VCSQI Patient (Person) and Family Engagement (PFE) Survey

VCSQI PFE Survey

Thank you for completing this brief, anonymous survey focused on patient (person) and family centered care. We request only one completed survey for each practice; please designate one person to respond, or complete it together as a group. As you answer, keep your group practice in mind, not the hospital where you may also work, unless the practice is actively engaged in these related hospital activities that affect the practice's patients. We will share aggregate results and use them to provide resources to practices.

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* 1. Please state the name of your practice.

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* 2. Please state the name, position and email for the person completing this survey.

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* 3. Does your practice use an e-tool (patient portal or other E-Connectivity technology) that is accessible to both patients and clinicians, and that shares information such as test results, medication management list, vitals and other information and patient record data? Select one answer but feel free to elaborate in the comment box.

Practice relies soley on face-to-face encounters and phone interactions with patients.

Practice is considering the use of technology to offer alternatives to face-to-face visits but has not yet formalized this practice nor communicated the options to patients.

Practice has the capability of providing alternative visit types or communication media but these are in limited use.

Practice offers multiple forms of alternative visit types (e.g. email, Skype, or tele-visits) or communication media (e.g., portal, texting) and has integrated these alternatives into regular practice.

Other (please specify)

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* 4. Does your practice support shared decision-making by training and ensuring clinicians integrate patient goals and preferences related to culture, language, religion, emotional, and economic status into care plan?

Practice does not regularly utilize shared decision making or other tools to encourage patient and family involvement in goal setting or decision making.

Practice is training its staff in shared decision making approaches and developing ways to consistently document patient involvement in goal setting, decision making, and self- management.

Practice has developed approaches to encourage and document patient and family involvement in goal setting, decision making and self-management, but the process is not yet routine.

Practice can demonstrate that patients and families are collaborating in goal setting, decision making and self-management (e.g., share care plans, documentation of self-management goals, compacts, etc.)

Other (please specify)

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* 5. Does your practice utilize a tool to assess and measure patient activation?

Yes (please specify which tool in the comment box below)

I'm not sure

Patient activation tool used:

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* 6. Does your practice assess the health literacy level of your patients? (e.g., CAHPS Health Literacy Item Set)?

Yes. (please specify how health literacy is assessed in the comment box below)

I'm not sure

Describe how health literacy is assessed, including the name of a tool if used.

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* 7. Does your practice promote patient-centric medication management practices (self-management of medication, etc.)?

Yes

I'm not sure

Additional comments

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* 8. Are there policies, procedures and actions taken to support patient and family participants in governance or operational decision-making committees of the practice (Person and Family Advisory Councils, Board Representatives, etc.)? Please check all that apply.

Yes, on the Board

Yes, on a Patient and Family Advisory Council

Yes, on committees such as quality improvement teams

Not for any committees at this time

I'm not sure

Additional comments:

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* 9. How does your practice obtain feedback from patients and families and use the information received?

The practice does not have a formal system for obtaining patient feedback.

The practice has a limited system for obtaining patient and family feedback and does not have a system for acting on the information received.

The practice has a formal system for obtaining patient and family feedback but does not consistently incorporate the information received into the QI and overall management systems of the practice.

The practice has a formal system for obtaining patient and family feedback and can document operational or strategic decisions made in response to this feedback.

Additional comments:

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* 10. Our practice would benefit and welcome education and assistance with (check all that apply):

Using E-tool features that support patient access to their records

Training and ensuring that our clinicians include patient goals and preferences into care plans (Shared decision-making)

Assessing our patients' level of activation

Evaluating health literacy levels of our patients

Promoting our patients' self-management of medications

Selecting and orienting patients and family members to participate on decision-making committees of the practice.

Other (please specify)

Thank you for completing this survey!