HT0011-16-R-0040-Global_NAL-Attachment_7-NAL_Satisfaction_Survey-12-13-16.docx

HT0011-16-R-0040-Global NAL-Attachment 7-NAL Beneficiary Satisfaction Survey-12-13-16

ATTACHMENT 7

NURSE ADVICE LINE

PATIENT EXPERIENCE SURVEY

INTRODUCTORY SCRIPT:

Hello, I’m _________, and I’m calling from ________, a research company contracted by the Department of Defense to help in its efforts to improve the Military Health System Nurse Advice Line (NAL) service. May I please speak with (Rank, Mr. or Ms. and Name)?

If yes Continue to ELIGIBILITY VERIFICATION If no “Do you know when (Rank, Mr. or Ms. and Name) will be available?”

i. If no time is given or they don’t know “Thank you for your time. I will call back later.”

ii. If a time is given “Thank you for your time. I will call back then.”

iii. No such person Thank you and terminate the interview

iv. Refused Thank you and terminate the interview

For Interviewer Only Interviewer code -- Reason the sample member is not available

· Deceased

· Incapacitated

· Deployed and not available

· Temporarily unavailable, such as on vacation or on a business trip

· Relocated, new location unknown

· Incarcerated

· Refused call

The purpose of this call is to find out more about how the Military Health System Nurse Advice Line is used. We would like to know what you think; this survey will take less than 10 minutes. Answering the questions is voluntary and you may ask to skip any question you don’t want to answer and can stop at any time. Although I won’t be asking any questions about your specific health or medical problems, any information you provide is protected under the federal Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996. Your answers will be confidential, and any identifying information will be protected by the research team, and will not be tied to your answers when the results are released. I have to caution you, however, that if you threaten to harm yourself or others, we have to notify appropriate authorities for action.

May we continue on with the survey?

|_| Yes [IF YES, GO TO THE NEXT QUESTION A1] |_| No [IF NO, END SURVEY]

A: ELIGIBILITY VERIFICATION:

A1. Our records show that you called the Nurse Advice Line on {DATE OF CALL}. Is this correct?

|_| Yes [IF YES, GO TO THE NEXT QUESTION A2] |_| No [IF NO, END SURVEY] |_| Don’t Know/Refused [IF DK/REF, END SURVEY]

A2. Was your primary care provider’s office open during this same time?

|_| Yes |_| No |_| Don’t Know

Please answer the following questions about the call to the Nurse Advice Line on {DATE OF CALL}. When thinking about your answers, please only focus on your call experience on this date.

B: BEGIN SURVEY:

B1. First, I am going to ask you a few questions about your call. Please answer yes or no.

If yes, move to question B1b. If no, read B2 statement and question B2a.

If yes, move to question B1c. If no, read B2 statement and questions B2a-B2b.

If yes, move to question B1d. If no, read B2 statement and questions B2a-B2e.

If yes or no, move to section B2 and read all questions.

B2. Now, I am going to read you a few statements. Please tell me if you strongly agree, agree, disagree, or strongly disagree with each statement. If you aren’t sure or the statement doesn’t apply, please let me know.

B3. How did you learn about the Nurse Advice Line? (Check all that apply)

|_| Other (specify: ____________________)

B4. Do you have any comments or suggestions for the NAL?

The following portion of the survey applies to those individuals who our records indicate participated in the PCM On-Call Pilot. If it does not, end survey.

B5. Our records show that you spoke with the Primary Care Manager (PCM) On-Call on {DATE OF CALL}. Is this correct?

|_| Yes [IF YES, GO TO THE NEXT QUESTION B6] |_| No [IF NO, END SURVEY] |_| Don’t Know/Refused [IF DK/REF, END SURVEY]

B6. I am going to read you three statements. Tell me if you strongly agree, agree, disagree, or strongly disagree with each statement. If you aren’t sure or the statement doesn’t apply, please just say so.

_________________________________END OF SURVEY____________________________________