			Tacoma - VA Puget Sound Health Care System (American Lake Division)
			Spokane - Spokane VA Medical Center
			Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center
EDO03922	XX	Which Medical Center in Wisconsin do you visit?	Madison - William S. Middleton Memorial Veterans Hospital		Radio button, one-up vertical
			Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center
			Tomah - Tomah VA Medical Center
EDO03923	YY	Which Medical Center in West Virginia do you visit?	Beckley - Beckley VA Medical Center		Radio button, one-up vertical
			Clarksburg - Louis A. Johnson VA Medical Center
			Huntington - Huntington VA Medical Center
			Martinsburg - Martinsburg VA Medical Center
EDO03924	ZZ	Which Medical Center in Wyoming do you visit?	Cheyenne - Cheyenne VA Medical Center		Radio button, one-up vertical
			Sheridan - Sheridan VA Medical Center
EDO03925		What type of information were you trying to find on this medical center web site? (Check all that apply)	Facility contact information		Checkbox, one-up vertical	Multi	Y
			Directions / Locations
			Hours of Operation
			Services Available
			Make, change, or cancel an appointment
			Prescription refills
			Emergency information
			Jobs
			Volunteer Information
			Transportation (Rural, DAV, etc.)
			Family & Dependent Health Benefits
			Healthcare Eligibility
			Health Education (classes, tutorials, etc.)
			General Health Information
			Healthcare Professional Training (Students, Residents, etc.)
			Home Health Care
			Nursing Home Care
			Telephone Care (after hours)
			Other, please specify:	A
EDO03926	A	Other, please specify							OE_Reason
EDO03927		Did you find what you were looking today?	Yes		Radio button, one-up vertical	Single	Y		Find Info
			No, I was looking for:	A
EDO03928	A	What specific information were you unable to find?							OE_Find
EDO03933		Do you believe the amount of information provided about services offered at this VA Medical Center is adequate?	Yes		Radio button, one-up vertical	Single	Y		Services Adequate
			No	A
EDO03934	A	Why not?			Text area, no char limit				OE_Not Adequate
EDO03935		Where did you first hear about this VA Medical Center web site?	During Enrollment		Radio button, one-up vertical	Single	Y		How Hear
			At the Medical Center
			From my provider (doctor, nurse, social worker, etc.)
			Search Engine
			Social Networks (Facebook, Twitter, etc.)
			www.va.gov
			www.va.gov/health
			I browsed directly to the site
			Other, please specify:	A
EDO03936	A	Other, please specify:							OE_How Hear
EDO03937		Would you like to see additional information about recent news & events at this medical center and its clinics?	Yes	A	Radio button, one-up vertical	Single	Y		Add Info
			No
EDO03938	A	How would you like to see this information? (Check all that apply)	Directly on the medical center's web site		Checkbox, one-up vertical	Multi	Y		How Add Info
			Email
			Social Networking (Facebook, Twitter, etc.)
			RSS
			SMS / Text Messaging
EDO03931		Do you use MyHealtheVet (prescription refills, personal health record, etc.)?	Yes	A	Radio button, one-up vertical	Single	Y		MHV Usage
			No	B
EDO03939	A	Have you completed the In-Person Authentication (IPA) which allows you to view the names of your prescriptions, view lab test results, and see your upcoming appointments?	Yes		Radio button, one-up vertical	Single	Y		IPA
			No
EDO03932	B	Why not?			Text area, no char limit				OE_Not Use MHV
EDO03929		Do you use any of the following while on the Internet? (Check all that apply)	Facebook		Checkbox, one-up vertical	Multi	Y		Social media
			MySpace
			LinkedIn
			Twitter
			YouTube
			Pinterest
			Google+
			Foursquare
			Yelp
			Flickr
			Blogs
			Del.icio.us
			Digg
			Podcasts
			I do not use any of these social media tools.			8889
			Other, please specify:	A
EDO03930	A	Other, please specify:			Text area, no char limit				OE_Social Media