Form 1 Clinic Director Survey

Appendix A. Clinic Director Survey

OMB No. 0906-XXXX
Expiration date: XX/XX/201X

Providing Primary Care and Preventive Medical Services in Ryan White-funded Medical Care Settings:

Clinic Director Survey

Supported by the Health Resources and Services Administration, HIV/AIDS Bureau

Contract Number: HHSH250201400042I

Public Burden Statement:  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.  The OMB control number for this project is 0906- XXXX.  Public reporting burden for this collection of information is estimated to average .5 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

Clinic Director Survey

Instructions:

You are completing this online survey via SNAP Survey. You will also be able complete the survey at your own pace. If you need to close out of the survey and complete it at another time, simply close the tab or browser and your answers will be saved. You will be able to log into your survey with the same login and password as you entered.

Please choose your answers from the response options provided. Only choose one answer unless you are asked to choose ALL that apply. Some response options will also include “Other” in which you are provided space to supply an explanation.

Terminology: Throughout the document the following four terms will be used throughout. The terms may differ from provider and institution, but for this survey we are using the following terms and definitions:

1. HIV Specialist: Physician or provider specializing in infectious disease with AAHIVM, HIVMA, or AARN certifications

2. Primary Care Provider: Medical doctor, Doctor of osteopathic medicine, general practitioner, physician’s assistant and/or nurse practitioner

3. Care Coordination Team: Team comprised of multi-disciplinary providers who meet to discuss management of patients care.

4. Comprehensive Physical Exam and Health Maintenance: Comprehensive physical exam and health maintenance includes annual complete physical exam, screenings, review of systems, medical history review, and education and counseling services.

If you need any assistance in completing the survey, please contact:

	West Coast: Vicki Wheeler, Tel: (415) 814-1557, Email: [email protected] East Coast: Aaron Lane, Tel: (301) 881-2590, Email: [email protected]

Thank you for your time.

Respondent Information (for follow-up purposes only)

Respondent Name _________________________________________________________________________________________________

Ryan White-funded Clinic Name______________________________________________________________________________________

Respondent's telephone number (include area code, phone number, and extension, if applicable) ___________________________________

Respondent's email address__________________________________________________________________________________________

1. Of patients served within the last year at your clinic, how many are people living with HIV (PLWH)?

 Less than 100 patients  Between 101 – 250 patients  Between 250 – 500 patients  Between 501 – 750 patients  Between 751 – 1,000 patients  1,000 + patients

2. What percentage of your clinic’s PLWH patients receive any services, core, and support that are funded by the Ryan White HIV/AIDS Program?

 Between 0 – 20%

 Between 21 – 40%

 Between 41 – 59%

 Between 60 – 79%

 Between 80 – 99%

 100%

3. Does your clinic provide primary and preventative care services to PLWH patients? (For a list of primary care services, see Q7 or attachment)

 Yes, we provide all primary and preventative care services to PLWH at our clinic (Go to Q4)

 Yes, but we refer PLWH to providers outside our clinic for some primary and preventative care services (Go to Q3a, 3b, 3c, and 3d)

 No, we refer PLWH to providers outside our clinic for all primary and preventative care services (Go to Q3a, 3b, 3c, and 3d)

3a. What are the reasons for referring primary and preventative care services outside of your clinic? (Please choose ALL that apply.)

 We do not provide primary medical services for particular patient conditions on site (Hepatitis B and C, heart disease, metabolic disorders, OB-GYN, etc)

 We do not provide preventative care services

 Other _______________________________________

3b. What are the three primary reasons why your clinicians would refer to a specific provider?

 Provider accepts insurance

 Appointment availability

 Provider’s professional reputation

 Patient preference

 Provider location

 Provider is part of clinic’s referral system

 Other__________________________________

3c. PLWH are referred to providers that are: (Please choose ALL that apply.)

 Outside of the clinic, but within our healthcare system

 Outside of our healthcare system

3d. Do you receive patient information such as impressions of exam, test results and treatment plans from referred providers?

 Never

 Rarely, between 1 – 20% of the time

 Not all the time, between 21 – 40% of the time

 Sometimes, between 41 – 59% of the time

 Almost Always between 60 – 79% of the time

 Always, between 80 – 99% of the time

 Yes, 100% of the time

4. Does your clinic have a protocol for providing primary care services, including preventive services, for PLWH?

 Yes (Go to Q4a)

 No (Go to Q5)

 Don’t know (Go to Q5)

4a. What services listed below are part of your clinic’s routine provision of primary and preventative care to PLWH. (Please choose ALL that apply.)

 Providing routine health maintenance (including physical exams, diagnostic screenings, and lab assessments)

 Monitoring of age and sex/gender specific health problems (e.g. colorectal screening, prostate screening, mammograms)

 Medication management in addition to HIV antiretroviral therapy

 Health promotion or prevention services (e.g. diet, nutrition and exercise, safer sex practices, immunization recommendations, etc.)

 Behavioral health screening and counseling for mental health and substance use

 Care Coordination via a team comprised of multi-disciplinary providers who meet to discuss management of patients care

 Medical case management

 Non-medical case management

 Other: _________________________

5. How often do your clinicians typically perform a comprehensive physical exam and health maintenance with PLWH? (Please choose ALL that apply.)

 Every visit

 As part of a patient’s first service appointment

 Annually

 Perform parts of physical exam more than once a year as appropriate due to patient’s medical condition

 Our clinic does not provide complete physical exams (go to Q7)

 Other ___________________

5. What services are included in your comprehensive physical exam and health maintenance? (Please choose ALL that apply.)

 Vital Signs

 Weight/BMI

 Pain assessment (arthritis, lower back pain, etc.)

 Ears, Nose, and Throat exam

 Pulmonary Exam

 Cardiac Exam

 Musculoskeletal Exam

 Oral Exam

 Genital Exam

 Depression and Mental Health Screening

 Tobacco Use Screening and Counseling

 Substance Use Screening and Counseling

 Medical Nutrition Therapy/Behavioral Counseling to Promote a Healthy Diet

 Accident prevention (falls, seatbelts, etc.)

 Routine lab tests (complete blood count, basic metabolic panel, and liver function test, etc.)

5. For each primary care service, please answer how the service is provided. (Please choose ALL that apply to each question.)

Primary Care Service	7_1. Does your clinic provide this service to PLWH?	7_2. Who provides this service at your clinic to PLWH? (please chose ALL that apply)	7_3. How often is this service provided to PLWH?	7_4. When PLWH are referred to another provider, is patient information shared with the outside referral?	7_5. When PLWH are referred to another provider, does your clinic receive patient information back from the provider?	7_6. How do you share information with other providers outside of your clinic?
Breast Cancer Screening	 Yes (go to 7_2 and 7_3)  No, we refer this service to another provider at a clinic operated by our same healthcare system (go to 7_4, 7_5, and 7_6)  No, we refer this service to another provider at a clinic outside our healthcare system (go to 7_4, 7_5, and 7_6)  Other:_______ (go to 7_2, 7_3, 7_4, 7_5, and 7_6)	 Primary Care Provider  HIV Specialist  Other Medical Specialist  Registered Nurse  Nurse Practitioner  Physician’s Assistant  Other: _________	 Every visit  Annually  Less than annually  Only when patient exhibits symptoms  More than once a year when appropriate due to patient’s medical condition  Other:______	 Yes, with clinic operated by our same healthcare system  Yes, with clinic outside our healthcare system  No, (please explain)________  Other:_______	 Yes, with clinic operated by our same healthcare system  Yes, with clinic outside our healthcare system  No, (please explain)________  Other:_______	 Through EHRs or other electronic means  Clinic staff follow up with referred clinic/provider  No, we do not share information with other providers  Other:_____
Cervical Cancer (including HPV Screening)
Cholesterol
Colorectal Cancer Screening
Diabetes Screening
Gonorrhea and Chlamydia Screening
Hepatitis B Screening
Hepatitis C Screening
Mental Health Screening
Osteoporosis Screening
Routine Vaccinations (Flu, Pneumococcal, Tetanus, Pertussis, etc.)
Substance Use Screening
Syphilis Screening
TB Screening

5. For PLWH who have co-morbidities, please answer how your clinic manages each disease listed below. Please note that answers are regarding general disease management, not advanced or complex services like surgeries or operations. (Please choose ALL that apply to each question.)

Disease	8_1. Does your clinic manage the disease in-house for PLWH?	8_2. Who is involved in managing the disease with the PLWH? Check all that apply.	8_3.How do the various clinicians involved in the care management share patient information?	8_4. If PLWH was referred to another provider, was patient information shared with the outside referral?	8_5. If PLWH was referred to another provider, do you receive patient information back from the provider?	8_6. How do you share information with other providers outside of your clinic?
Cardiovascular	 Yes (go to 8_2 and 8_3)  No, we refer PLWH to another provider at a clinic operated by our same healthcare system (go to 8_4, 8_5, and 8_6)  No, we refer PLWH to another provider at a clinic outside our healthcare system (go to 8_4, 8_5, and 8_6)  Other:_____(go to 8_2, 8_3, 8_4, 8_5, and 8_6)	 Primary Care Provider  HIV Specialist  Other Medical Specialist  Registered Nurse  Nurse Practitioner  Physician’s Assistant Care  Coordinator/ Case Manager  Clinical Pharmacist  Other:_____	 Through EMRs or other electronic means  Via regular meetings  Other:____	 Yes, with clinic operated by our same healthcare system  Yes, with clinic outside our healthcare system  No, (please explain)________  Other:_______	 Yes, we always receive information back  Sometimes It depends on the clinic  Yes, with clinic operated by our same healthcare system  Yes, with clinic outside our healthcare system  No, (please explain)_________  Other:_______	 Through EHRs or other electronic means  Clinic staff follow up with referred clinic/provider  No, we do not share information with other providers  Other: ____
Diabetes
Hypertension
Thyroid
Respiratory
Hepatitis C
Renal

5. What elements from the list below are part of your clinic’s provision of primary and preventative care to PLWH with co-morbidities. (Please choose ALL that apply.)

 Consult with HIV Specialist (Go to question Q10)

 Use of Care Coordinator/Case Manager (Go to question Q10)

 Use of Care Team to share information and manage patient care (Go to Q9a)

 Follow up to share information with other specialists or medical professionals outside clinic involved in patient care (Go to question Q10)

 Use of Clinical Pharmacist (Go to question Q10)

 Use of specialists (hepatologist, cardiologist, gastroenterologist, gynecologist, etc.) (Go to question Q10)

 Other ______________________________________ (Go to question Q10)

 None of the above (Go to question Q10)

9a. Who are the members of the co-morbidities Care Team? A Care Team is comprised of multi-disciplinary providers who meet to discuss management of patients care. (Please choose ALL that apply)

 Primary Care Provider  HIV Specialist  Care Coordinator/Case Manager  Clinical Pharmacist  Specialists (Hepatologist, Gastroenterologist, Cardiologist, Endocrinologist, Psychiatrist, Gynecologist, etc.)

 Mental Health Provider  Substance Use Counselor  Oral Health Provider  Other ____________________________

5. What other specialists or other medical professionals do your clinicians consult or collaborate with when providing primary and preventative care to PLWH at your clinic? (Please choose ALL that apply.)

 Primary Care Provider  HIV Specialist  Care Coordinator/Case Manager  Clinical Pharmacist  Specialists (Hepatologist, Gastroenterologist, Cardiologist, Endocrinologist, Psychiatrist, Gynecologist, etc.)

 Mental Health Provider  Substance Use Counselor  Oral Health Provider  Other ____________________________

5. What are your clinic’s three top strengths in providing primary and preventative care, including preventative services? (Please choose ALL that apply.)

 Sufficient number of non-medical staffing  Sufficient number of primary care clinicians  Clinician training and expertise with primary and preventative care  Availability of HIV Specialists  Availability of other Medical Specialists  Care Team and Case Management located within the clinic  Ability to meet encounter ratio requirements

 Sufficient linkages and referrals to other community resources  Co-location of some primary and preventative care services  One-stop shopping  Funding to provide services not covered by insurance  Physical size of clinic  Other_____________________________________________

5. What are your clinic’s three top challenges in providing primary care services, including preventative services? (Please choose ALL that apply.)

 Lack of non-medical staffing  Lack of primary care clinicians  Unavailability of HIV Specialists  Unavailability of other Medical Specialists  Unavailability of Care Team and Case Management  Cannot take new patients because of size of current patient panel  Administrative work is too burdensome

 Inability to meet encounter ratio requirements  Lack of linkages and referrals to other community resources  Lack of funding to provide services not covered by insurance  Lack of co-location of primary and preventative care services.  Physical size of the clinic  Reimbursement rate is too low  Other_____________________________________________

5. How difficult would it be for your agency to extract data from your electronic health record (EHR) on the percent of HIV-positive clients who received a given preventative/primary care service?

 Not difficult at all

 Somewhat difficult

 Moderately difficult

 Difficult

 Very difficult

5. How difficult would it be for your agency to look up information in a client’s medical chart to determine whether he/she received a given preventative/primary care service?

 Not difficult at all

 Somewhat difficult

 Moderately difficult

 Difficult

 Very difficult

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