NHSC Site Ret Questionnaire_pilot report_final

NHSC Site Retention Assessment Questionnaire
Pilot Survey/Pre-Testing Report

On July 25, 2012, approximately 16 sites were randomly selected to participate in a pilot survey administered by the National Health Service Corps (NHSC). The selected sites were given 1 week (7 days) to review and complete the pilot survey. The NHSC Site Retention Assessment Questionnaire Pilot Test was conducted to 1) obtain burden estimates which account for the time (in minutes) it would take respondents to complete the evaluation tool, and 2) have sites provide general feedback or comments regarding the survey (inquiries and/or suggestions regarding information collected or questions posed). Nine out of the 16 sites (56%) responded to the pilot, with an average (mean value) burden estimate of 30 minutes. No additional comments on the survey and/or the survey questions were stated by the respondents.

Below is a listing of the sites selected for the pilot survey; participants are highlighted in yellow.

Name	Organization	Location
Michelle Davis	Stewart Memorial Hospital/ McCrary-Rost Clinics	Lake City, Iowa
Todd Consbruck	Dinklage Medical Clinic	West Point, Nebraska
Brandy Weber	Grace Med FQHC	Wichita, Kansas
Chrissy Warren	Cross Trails FQHC	Cape Girardeau, Missouri
Rebecca Rayman	Good Neighbor FQHC	Columbus, Nebraska
Teddy Foster	BJC Behavioral Health	St. Louis, Missouri
Mike DeAnda	Des Moines Health Center	Des Moines, Iowa
Chrysanne Grund	Greeley County Family Practice	Tribune, Kansas
Kristi Carmean	Three Lower Counties Community Services, Inc.	Princess Anne, Maryland
Rosa Rivera	Henrietta Johnson Medical Center	Wilmington, DE
Mark Mancinelli	Delaware Valley Community Health Inc.	Philadelphia, PA
Russell Miller, MD	Russell Miller MD Family Practice, PC	Patton, PA
Jeanette Edwards	Eastern Shore Rural Health	Onancock, VA
Carolyn Bagley	Johnson Health Center	Lynchburg, VA
Velvet Harper	Community Care WV	Rock Cave, WV
Mandi Pitsenbarger	Valley Health Systems, Inc.	Huntington, WV

6/17/2013