Exit this survey

* 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: