Survey - word

Attachment B – Instrument: Word Version

Form Approved

OMB No. 0920-0879

Expiration Date 03/31/2018

Assessment of the Tuberculosis Laboratory Aggregate Report

Welcome! This information collection is for state, local, and territorial public health laboratory supervisors, or their designees, who administer tuberculosis laboratory services and are funded by Division of Tuberculosis Elimination (DTBE) cooperative agreements. We would like to know your perceptions regarding the Fourth Edition of the Tuberculosis Laboratory Aggregate Report issued by the DTBE Laboratory Branch and how information in the report was utilized by your program.

A PDF of The Fourth Edition of the Tuberculosis Laboratory Aggregate Report can be viewed and downloaded at: (insert link when report posted on DTBE website)

The information you provide will assist the DTBE in modifying the distribution and content of the Laboratory Aggregate Report to be more useful for your program objectives. In addition, this assessment will also guide the development of future Laboratory Branch resources.Completion of the assessment is voluntary and will take approximately 15 minutes. All information will be kept secure and will not be linked to any individual. Upon submission, you will immediately receive an email confirmation with a copy of your completed survey for your records. To begin, please click the NEXT button.

CDC estimates the average public reporting burden for this collection of information as 15 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. 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 burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).

1. Please indicate how you received the Fourth Edition of the Tuberculosis Laboratory Aggregate Report (Select one)*

1. Received for Laboratory Consultant

2. Received from Laboratory Manager or Director

3. Downloaded PDF from CDC website

4. I did not receive the Fourth Edition of the Tuberculosis Laboratory Report (Go to Question 10)

5. Other. Please provide details:

2. To what extent do you agree or disagree with each of the following statements*

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I used the Aggregate Report to compare the performance of my laboratory with other laboratories.
The tables and figures in the Aggregate Report were easy to read and interpret.
I used the Aggregate Report to support or request changes in my laboratory’s activities.
The Aggregate Report was used to document my laboratory’s accomplishments.
The Aggregate Report was used to increase awareness of my laboratories impact.
The information in the Aggregate Report was too technical for my laboratory’s needs.
The information in the Aggregate was too basic for my laboratory’s needs
The Aggregate Report is a primary source of information regarding identification and drug susceptibility testing of TB specimens.
The Aggregate Report should use the names of state and city laboratories when reporting turnaround time data.

3. Did you use the information from the Aggregate Report to substantiate planned changes in any of the following activities? Select all that apply. *

1. Methodology (Go to Question 5)

2. Protocols (Go to Question 6)

3. Staffing (Go to Question 7)

4. Equipment (Go to Question 8)

5. Services (e.g. Courier) (Go to Question 9)

6. We did not use the Aggregate Report to substantiate planned changes in laboratory activities (Go to Question 10)

7. Other. Please provide details:

4. Please describe the changes you have made or plan to make in methodology based on information from the Aggregate Report.*

5. Please describe any changes in protocols you have made or plan to make based on information from the Aggregate Report.*

6. Please describe the staff changes you have made or plan to make based on information from the Aggregate Report.*

7. Please describe equipment changes you have made or plan to make based on information from the Aggregate Report.*

8. Please describe any changes you have made or plan to make to services provided by your laboratory based on information from the Aggregate Report.*

9. Please describe what information or data analysis you would like to see in future Aggregate Reports.

10. Overall, how important is the information provided in the Aggregate Report to your program?

Very Important	Important	Moderately Important	Little Importance	Unimportant

11. What was the volume of TB clinical specimens tested in your laboratory for calendar year 2015?* (Select one)

    1. <500

    2. 500—999

    3. 1000—1999

    4. 2000—3999

    5. >4000

    6. Don’t know

Thank you for participating in our assessment. You will receive a confirmation email with your submitted responses for your records.