Form #4 Form #4 Initial survey assessment for CME participants

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

Attachment D)

Initial Questionnaire for Learners

1. Please indicate your prior and current levels of knowledge of the process by which Comparative Effectiveness Research (CER) reviews are developed by the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care (EHC) program:

	No Some High Very High Knowledge Knowledge Knowledge Knowledge 1 2 3 4 5 6 7 8 9 10
Before CME activity:	         
After CME activity:	         

2. How would you rate the credibility and rigor of each of the following in comparison to AHRQ CER reviews:

	Superior to CER Reviews	About the Same	Inferior to CER Reviews	[Not Sure]
a. Single Research Studies				
b. Clinical Guidelines				
c. Systematic Reviews, Meta Analyses				

Public reporting burden for this collection of information is estimated to average 5 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.

3. How do you plan to make use of the evidence-based research and materials that were presented during this CME activity in relation to specific content? (select all that apply)

 Use in discussing evidence-based clinical options with patients

 Use in identifying areas for discussion with patients regarding their values and preferences concerning benefits and harms

 Use in determining those treatments and interventions that are associated with the highest levels of evidence

 Use in another way:

_____________________________________________________________________

_____________________________________________________________________

 Do not plan to make use of the information; Why not?

_____________________________________________________________________

_____________________________________________________________________

4. To what extent will the evidence-based research presented during this CME activity enable you to improve the care that you give to your patients?

 No improvement expected

 Some improvement expected

 Significant improvement expected

 Uncertain at this time

5. Do you see any challenges or barriers that might hinder your application in practice?

_________________________________________________________________________

_________________________________________________________________________

6. Are there additional tools or applications associated with CER evidence that would be useful to you?

_________________________________________________________________________

_________________________________________________________________________

DEMOGRAPHICS

7. What year did you graduate from medical school? __________

8. What is your professional category/degree?

 MD/DO—in practice  Nurse Specialist (e.g., CRNA, NP)  PA-C

 MD/DO—Resident/Fellow  Nurse (e.g., RN, LVN)  Allied Health

 Pharmacist  PhD/PsyD/EdD/DrPH  Other

9. If you are a physician, how would you classify yourself?

 Primary Care

 Specialist

 Surgeon

 Other: ________________________________

10. If you are a physician, what is your practice setting?

 Solo

 Group

 Hospital-based

 Clinic-based

 Other

11. If you are a physician, please indicate the population of the area where you conduct the majority of your practice:

 0 – 5,000

 5,001 – 10,000

 10,001 – 25,000

 25,001 – 50,000

 50,001 – 100,000

 100,001 – 250,000

 250,001 – 500,000

 500,001 – 1 million

 1 million +

12. If you are a physician, what are your patient population(s)? (select all that apply)

 Adults

 Older adults

 Children/Adolescents

 Diverse cultural backgrounds

 Diverse socioeconomic status (SES) conditions

The John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine

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