Form 5 Attachment 5 -- Evaluation Site Champion Interview

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

Evaluation Site Champion Interview

Introduction

Hello, my name is [STAFF NAME], and I am a researcher from [ORGANIZATION NAME]. On behalf of the MedStar-IMPAQ team, thank you for your interest and willingness to participate in a brief interview about [CDS TOOL NAME], developed under the funding of the Agency for Healthcare Research and Quality within the U.S. Department of Health and Human Services. Your answers to these questions will help us understand the implementation of [CDS TOOL NAME] and how we could improve it in the future.

There are no right or wrong answers to these questions – we are interested in your thoughts, opinions, and experiences. All the information you share with us today is voluntary and will be kept strictly confidential. We will only report information in such a way that it is not possible to identify any single respondent (for example, summarizing suggestions for improvements). However, if you do not feel comfortable answering a question, let me know and we can skip that question. If you need to end the interview at any time, for any reason, please let me know.

Finally, with your permission, we would like to audio record this interview. This helps us focus on having a conversation with you and ensures that your responses are captured accurately. This recording and any notes will be securely stored in our data enclave. Only project staff will have access to these files. We can also provide you a copy of those interview notes, upon request.

Would it be okay with you if we record the audio from today’s conversation?

[IF NO, READ THE FOLLOWING.]

Okay, we can still continue with the interview.

[IF YES, READ THE FOLLOWING.]

Thank you. I am going to start the recording, and I will ask you one more time if you agree to participate in this interview, and if it is okay to record.

Verbal Consent

To confirm: Do you agree to participate in this interview today?

[WAIT FOR RESPONSE.]

[FOR AUDIO RECORDING:] And do you agree to have this conversation audio recorded?

[WAIT FOR RESPONSE.]

Thank you. Let’s get started.

Section 1: Decision to Use [CDS TOOL NAME]

1. How did you learn about [CDS TOOL NAME]?

2. What about [CDS TOOL NAME] appealed to you?

3. Tell me more about your decision to implement [CDS TOOL NAME] at your site.

Probes: What made you feel like it was a good resource for your site?

4. How did you communicate the tool to others?

5. What were their initial impressions?

Probes: Pros, cons, first reactions.

Section 2: Feedback on Implementing and Using [CDS TOOL NAME]

6. What were some of the challenges you faced getting [CDS TOOL NAME] set up for your site?

Probes: What solutions did you find to those challenges? What resources were important for getting set up?

7. What does your site do to encourage patients and clinicians to use [CDS TOOL NAME]?

Probes: What’s worked well, and what hasn’t?

8. What feedback on [CDS TOOL NAME] have you heard from clinicians? From patients?

9. What recommendations do you have for sites who aren’t yet using the tool?

Probes: What resources (such as IT support, recruitment staff) would have made it easier to get set up, if you had them at the time?

Section 3: Future Suggestions [CDS TOOL NAME]

10. Do you plan to keep using it at your site – why or why not?

11. What would you like to see in a future version of the tool?

12. Finally, is there anything else you would like to share with me today about [CDS TOOL NAME]?

That concludes my questions. Thank you again for sharing your thoughts and your time with us!

This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could identify you will not be disclosed unless you have consented to that disclosure. Public reporting burden for this collection of information is estimated to average 30 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, 5600 Fishers Lane, Room #07W42, Rockville, MD 20857