686 2013 686 VHA Medical Centers Questionnaire Redesign Ques

American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

2013 686 VHA Medical Centers Questionnaire Redesign Questions April 8 2013.xlsx

2013 659 FDA Mobile - 2013 686 VA Medical Centers

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Current Model Qsts
Current Custom Qsts


Sheet 1: Current Model Qsts







VHA Medical Centers



MID: 4E989k41otEAc5w1UI9opw==


Date: Fill In Date

\
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.













































































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
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