Crosswalk of changes 7.15.20

Form	Current Question/Item	Requested Change
Attachment B1 Patient Survey: Baseline Q3 intro text	Recently you visited your Emory provider and participated in a falls risk screening. Our records indicate that visit took place on XX/XX/XXXX. Please answer the following questions, thinking about your life in the 12 months before that visit.	Recently you had a primary care appointment with your Emory provider and completed a falls risk screening questionnaire. Our records indicate that visit took place on [FILL DATE FROM SAMPLE FILE]. Throughout this survey we are going to refer to this visit, which may have occurred over telemedicine or in person at an Emory facility. Please answer the following questions, thinking about your life in the 12 months before that visit.
Attachment B1 Patient Survey: Baseline Q38	N/A adding additional question	Q38. You previously indicated that you were able to have someone available to help you participate in an at-home falls risk assessment. Is this person someone who: 01 Lives in your home 02 A friend or family member who does not live in your home 03 A home health care worker 04 Other 77 Don’t Know 99 Prefer not to Answer
Attachment B2 Patient Survey: Follow-up Q5b.	Q5b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit 5. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer	Q5b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit In-person 5. Doctor’s Visit over Telemedicine 6. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer
Attachment B2 Patient Survey: Follow-up Q7b.	Q7b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit 5. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer	Q7b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit In-person 5. Doctor’s Visit over Telemedicine 6. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer
Attachment B2 Patient Survey: Follow-up Q9b.	Q9b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit 5. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer	Q9b. What kind of medical attention did you receive? Please select all that apply. 1. Emergency Medical Services (EMT, Ambulance) 2. Emergency Room Visit 3. Urgent Care Visit 4. Doctor’s Office Visit In-person 5. Doctor’s Visit over Telemedicine 6. Admitted to Hospital 77. Don’t know 99. Prefer not to Answer
Attachment B2 Patient Survey: Follow-up Q17	Since the last time you took this survey, have you done any of the following: Q17. Gone to physical therapy? 1 Yes 2 No 77 Don’t know 99 Prefer not to Answer	Since the last time you took this survey, have you done any of the following: Q17. Gone to physical therapy? 1 Yes (go to Q17a) 2 No (go to Q18) 77 Don’t know (go to Q18) 99 Prefer not to answer (go to Q18) Q17a. Did you receive physical therapy: 1. Over telemedicine 2. In-person 3. Both in person and telemedicine
Attachment B2 Patient Survey: Follow-up Q18	Since the last time you took this survey, have you done any of the following: Q18. Gone to occupational therapy? 1 Yes 2 No 77 Don’t know 99 Prefer not to Answer	Since the last time you took this survey, have you done any of the following: Q18. Gone to occupational therapy? 1 Yes (go to Q18a) 2 No (go to Q19) 77 Don’t know (go to Q19) 99 Prefer not to Answer (go to Q19) Q18a. Did you receive occupational therapy: 1. Over telemedicine 2. In-person 3. Both in person and telemedicine
Attachment B2 Patient Survey: Follow-up Q19	Since the last time you took this survey, have you done any of the following: Q19. Have you visited an eye doctor? 1 Yes 2 No 77 Don’t know 99 Prefer not to Answer	Since the last time you took this survey, have you done any of the following: Q19. Visited an eye doctor? 1 Yes (go to Q19a) 2 No (go to Q20) 77 Don’t know (go to Q20) 99 Prefer not to Answer (go to Q20) Q19a. Did you visit an eye doctor: 1. Over telemedicine 2. In-person 3. Both in person and telemedicine
Attachment B2 Patient Survey: Follow-up Q20	Since the last time you took this survey, have you done any of the following: Q20. Have you visited a foot doctor? 1 Yes 2 No 77 Don’t know 99 Prefer not to Answer	Since the last time you took this survey, have you done any of the following: Q20. Visited a foot doctor? 1 Yes (go to Q20a) 2 No (go to Q21) 77 Don’t know (go to Q21) 99 Prefer not to Answer (go to Q21) Q20a. Did you visit an eye doctor: 1. Over telemedicine 2. In-person 3. Both in person and telemedicine
Attachment B2 Patient Survey: Follow-up Q24	Q24. [multiple selection] IF SURV_NUM=1 DISPLAY: Since the Emory visit, have you participated in Tai Chi, Matter of Balance, or some other exercise either in person or online? ELSE DISPLAY: Since the last time you took this survey, have you participated in Tai Chi, Matter of Balance, or some other exercise? 1. Tai Chi 2. Matter of Balance 3. Other Exercise 77. Don’t know 99. Prefer not to Answer	Q24. [multiple selection] IF SURV_NUM=1 DISPLAY: Since the Emory visit, have you participated in Tai Chi, Matter of Balance, or some other exercise either in person or online? ELSE DISPLAY: Since the last time you took this survey, have you participated in Tai Chi, Matter of Balance, or some other exercise? 1. Tai Chi (ask Q24a) 2. Matter of Balance (ask Q24b) 3. Other Exercise (go to Q25) 77. Don’t know (go to Q25) 99. Prefer not to Answer (go to Q25) Q24a Did participate in Tai Chi: □ Online □ In-person □ Both in person and online Q24b Did you participate in Matter of Balance: □ Online □ In-person □ Both in person and online
Attachment E1 Provider Interview Guide Q1	1. How do you know whether you should use the fall prevention intervention with a patient? Prompts: Does the operations manager tell you at the beginning of the day? Does a nurse inform you?	1. How do you know whether you should implement the fall prevention intervention with a patient? Prompts: Does the Medical Assistant tell you before seeing a patient manager tell you at the beginning of the day? Were you given a schedule? Flag in Tonic? Does a nurse inform you?
Attachment E1 Provider Interview Guide Q2 and Q3	2. For patients that are assigned to the fall prevention intervention, can you please walk us through a typical patient visit? a. How is this different from your patient visits for patients that don’t receive a fall prevention intervention? b. How is decision making about falls prevention different for those that receive the falls prevention intervention compared to those who do not? c. Prior to this study, did you discuss fall prevention with your patients?	2. For patients that are assigned to the fall prevention intervention, can you please walk us through a typical patient visit? a. How is this different from your patient visits for patients that don’t receive a fall prevention intervention? b. How is decision making about falls prevention different for those that receive the falls prevention intervention compared to those who do not? 3. Prior to this study, did you discuss fall prevention with your patients?
Attachment E1 Provider Interview Guide Q4	N/A Added new question	4. Has COVID-19 affected the way you think about falls prevention in your practice?
Attachment E1 Provider Interview Guide Q5	5. Can you describe any challenges you have experienced while addressing fall risks identified by the nurse? a. Integrating the STEADI intervention into the patient visit? b. Entering data into the EHR? c. Changing your workflow?	5. Can you describe any challenges you have experienced while addressing fall risks identified by the STEADI nurse? a. Integrating the STEADI intervention into the patient visit? b. Entering data into the EHR? c. Changing your workflow?
Attachment E1 Provider Interview Guide Q7	7. What aspect of the risk assessment information is most challenging to implement? Which is least challenging?	7. Does conducting appointments via telemedicine complicate or facilitate using information from STEADI to implement the falls prevention decisions you make?
Attachment E1 Provider Interview Guide Q8	8. On a typical visit, how long does it take you to go through the risk assessment summary provided by the nurse? a. How long is a typical visit for patients not assigned to STEADI?	8. On a typical visit, how long does it take you to go through the risk assessment summary with the patient provided by the nurse? a. How long is a typical visit for patients not assigned to STEADI?
Attachment E1 Provider Interview Guide Questions about communication between providers and nurses	The next set of questions asks about the patient hand off from the STEADI nurse to provider. 13. Can you please describe what happens during the patient hand off from the STEADI nurse? Prompts and/or follow-up questions: a. What information is relayed during the hand off? b. How does the nurse walk through the summary of risk assessment recommendations? i. Is that summary shared electronically? Verbally? By paper chart? Some combination? ii. How do you know what referral, actions, or discussions are needed for the following recommendations: (1) Physical therapy (2) Community-based exercise (3) Ophthalmology or optometry (4) Podiatry (5) Medication management (6) Orthostatic hypotension (7) Management of comorbidities associated with fall risk (8) Vitamin D 14. How long does the hand off of the patient and risk assessment information usually take	The next set of questions asks about communication with the STEADI nurse regarding the STEADI patient. 13. How is STEADI assessment information relayed to you (from the STEADI nurse)? a. Electronically (via EHR)? Verbally (on the phone)? Some combination? b. What STEADI information is relayed during the hand off? c. Are STEADI recommendations discussed via e-mail or phone? If so, how and when are they discussed? d. How long does reviewing the STEADI information usually take?