Form #4 Form #4 Annual Survey

C omplex Patient Investigator

Annual Survey

P

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

lease indicate which type of grant you have:

 R21

 R24

General Questions

1. How likely are you to collaborate with other investigators studying complex patients?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

2. In your opinion, how important is it for the investigators studying complex patients to collaborate?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

3. How confident do you currently feel about your research team’s ability to carry out all of the tasks as required by your grant?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

4. In your opinion, how important is it for complex patient investigators to make their data

available to other researchers?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

R24 grants only:

5. How confident do you currently feel about your research team’s ability to create a public use dataset as required by your grant?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

R24 grants only:

6. How concerned are you about making your data available to other researchers?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

Public reporting burden for this collection of information is estimated to average 10 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.

Complex Patient Research Learning Network and Technical Assistance activities

7. Please indicate which Complex Patient Research Learning Network and Technical Assistance activities you participated in during the last year:

___ In-person Learning Network meeting

___ Workgroup teleconferences

___ Webinars/ other group technical assistance

___ Individual technical assistance

___ Accessed project website (Plexnet)

8. How useful did you find the project website (Plexnet)?

1	2	3	4	5	6	7	8	9	10
Not at all					Extremely

Please answer the following “yes” or “no” questions

9. Have you made any changes to your research (i.e., study design/ protocol/ implementation/ analysis/ results interpretation) because of your involvement in the Complex Patient Research Learning Network and Technical Assistance project (e.g., from something you learned during a Learning Network session, a webinar, technical assistance you received, or due to collaboration with another complex patient investigator)?

 Yes

 No

If YES, please briefly describe:

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10. Has your research been enhanced or facilitated by collaboration (e.g., shared research methods, shared code or variables, shared datasets, etc.) with other complex patient investigators?

 Yes

 No

If YES, please briefly describe:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

11. Have you created any new measures, developed new coding schemes, or otherwise created something new with other complex patient investigators?

 Yes

 No

If YES, please briefly describe:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

R24 grants only:

12. Has participation in the Complex Patient Research Learning Network and Technical Assistance project helped you with the development of your public use dataset?

 Yes

 No

Please briefly explain:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

General Comments

13. Other comments:

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