Form 039 HRSA NHSC Site Survey

HRSA NHSC Site

Customer Satisfaction Survey

Introduction

Throughout the following survey, we will frequently refer to the term “NHSC Site”. An "NHSC Site" is a health care facility that generally provides comprehensive outpatient,

primary health care services to populations residing in Health Professional Shortage Areas (HPSAs) and has been determined to meet the NHSC site eligibility requirements and qualifications.

This survey is authorized by Office of Management and Budget Control No. 1090-0007 which expires on September 30, 2021. This survey will take approximately 10-15 minutes.

INTRO1. Are you an NHSC Site Point of Contact?

1. Yes

2. No [TERMINATE Survey]

INTRO2. Are you also a Nurse Corps Point of Contact?

1. Yes (I work with, manage or support one or more of the following types of Nurse Corps eligible employees: Nurse faculty, Registered Nurses, and Advanced Practice Registered Nurses (Nurse Practitioners, Certified Registered Nurse Anesthetists, Certified Nurse Midwives, and Clinical Nurse Specialists)).

2. No

INTRO3. What is your role at your NHSC-approved site? (Select all that apply)

1. Recruiter (I hire and/or recruit new employees)

2. Personnel Verifier (I can officially confirm employment status, work schedules, and/or absences of employees at my site)

3. Administrator (I own, oversee, or manage my site(s) or a significant portion of my site(s) and/or I understand and can answer questions about site policies and operating procedures)

INTRO4. How long has your site been NHSC approved?

1. Less than 1 year

2. 1-2 years

3. 2-5 years

4. More than 5 years

5. Don’t know

INTRO5. How long have you been an NHSC Point of Contact at your site?

1. 1-6 months

2. 7-12months

3. >1year, <3years

4. >3 years, < 5 years

5. > 5 years

6. Don't know

PROGRAMMING NOTE - IF INTRO6=YES, add the following header for remainder of survey (in normal black font at the first page, then gray for the remaining pages): Please consider your entire network of sites, rather than any one specific site when providing answers and ratings throughout the survey.

INTRO6. Do you oversee multiple NHSC-approved sites?

1. Yes, Sites are in a Network [GROUP=2 (Network)]

2. Yes, Sites are separate NOT in a Network [GROUP=1 (Single Site)]

3. No [GROUP=1 (Single Site)]

INTRO7. [If GROUP=1 (Single Site)] From the list below, please select the option that best describes the type of NHSC site you are located at:

1. Federally Qualified Health Center (FQHC)

2. FQHC Look-Alike

3. Rural Health Clinic

4. Hospital Affiliated Primary Care Outpatient Clinic

5. Indian Health Service

6. Tribal Clinic

7. Urban Indian Health Clinic

8. Correctional Facility

9. Private Practice (Solo/Group)

10. Community Mental Health Facility

11. Community Outpatient Facility

12. Critical Access Hospital

13. Free Clinic

14. Immigration and Customs Enforcement (ICE) Health Service Corps

15. Mobile Unit

16. School-based Health Program

17. State or County Department of Health Clinic

INTRO8. [If GROUP=2 (Network)] From the list below, please select all the options that best describe the type(s) of NHSC sites within your network:

1. Federally Qualified Health Center (FQHC)

2. FQHC Look-Alike

3. Rural Health Clinic

4. Hospital Affiliated Primary Care Outpatient Clinic

5. Indian Health Service

6. Tribal Clinic

7. Urban Indian Health Clinic

8. Correctional Facility

9. Private Practice (Solo/Group)

10. Community Mental Health Facility

11. Community Outpatient Facility

12. Critical Access Hospital

13. Free Clinic

14. Immigration and Customs Enforcement (ICE) Health Service Corps

15. Mobile Unit

16. School-based Health Program

17. State or County Department of Health Clinic

INTRO9. Have you promoted the NHSC to any students or clinicians in the past 12 months?

1. Yes

2. No

INTRO10. [If INTRO9=Yes] Aside from the NHSC requirements (e.g., complete and update an online NHSC Site Profile in the Customer Service Portal) how has your organization promoted the NHSC in the past 12 months? (Select all that apply)

1. Verbally provided recommendation

2. Provided NHSC website link

3. Provided NHSC materials

4. Other [CAPTURE RESPONSE]

INTRO11. [If INTRO9=Yes] Did you know of any NHSC applicants or awardees at your site?

1. Yes

2. No

INTRO12. [If GROUP=1 (Single Site)] Does your site currently employ a current NHSC program participant or a former NHSC program participant who has finished their service obligation?

1. Yes, at least one NHSC clinician (or former NHSC clinician) is currently employed at my site

2. No, there are no NHSC clinicians (or former NHSC clinician) currently employed at my site

3. I don’t know

INTRO13. [IF INTRO11=1] How many NHSC clinicians are currently employed at your site? [ACCEPT A WHOLE NUMBER VALUE]

INTRO14. [If GROUP=1 (Single Site) AND INTRO11=Yes] Through which program(s) did the clinician(s) currently employed at your site enter the NHSC? (Select all that apply)

1. Loan Repayment Program

2. Scholarship Program

3. Students to Service Loan Repayment Program

4. I don’t know

INTRO15. [If GROUP=2 (Network)] Does at least one of the sites in your network currently employ an NHSC clinician?

1. Yes, at least one NHSC clinician is currently employed at a site in my network

2. No, there are no NHSC clinicians currently employed at any of the sites in my network

3. I don’t know

INTRO16. [If GROUP=2 (Network) AND INTRO15=Yes] Through which program(s) did the clinician(s) currently employed at your network enter the NHSC? (Select all that apply)

1. Loan Repayment Program

2. Scholarship Program

3. Students to Service Loan Repayment Program

4. I don’t know

INTRO17. [If GROUP=2 (Network) AND INTRO15=No] Have sites in your network ever employed an NHSC clinician?

1. Yes

2. No

3. I don’t know

NHSC Site Assistance

Q1.1. Have you received any technical assistance from the NHSC pertaining to your site in the last 12 months?

1. Yes

2. No [SKIP TO NEXT SECTION]

Q1.2. In the past 12 months, which of the following types of support did you receive from the NHSC to aid you in your role as an NHSC site POC? Select all that apply:

1. Recruitment

2. Retention

3. NHSC program compliance

4. NHSC site compliance

5. Becoming a new site

6. Site recertification

7. Health Professional Shortage Area (HPSA) score

8. Other [CAPTURE RESPONSE]

Q1.3. In the past 12 months, where have you received this type of support? Select all that apply:

1. NHSC Website (online materials)

2. On-site technical assistance (site visit)

3. Call Center

4. NHSC Program Representative (Regional/program analyst)

5. Health Workforce Connector Customer Service Portal

6. Webinar/webcast

7. Other [CAPTURE RESPONSE]

Q1.4. Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate the quality of support provided to you by the NHSC in the past 12 months to aid you in your role. [CAPTURE RESPONSE]

Customer Service

Q2.1. Have you contacted the NHSC during the past 12 months regarding your site?

1. Yes

2. No [SKIP TO NEXT SECTION]

Q2.2. In the past 12 months, through what means have you contacted the NHSC regarding your site? (Select all that apply)

1. Telephone

2. E-mail

3. Fax

4. Customer Service Portal

5. Facebook

6. Twitter

7. LinkedIn

8. Other [CAPTURE RESPONSE]

Q2.3 Please select all the reasons that you contacted the NHSC regarding your site in the past 12 months.

1. General information

2. Program requirements

3. Posting job opportunities

4. Employee applying to NHSC Loan Repayment Program/Scholar fulfilling service commitment

5. Maternity/paternity/adoption leave

6. Medical or non-medical suspension

7. NHSC participant converting to half-time service

8. Participant resignation/termination

9. Six-month verification

10. Site visit

11. Leave of absence request (personal/family/medical reasons)

12. Update contact information

13. Recertification

14. New site application

15. Health Professional Shortage Area (HPSA) score

16. Other [CAPTURE RESPONSE]

Thinking about your most recent contact with the NHSC, and using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate:

Q2.4 Ease of reaching an NHSC representative

Q2.5. Courteousness of the NHSC representative

Q2.6. Knowledge of the NHSC representative

Q2.7. Timeliness of the representative’s response to your inquiry or concern

Q2.8. Overall professionalism of the NHSC representative

Q2.9. Please use this space for any additional information you would like to provide the NHSC regarding ways we can improve our customer service/communication process. [CAPTURE RESPONSE]

Customer Service Portal

Qportal1. Have you used the Customer Service Portal in the last 12 months? The Customer Service Portal is a secured online account where NHSC Sites can post and update job positions, view clinicians currently under obligation, update site contact information, and ask the NHSC questions.

1. Yes

2. No [SKIP TO NEXT SECTION]

3. Don’t know [SKIP TO NEXT SECTION]

Qportal2. How have you used the Customer Service Portal in the last 12 months? (Select all that apply)

1. Complete in-service verification

2. Employment verification

3. Update contact information

4. Apply for site recertification

5. Update or complete an NHSC Site Profile

6. Manage current job openings

7. Alert the NHSC to any changes at your site (e.g., POC, location, etc.)

8. Manage job openings on the Health Workforce Connector

9. Other [CAPTURE RESPONSE]

Please think about your overall experience using the Customer Service Portal in the last 12 months. Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate:

Qportal4. Ease of navigation

Qportal5. Ability to find the information needed

Qportal6. Your ease of understanding the information communicated

Qportal7. Organization of the information provided

Qportal8. Usefulness of conducting business through the Customer Service Portal

Qportal9. Timeliness of NHSC responses

Qportal10. What additional feature, if any, would you like to see added to the Customer Service Portal? [CAPTURE RESPONSE]

Information/Communication

Thinking about your communications with the NHSC, and using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate:

QInfo1. Timeliness of the communications

QInfo2. Relevance of the information provided to your inquiry

QInfo3. Received enough detail to meet your needs

QInfo4. Ease of understanding the information communicated

QInfo5. Organization of the information provided

QInfo6. Helpfulness of information in guiding your decision-making

QInfo7. Frequency of receiving information

QInfo8. In the past 12 months, which resource do you consider to be the most beneficial in keeping you up to date on NHSC activities/events? (Select one)

1. NHSC website

2. NHSC online newsletters

3. Fact sheets related to NHSC programs and services

4. NHSC Facebook page

5. NHSC Twitter account

6. Customer Service Portal

7. Other [CAPTURE RESPONSE]

QInfo9. In the past 12 months, which resource and/or event do you consider to be the most beneficial in keeping you up to date on programmatic requirements? Examples of programmatic requirements include completing in-service and employment verifications. (Select one)

1. NHSC website

2. NHSC online newsletters

3. NHSC Site Reference Guide

4. NHSC Facebook page

5. NHSC Twitter account

6. Customer Service Portal

7. NHSC educational videos

8. Educational webinars hosted by the NHSC

9. Technical assistance conference calls hosted by the NHSC

10. Fact sheets related to NHSC programs and services

11. E-mails from the Customer Service Portal

12. Other [CAPTURE RESPONSE]

Regional Offices

QRegions1. The NHSC Regional Offices serve as the point of contact for NHSC sites in certain parts of the country. Are you aware there are NHSC Regional Offices available to provide support to NHSC-approved sites?

1. Yes

2. No

QRegions2. Are you aware the NHSC conducts site visits to NHSC-approved sites?

1. Yes

2. No

QRegions3. [QRegions_2=Yes] Has your site ever received a site visit from the NHSC Regional Office?

1. Yes

2. No

3. Don’t know

QRegions4. [QRegions_1=Yes OR QRegions_2=Yes] Have you interacted with the NHSC Regional Offices in the past 12 months?

1. Yes

2. No

QRegions5. [QRegions_4=Yes] Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate the level of support provided by the NHSC Regional Offices.

1. General information

2. Program requirements

3. Update contact information

4. Site visit

5. N/A

QRegions6. [QRegions_1=Yes OR QRegions_2=Yes] What other types of support would you like the NHSC Regional Offices to provide? [CAPTURE RESPONSE]

ACSI Benchmark Questions

ACSI1. Please consider all of the experiences you have had with the NHSC program as an approved site. Using a 10-point scale on which 1 means Very Dissatisfied and 10 means Very Satisfied, how satisfied are you with the NHSC program? [CAPTURE RESPONSE]

ACSI2. Using a 10-point scale on which 1 means Falls Short of Your Expectations and 10 means Exceeds Your Expectations, to what extent has the NHSC program fallen short of or exceeded your expectations? [CAPTURE RESPONSE]

ACSI3. Imagine an ideal scholarship and loan repayment program. How well do you think the NHSC compares with that ideal program? Please use a 10-point scale on which 1 means Not Very Close to Ideal, and 10 means Very Close to Ideal. [CAPTURE RESPONSE]

Outcome Measures

Outcome1. On a scale from 1 to 10 where 1 means Completely Disagree and 10 means Completely Agree, to what extent do you agree that the National Health Service Corps is delivering a meaningful experience to its members? [CAPTURE RESPONSE]

Outcome2. On a scale from 1 to 10 where 1 means Completely Disagree and 10 means Completely Agree, to what extent do you agree that you have made a difference in connecting dedicated providers with communities in need by promoting the NHSC? [CAPTURE RESPONSE]

Outcome3. On a scale from 1 to 10 where 1 means Not at All Likely and 10 means Very Likely, how likely are you to continue promoting NHSC as a partner? [CAPTURE RESPONSE]

Outcome4. On a scale from 1 to 10 where 1 means Not at All Likely and 10 means Very Likely, how likely are you to recommend the National Health Service Corps to someone else? [CAPTURE RESPONSE]

NHSC Recruitment Tools

QJobs1. The Health Workforce Connector (formerly NHSC Jobs Center) is an interactive online resource, launched in 2012, that allows sites to list job opportunities and promote their organization to clinicians seeking employment. Have you heard of the Health Workforce Connector?

1. Yes

2. No [SKIP TO QJobs_20 – VJF SECTION]

QJobs2. Has your site used the Health Workforce Connector in the past 12 months to create or update your site profile?

1. Yes

2. No

3. Don’t know

QJobs3. [IF QJobs_2=NO] Why has your site not used the Health Workforce Connector to create or update your site profile? [CAPTURE RESPONSE]

QJobs4. Has your site used the Health Workforce Connector in the past 12 months to post job vacancies at your site?

1. Yes

2. No

3. Don’t know

QJobs5. [IF QJobs_4=NO] Why has your site not used the Health Workforce Connector to recruit? [CAPTURE RESPONSE]

QJobs6. Have you been contacted by providers based on your job vacancies listed in Health Workforce Connector?

1. Yes

2. No

QJobs7. [IF QJobs_6=YES] Of the providers who contacted you, how many did you interview?

1. 1

2. 2-3

3. 4-6

4. More than 6

5. None

6. I don’t know

QJobs8. [IF QJobs_7=1, 2, 3 or 4] Of the providers whom you interviewed, how many did you successfully recruit based on your NHSC Site Profile?

1. 1

2. 2-3

3. 4-6

4. More than 6

5. None

6. I don’t know

QJobs9. Has your site used other online recruitment sites in the past 12 months?

1. Yes

2. No [SKIP to QJobs_13]

3. Don’t know [SKIP to QJobs_13]

QJobs10. What other online sites has your site used in the past 12 months to recruit clinicians for your site? (Please list up to five sites)

PROGRAMMING NOTE: For EACH response provided to QJobs_10, ask QJobs_11 and QJobs_12:

QJobs11. Did your site pay a fee for using [ENTER RESPONSE FROM QJobs_10]?

1. Yes

2. No

3. Don’t know

QJobs12. Would change to "Were you able to recruit a clinician for your site using the other recruitment sites you mentioned?

1. Yes

2. No

QJobs12a. Which sites were used to successfully recruit a clinician to your site? [OPEN END]

QJobs13. [ONLY IF QJob_1=Yes] How could the Health Workforce Connector be more useful in helping your site recruit and post-employment opportunities? [CAPTURE RESPONSE]

[ONLY IF QJob_2=Yes] Please think about your overall experience while visiting the Health Workforce Connector in the past 12 months. Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate:

QJobs14. Ease of navigation

QJobs15. Ease of creating and updating site profile

QJobs16. Ease of posting job vacancies

QJobs17. Accuracy of site information

QJobs18. Quantity of applicants/responses for posted positions

QJobs19. Ease of onboarding selected candidates

QJobs20. HRSA Virtual Job Fairs are on-line versions of traditional job fairs that connect qualified job-seekers with NHSC-approved sites with open job opportunities. Has your site participated in an NHSC Virtual Jobs Fair within the last 12 months? (Select all that apply)

1. January 30, 2018

2. April 11, 2018

3. June 27, 2018

4. October 17, 2018

5. November 28, 2018

6. No [SKIP TO QJobs_25]

7. Don’t know [SKIP TO NEXT SECTION]

PROGRAMMING NOTE: For EACH response to QJobs_20 (1-4) ask QJobs_21 and QJobs_22:

QJobs21. Were you contacted by any providers regarding your job vacancy following your site’s participation in a Virtual Job Fair?

1. Yes

2. No

QJobs22. [IF QJobs21=YES] Of the providers who contacted you following your participation in the HRSA Virtual Job Fairs, how many did you interview?

1. 1

2. 2-3

3. 4-6

4. More than 6

5. None

6. Not sure

QJobs23. [IF QJobs_22= 1-4] Of the providers whom you interviewed, how many did you successfully recruit based on participation in the [QJobs_20 DATE RESPONSE] HRSA Virtual Job Fairs?

1. 1

2. 2-3

3. 4-6

4. 6 or more

5. None

6. Not sure

QJobs24. How could the HRSA Virtual Job Fairs improve and assist with your site’s recruitment efforts? [CAPTURE RESPONSE]

QJobs25. [If QJobs_20=NO] Why have you not participated in an HRSA Virtual Job Fair in the last 12 months?

1. Wasn’t aware of NHSC Virtual Job Fairs

2. Scheduling conflicts

3. No available job opportunities to promote

4. Using other recruitment sites/tools

5. Did not qualify to participate

6. Other [CAPTURE RESPONSE]

Recruitment and Retention

The following questions are intended to help us assess the needs of NHSC approved sites so that we can better serve you in your recruitment and retention efforts.

RecRet1. On a scale of 1-10 where 1 means Not at all important use and 10 means critically important, how important are the NHSC-supported disciplines in meeting the needs of your site? [Ask question for each discipline listed below; include a “Do not use” option]

1. Physician (MD, DO) (family medicine, obstetrics/gynecology, general internal medicine, geriatrics, general pediatrics, general psychiatry)

2. Physician Assistant (adult, family, pediatrics, psychiatric/mental health, geriatrics and women’s health)

3. Nurse Practitioner (adult, family, pediatric, psychiatric/mental health, geriatrics and women’s health)

4. Certified Nurse Midwife

5. Psychiatric Nurse Specialist

6. Dentist (DDS, DMD)

7. Dental Hygienist

8. Health Service Clinical Psychologist

9. Licensed Clinical Social Worker

10. Licensed Professional Counselor

11. Marriage and Family Therapist

12. Behavioral Health professionals

13. Substance use disorder counselors

14. Registered Nurses

15. Pharmacists

RecRet2. Of the following NHSC-supported disciplines, which are the hardest to fill? Choose and rank up to three, with 1 being the most difficult.

1. Physician (MD, DO)

2. Physician Assistant

3. Nurse Practitioner

4. Certified Nurse Midwife

5. Psychiatric Nurse Specialist

6. Dentist (DDS, DMD)

7. Dental Hygienist

8. Health Service Clinical Psychologist

9. Licensed Clinical Social Worker

10. Licensed Professional Counselor

11. Marriage and Family Therapist

12. Behavioral Health professionals

13. Substance use disorder counselors

14. Registered Nurses

15. Pharmacists

RecRet3. [For EACH discipline selected in RecRet_2] On average, how long does it take your site to recruit for a [RecRet_2 DISCIPLINE RESPONSE]?

1. 1-3 months

2. 3-6 months

3. 6 months to 1 year

4. 1-2 years

5. More than 2 years

RecRet4. Does your site have a recruitment plan?

1. Yes

2. Currently developing one

3. No

4. I don’t know

RecRet5. [If RecRet_4=No] What resources does your site need in order to create a recruitment plan? [CAPTURE RESPONSE]

RecRet6. [If RecRet_4=Yes] Does your site use its recruitment plan?

1. Yes

2. No

3. I don’t know

RecRet7. [If RecRet_6=No] What resources does your site need in order to use its recruitment plan? [CAPTURE RESPONSE]

RecRet8. [For EACH discipline rated 6-10in RecRet_1] Does your site offer clinical training opportunities for [RecRet_1 DISCIPLINE RESPONSE] students?

1. Yes

2. No

3. I don’t know

RecRet9. [If RecRet_8=No] What has prevented you from offering training: Check all that apply?

1. Financing/return on investment

2. Administration and coordination of the program

3. Training preceptors and faculty

4. Partnerships with academic institutions

5. Logistics – space, clinic schedules, time, etc.

6. Other (please specify)

RecRet10. [For EACH discipline rated 6-10 in RecRet_1] Does your site offer clinical training opportunities for recent [RecRet_1 DISCIPLINE RESPONSE] graduates (e.g., residents)?

1. Yes

2. No

3. I don’t know

RecRet11. [If RecRet_10=No] What resources does your site need to be able to accommodate for [Each RecRet_1 DISCIPLINE RESPONSE rated 6-10] graduate trainees? [CAPTURE RESPONSE]

RecRet12. Does your site have a retention plan?

1. Yes

2. Currently developing one

3. No

4. I don’t know

RecRet13. [If RecRet_12=No] What resources does your site need in order to create a retention plan? [CAPTURE RESPONSE]

RecRet14. [If RecRet_12=Yes] Does your site use its retention plan?

1. Yes

2. No

3. I don’t know

RecRet15. [If RecRet_14=No] What resources does your site need in order to use its retention plan? [CAPTURE RESPONSE]

RecRet16. How long do you expect clinicians to remain working at your service site after they have completed their NHSC service obligation?

1. I do not expect them to remain after their obligation is complete

2. 1-6 months

3. 7 months- 1 year

4. >1 year - <2 years

5. >2 years - <5 years

6. More than 5 years

RecRet17. Do you have challenges in retaining NHSC clinicians at your site past the completion of their service obligation?

1. Yes [Go to RecRet_18]

2. No [Go to RecRet_19]

RecRet18. What do you think the challenges are in retaining NHSC clinicians at your site past the completion of their service obligation? Please rank responses from 1 being most challenging to 10 being least challenging.

1. Noncompetitive salary

2. Opportunities for advancement

3. Opportunities for distance learning

4. Site operation/employer

5. Academic opportunities

6. Community and/or lifestyle

7. Work/life balance

8. Family considerations

9. Retirement

10. Flexibility

11. Benefits

12. Other [CAPTURE RESPONSE]

RecRet19. How are you working to retain NHSC clinicians at your site? Select all that apply

1. Offering salary above the local average salary for similar positions

2. Offering additional fringe benefits

3. Providing a flexible work environment

4. Paying for continuing education

5. Providing malpractice coverage

6. Providing a pension plan

7. Including NHSC clinician in key practice decisions

8. Offering NHSC clinician leadership roles at the site

9. Including NHSC clinician in the development of site policies and procedures Offering performance-based compensation

10. Implementing new care delivery and payment models, such as the Patient Centered Medical Home

11. Streamlining workflows and processes to make practice more efficient

12. Offering academic linkages that include teaching and/or research responsibilities

13. Improving site leadership skills

14. Providing career guidance and skill development

15. Other [CAPTURE RESPONSE]

RecRet20. What resources does your site have to support the development of your workforce? [CAPTURE RESPONSE]

RecRet21. What workforce development resources do you need from the NHSC program that you are not currently receiving? [CAPTURE RESPONSE]

RecRet22. In order to help retain NHSC clinicians at your site past the completion of their service obligation, what types of support do you need from the NHSC program that you are not currently receiving? [CAPTURE RESPONSE]

RecRet23. Does your site provide or participate in any of the following clinical telemedicine services? (Check all that apply)

1. Video conferencing

2. Store and forward video

3. Remote patient monitoring

4. Mobile health (mhealth)

4. I don’t know

5. Other [CAPTURE RESPONSE]

6. My site does not provide or participate in any clinical telemedicine services [EXCLUSIVE]

RecRet24. [If RecRet_23=6] On average, what percentage of clinical service time do clinicians at your site spend providing health care services to patients at other locations? [Capture % response or “Don’t Know”]

RecRet25. For which type of clinical consultation service(s) does your site use telemedicine? (Check all that apply)

1. Behavioral health (mental health or substance abuse)

2. Dental

3. Dermatology

4. Diabetic retinopathy

5. Endocrinology

6. High risk obstetrics

7. HIV or AIDS related

8. Viral hepatitis

9. Pain management

10. Neurology

11. Primary care backup to School-based Health Clinic(s)

12. Primary care backup to HIV/AIDS Clinic(s)

13. Primary care backup to Homeless Clinic(s)

14. Primary care backup to Public Housing Clinic(s)

15. Primary care backup to remote or rural health clinic(s)

16. Primary care backup to Free Clinic(s)

17. Primary care backup to Family Planning Clinic(s)

18. Primary care backup to Home Health Care program(s)

19. Psychiatry

20. Radiology

21. Trauma/Emergency services

22. Not sure

23. Other [CAPTURE RESPONSE]

RecRet26. [If RecRet_22=1] Does your site foresee integrating telemedicine services into your care delivery model in the near future (1-2 years)?

1. Yes

2. No

3. Don’t know

RecRet27. [If RecRet_22=1] What does your site see as barriers to implementing telemedicine services? (Check all that apply)

1. Availability of certified specialists

2. Reimbursement of for telemedicine services

3. Equipment costs

4. Training staff

5. Low demand or utilization

6. Connectivity / bandwidth availability

7. Connectivity/ bandwidth costs

8. Workflow

9. EHR barriers

10. Licensure/certification barriers

11. Policies/Regulations

12. Not sure

13. Other [CAPTURE RESPONSE]

RecRet28. Outside of the NHSC-approved disciplines that are already offered, which of the following clinicians would your site like to recruit using the NHSC Loan Repayment Program as a tool? Select 5 in rank order.

1. Chiropractors

2. Clinical Laboratory Technologists

3. Diabetes Health Educators

4. Dieticians/Nutritionists

5. General Surgeons

6. General Practitioner Physicians

7. Occupational Therapists

8. Optometrists

9. Pharmacy Technicians

10. Physical Therapists

11. Podiatrists

12. Preventive Medicine Physicians

13. Radiologic Technologists and Technicians

14. Respiratory Therapists

15. Speech Language Pathologists

16. Other [CAPTURE RESPONSE]

RecRet29. Among the following disciplines (NHSC-approved and non-NHSC-approved), which five (5) disciplines does your site require to operate most effectively? Please rank the top 5 disciplines.

1. Certified Nurse Midwife

2. Chiropractors

3. Clinical Laboratory Technologists

4. Dental Hygienist

5. Dentist (DDS, DMD)

6. Diabetes Health Educators

7. Dieticians/Nutritionists

8. General Practitioner Physicians

9. General Surgeons

10. Health Service Clinical Psychologist

11. Licensed Clinical Social Worker

12. Licensed Professional Counselor

13. Marriage and Family Therapist

14. Nurse Practitioner

15. Occupational Therapists

16. Optometrists

17. Pharmacists

18. Pharmacy Technicians

19. Physical Therapists

20. Physician (MD, DO)

21. Physician Assistant

22. Podiatrists

23. Preventive Medicine Physicians

24. Psychiatric Nurse Specialist

25. Radiologic Technologists and Technicians

26. Registered Nurses

27. Respiratory Therapists

28. Speech Language Pathologists

29. Substance Abuse Counselors

30. Nurse Anesthetist

31. School psychologist

32. Nephrologists

33. Naturopaths

34. Advanced dental hygiene practitioners

35. Emergency medicine

Demographics about Site’s Patient Population

Dem1. [If INTRO6= 3 No (Single Site)] Please list the zip-code of your site.

Dem2. [If INTRO6=Yes (Network)] Please select the region where the majority of your sites are located from the list below.

1. Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont

2. Region 2: New Jersey, New York, Puerto Rico, and the Virgin Islands

3. Region 3: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia

4. Region 4: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee

5. Region 5: Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin

6. Region 6: Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

7. Region 7: Iowa, Kansas, Missouri, and Nebraska

8. Region 8: Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming

9. Region 9: Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau

10. Region 10: Alaska, Idaho, Oregon, and Washington

Dem3. What language(s), other than English, does your patient population speak? Select all that apply.

1. Spanish

2. French

3. German

4. Chinese/Mandarin

5. Hindi

6. Arabic

7. Portuguese

8. Vietnamese

9. Russian

10. Other [CAPTURE RESPONSE]

Dem4. [If INTRO6=No (Single Site)] How many patients does your site see annually?

1. 1-2,500 patients

2. 2,501-5,000 patients

3. 5,001-7,500 patients

4. 7,501-10,000 patients

5. Over 10,000 patients

Dem5. [If INTRO6=Yes (Network)] How many patients does your network see annually?

1. Under 20,000 patients

2. 20,001-50,000

3. 50,001-100,000

4. 100,001-150,000

5. Over 150,000 patients

Dem6. From which of the following racial and ethnic groups is your patient population? Select all that apply.

1. Asian

2. Native Hawaiian and Other Pacific Islander

3. Black/African American

4. American Indian/Alaska Native

5. White

6. Hispanic/Latino

7. Other [CAPTURE RESPONSE]

8. I prefer not to say

9. I don’t know

Dem7. Please rank up to five of the following insurance sources in terms of their frequency of use among your patient population, with 1 being the most frequent. If you prefer not to answer or do not know the answer to this question, please mark the appropriate response option with a “1” and select “Next”.

1. None/Uninsured

2. Medicaid

3. CHIP Medicaid

4. Medicare

5. Private Insurance

6. Other [CAPTURE RESPONSE]

7. I prefer not to say

8. I don’t know

Dem8. Which special populations does your site serve? Select all that apply.

1. Migrant/seasonal

2. Homeless (including shelter, transitional, doubling up, street)

3. School-based

4. Veterans

5. LGBT

6. Other [CAPTURE RESPONSE]

7. I prefer not to say

8. I don’t know

Thank you for your time. The National Health Service Corps greatly appreciates your input!

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