Form
Approved
OMB No. 0935-0XXX
Exp.
Date XX/XX/2017
/
INITIAL CALLS WITH OFFICE MANAGER, PRACTICE MANAGER
WHEN CONDUCTING INITIAL CALLS WITH SITES TO SPEAK WITH OFFICE MANAGER/ CLINIC MANAGER/NURSE MANAGER AT SITE:
Intro when person answers
Hello, my name is _____________ and I’m calling from the RAND Corporation, a research firm. May I speak with Mr./Ms. ____ (OR OFFICE MANAGER OF {PRACTICE NAME}?
OBTAIN AS MUCH INFO FROM RECEPTIONIST/PERSON ANSWERING PHONE.
TO OBTAIN INFORMATION FOR THE PRACTICE CHARACTERISTICS FORM:
ONCE YOU ARE SPEAKING WITH OFFICE MANAGER/CLINIC MANAGER/NURSE MANAGER:
We recently sent (_________________) from your practice a letter about the CAHPS PCMH Items QI Demonstration Study. We are hoping to set up an interview with a clinical leader identified with your practice’s National Committee for Quality Assurance (NCQA) PCMH Recognition. We have the following physician name(s) (_________________).
At this time, we are calling sites to help us with this component of the study.
Q1- First of all, are you the main person who would be able to answer a few brief questions about your practice such as staffing, patient mix, specialties, and use of any patient experience surveys?
YES That’s great. GO to Q2
NO Who is best person whom I should speak with?
Q2- Would it be possible for me to ask you those questions now?
Those questions should take about 5 minutes to complete.
YES PROCEED WITH PRACTICE CHARACTERTISTICS QUESTIONS (OMB Attachment B) (ONCE QUESTIONS ARE COMPLETE, RESUME AT Q3 ON NEXT PAGE)
NO SET UP TIME THAT IS BEST FOR PERSON
Public
reporting burden
for this
collection of
information is estimated
to average
3 minutes
per response,
the estimated time
required to
complete the
survey. 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 (0935-0XXX,
expires XX/XX/20XX), AHRQ, 5600 Fishers Lane,
# 07W41A, Rockville,
MD 20857.
IF TRYING OT SET UP APPOINTMENTS WITH MDS OR TO LEAVE MESSAGES AS FOLLOW-UP TO LETTER MAILED/FAXED TO MD:
Q3- Based on the records we received from NCQA, the following provider(s) were identified as the main clinical leaders at your site who were involved in the NCQA PCMH Recognition process. We have listed (PROVIDER NAME (S)).
I have a few questions about this/these provider(s). First, could I confirm the contact information that I have for he/she/them?
REVIEW CONTACT INFO AND OBTAIN:
MD
PHONE NUMBER
MD EMAIL
MD FAX
MD MAILING ADDRESS
Q4- We recently sent (MD NAME (s)) a letter/fax regarding the PCMH Items Demonstration Study. We’d like to confirm that he/she/they has/have received it.
--Do you know if he/she/they has/have received it?
--Can you ask (MD NAME) if he/she/they has/have received it?
NO -- I’d like to fax another copy of the letter. May I have your fax # to send it? OBTAIN FAX # TO REFAX, MAIL OR E-MAIL
Confirm who should receive this letter (apart from MD in the practice).
Q5- Lastly, may I speak with (PROVIDER NAME) to tell him/her a little bit about the provider interview and set up an appointment with him/her? Or should I work with you (or someone else) to be able to set up an appointment with him/her? Or can I leave a message for {Provider Name}
Q6-Is there someone else that was a clinical leader involved in your practice’s NCQA PCMH Recognition process that I could contact regarding the interview? IF YES, What is their name and contact information?
DOCMENT FIRST LAST NAME AND CONTACT INFO:
FIRST AND LAST NAME
PHONE
NUMBER
EMAIL
FAX
MAILING ADDRESS
LEAVE MESSAGE
TELL THEM YOU WILL FOLLOW UP WITH THEM IN X DAYS TO FIND OUT IF MD GOT LETTER/FAX AND WHAT HIS/HER REPSONSE WAS
THANK YOU FOR YOUR TIME TODAY
| File Type | application/msword |
| File Title | Usability Testing Recruitment Screener |
| Author | kfrazier |
| Last Modified By | Windows User |
| File Modified | 2017-01-19 |
| File Created | 2017-01-19 |