10-10127 Telehealth Master Preceptor

OMB Number 2900-0770

Estimated Burden: 10 min

ExpirationEXP Date: XX/XX/2014

Telehealth Master Preceptor

VA Form 10-10127

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 130 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve improved mental health services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be

Telehealth Master Preceptor project

Purpose of survey: To determine why Telehealth participants are non-responders. A non-responder is someone who is not completing their health check sessions as required by Telehealth policy. This information can be utilized for program improvements to increase Veteran satisfaction.

Method: A four (4) question phone survey conducted by Telehealth Care Coordinator with Veterans who are either currently enrolled in home Telehealth or have been enrolled in the past 3-6 months.

1. What might have prevented you from completing your sessions daily?

• Takes too long to complete a session; too many questions

• To complicated

• Other life events happening that limits participation, such as family or work

• The program became repetitive or boring

• Equipment issues

• Other ________________________________________________________

2. Do you have suggestions to improve frequency of completing sessions daily?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. How often do you feel health check sessions should be required?

___________________________________________________________________

2. On days you did respond or complete your health checks did you find the program helpful?

 YES  NO