C
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
Please respond to the following statements about asthma care in your clinic…
(fill in one circle for each line)
strongly disagree somewhat disagree neither agree nor disagree somewhat agree strongly agree
1. Clinicians in our clinic believe that
good asthma care is very important ..... 1 2 3 4 5
2. We have greatly improved the
process of asthma care in the past year 1 2 3 4 5
3. Our resources (personnel, time, financial)
are too tightly limited to improve asthma care 1 2 3 4 5
4. Our clinic operations rely heavily on
organized systems 1 2 3 4 5
5. The thinking of our leadership is
strongly oriented toward systems 1 2 3 4 5
6. Our clinic attaches more priority to
quality of care than to finances 1 2 3 4 5
7. The clinicians in our clinic espouse a
shared mission 1 2 3 4 5
8. The clinicians in our clinic adhere to
clinic policies 1 2 3 4 5
9. Our clinic leadership is strongly
committed to the need for change in
asthma care and for leading that change 1 2 3 4 5
Public
reporting burden for this collection of information is estimated to
average 15
minutes per response, the estimated time required to complete
the survey. 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
this burden, to: AHRQ Reports Clearance Officer Attention: PRA,
Paperwork Reduction Project (0935-XXXX) AHRQ,
540 Gaither Road, Room # 5036, Rockville, MD 20850.
strongly disagree somewhat disagree neither agree nor disagree somewhat agree strongly agree
10. Our clinic has well-developed
administrative structures and
processes in place to create change 1 2 3 4 5
11. Our clinic is undergoing considerable stress
as the result of internal changes 1 2 3 4 5
12. The working environment in our clinic is
collaborative and cohesive, with shared sense of
purpose, cooperation, and willingness to
contribute to the common good 1 2 3 4 5
13. The clinicians in our clinic are very interested
in improving asthma care 1 2 3 4 5
14. We have clinician champions interested in
leading the improvement of asthma care 1 2 3 4 5
15. Our clinic understands and uses quality
improvement skills effectively 1 2 3 4 5
16. The leaders of our efforts to improve clinic care
are enthusiastic about their task 1 2 3 4 5
17. Our clinic has a well-defined quality
improvement process for designing and
introducing changes in the quality of care 1 2 3 4 5
18. The new process of care for asthma is more
advantageous than the old to everyone involved
(patients, personnel, and clinic) 1 2 3 4 5
Our clinic has used the following strategies to implement improved asthma care …
(fill in one circle for each line)
19. Providing information and skills-training related
to improved asthma care 1 2 3
20. Use of opinion leaders, role modeling, or other
vehicles to encourage support for changes in
asthma care 1 2 3
21. Changing or creating systems in the clinic that
make it easier to provide good asthma care 1 2 3
22. Removal or reduction of barriers to better
asthma care 1 2 3
23. Organizing people into teams focused on
accomplishing the change process for asthma
care 1 2 3
24. Delegating to non-physician staff the
responsibility to carry out aspects of asthma
care that are normally the responsibility of
physicians 1 2 3
25. Providing to those who are charged with
implementing improved asthma care the power
to authorize and make the desired changes 1 2 3
26. Using periodic measurement of asthma care for
the purpose of assessing compliance with the
new approach to asthma care 1 2 3
27. Reporting measurements of individual or care
unit performance for asthma care by
comparison with their peers 1 2 3
28. Setting goals and benchmarking rates of asthma
care at least yearly 1 2 3
29. Customizing the implementation of asthma care
changes to each site of care 1 2 3
30. Use of rapid cycling, piloting, pre-testing, or
other vehicles for reducing the risk of negative
results from introducing organization-wide
change in asthma care 1 2 3
31. Deliberately designing asthma care
improvements so as to make physician
participation less work than before 1 2 3
32. Deliberately designing asthma care as a means
to make the care more beneficial to the patient 1 2 3
33. Considering all the priorities your clinic has over the next year (e.g., EMR, financial goals, quality
improvement of various conditions, MD recruitment), what is the priority of your clinic for
improving asthma care? (on a scale of 0-10 where 0 = not a priority, 5 = medium priority, & 10 =
highest priority of all)
1...............2 ............3 ............4 ..................5 ............6 .........7 ...............8 .........9 ............10
Not a Priority Medium Priority Highest Priority of all
| File Type | application/msword |
| File Title | CPCQ-MG Questionnaire for ASTHMA |
| Author | Maryam |
| Last Modified By | wcarroll |
| File Modified | 2010-03-24 |
| File Created | 2009-11-13 |