Form 1 Survey Instrument – QI Software Users

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Draft survey instrument - QI software users 3_9_23_KHC

QI Program User Survey

OMB: 0935-0179

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Survey Instrument – QI Software Users

The Agency for Healthcare Research and Quality (AHRQ) would appreciate your feedback about your use of the Quality improvement (QI) modules. Your responses will be used to improve the QI modules and tools. All answers will be confidential. This survey should take three minutes to complete.

  1. How do you expect to use this ED-PQI module? (Please select all that apply)

  1. Benchmarking

  2. Innovation and research

  3. Performance measurement

  4. Quality improvement

  5. Other (please specify):

  6. Not applicable

  7. I don’t know

  1. Which of the following AHRQ QI module(s) have you used? (Please select all that apply)

    1. Inpatient Quality Indicators (IQIs)

    2. Patient Safety Indicators (PSIs)

    3. Pediatric Quality Indicators (PDIs)

    4. Prevention Quality Indicators (PQIs)

    5. I have not used any AHRQ QI modules

  1. In which of the following setting(s) have you used the AHRQ QI modules? (Please select all that apply)

    1. Accountable care organization (ACO)

    2. Federal, state or local health department or program

    3. Healthcare or professional association

    4. Health plan

    5. Hospital or health system

    6. Quality improvement organization

    7. Research

    8. Other (please specify):

    9. Not applicable

  1. How do you use the AHRQ QI modules? (Please select all that apply)

    1. Benchmarking

    2. Innovation and research

    3. Performance measurement

    4. Quality improvement

    5. Performance measurement

    6. Quality improvement

    7. Other (please specify):

    8. Not applicable

  1. Which of the following is/are important benefit(s) of the AHRQ QI software modules? (Please select all that apply)

    1. Available at no cost

    2. Ease of use

    3. Quality of measures

    4. Resources/tools on AHRQ QI website

    5. Technical assistance support from AHRQ

    6. Other (please specify):

    7. Not applicable

  1. Please add any additional feedback you may have about the AHRQ QI modules below:



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