* 1. Which Co-Management Tool-Kit did you use today?

* 2. How did or how will you use this Co-Management Tool-Kit?

* 3. How did you learn of Connecticut Children's Co-Management plans?

* 4. Have you viewed the web-based CME module for this condition?

* 5. If yes, please rank how satisfied you are with the online CME for this condition:

* 6. Please rate how satisfied you are with the clarity of the materials in this tool-kit:

* 7. Please rate how satisfied you are with the usefulness of the tool-kit:

* 8. Please rank your overall satisfaction with each of the tool-kit components:

  Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied Not applicable (N/A)
Protocol (algorithm)
Initial Visit Template
Follow-up Visit Template

* 9. Please rate the tool-kit in terms of ease of use:

* 10. Did this tool-kit change the care you delivered in any of the following areas:

  Yes No
Initial Management
Follow-up Management
Initial Diagnostic Testing
Referral to Subspecialists

* 11. If 'yes' to any of the above, please feel free to comment further:

* 12. Did use of this tool-kit allow you to initiate treatment sooner?

* 13. Did use of this tool-kit increase your confidence in your approach to the patient?

* 14. How many providers are in your practice?

* 15. Do other providers in your practice participate in Co-Management?

* 16. Did you deviate in any way from this Co-Management plan?

* 17. If 'yes', please describe your reason for deviating from this protocol:

* 18. Please feel free to provide us with any additional comments or feedback, including recommendations for other conditions for Co-Management: