1 Provider and Patient Interview

Form Approved

OMB No. 0935-XXXX

Exp. Date XX/XX/20XX

Provider and Patient Interview

Public reporting burden for this collection of information is estimated to average XX 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, # 07W41A, Rockville, MD 20857.

Demographic Questions	Format
What is your age?	List: <25 25-34 35-44 45-54 55-64 65-74 >=75
How do you currently describe yourself? (Mark all that apply)	List: - Female - Male - Transgender - I use a different term (free text)
What is your race? (One or more categories may be selected)1	List: - American Indian or Alaska Native  - Asian  - Native Hawaiian or other Pacific Islander  - Black or African American  - White
Are you Hispanic or Latino/Latina?	Yes/No
What are your number of years in practice?	List: 0-4 5-9 10-19 >=20
What is your specialty?	Open Ended (format)
How familiar are you with shared care planning?	Likert

Discussion Questions/Topics

1. How do you currently approach care planning for your adult patients with MCC?

2. How might the use of this app change your approach to care planning for your adult patients with MCC?

3. What data might be missing from the clinician-facing app?

4. How might the data be presented or organized to be more helpful to you, the clinician?

5. What summary information would be most helpful to you on the landing page of the app? How do you like that information to be presented (e.g., graphs, charts, level of granularity, etc.)?

6. What information would you want to see from clinicians outside of OHSU who provide care to your MCC patient? How could it be displayed to be most useful?

7. Thinking about how you might want to improve care planning or shared decision-making with your MCC patients and their caregivers: what data would you prioritize and when (and how)?

8. What data/information would be most useful for informing clinical action/follow-up? What data/information can drive action? New data? Conflicting data? Other?

9. What changes would bring the clinician-facing app more into alignment with your clinical workflow?

10. What should the incorporation of patient reported information (including goals) look like to be most useful? What do you perceive as the value of seeing such data at the point of care?

11. Would you expect any changes in how your patients/caregivers approach appointments because of the patient app?

12. How might the availability of information from multiple sources contribute to a more efficient and/or effective shared care planning conversation?

13. Taking a moment to reflect on our discussion so far, do you have any other thoughts about how the MyCarePlanner app(s) might impact on your ability to develop and use shared care plans with your patients with/at risk of MCC

N= ~20 clinicians from practices where patients are recruited to include specialties in primary care, gerontology, nephrology, and related clinical areas and health IT staff from the respective sites