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ICD/CRT Appropriate Use Criteria Survey
1.
In which of the following ways have you used the ICD/CRT Appropriate Use Criteria App?
(Select all that apply)
As a tool to support my own clinical decision making
To facilitate a discussion with a patient during a visit
To consult the likelihood of CMS coverage of a treatment option for a patient
To facilitate the documentation process (i.e. have a record of the appropriateness rating of a treatment for a given patient)
To facilitate treatment discussions across specialties
To guide or teach others at my practice/institution
As an informational reference
As a patient, to review my risk and treatment options
Other (please specify)
2.
What other tools have you used to help make decisions about ICD and CRT therapy for your patients?
2013 ACC/HRS ICD/CRT Appropriate Use Criteria document
2012 ACC/AHA Device-Based Therapy Guideline document
ACC ICD Clinical Data Registry reports
Other (please specify)
3.
Which information or function within the app is most useful to you? (Select all that apply.)
Appropriate use score (I.e., Appropriate, May Be Appropriate, Rarely Appropriate)
CMS Advice (i.e., Coverage can be expected/Coverage cannot be expected)
Ability to email results
Please explain:
4.
Overall, how useful is the ICD/CRT AUC App to you?
Very Useful
Useful
Somewhat useful
Not very useful
Not at all useful
Please explain:
5.
Would you recommend the ICD/CRT AUC App to a colleague?
Yes
No
6.
What best describes your clinical designation?
General Cardiologist
Electrophysiologist
Cardiac Surgeon
Primary Care Physician
Physician Assistant
Nurse Practitioner
Registered Nurse
Pharmacist
Medical Trainee or Student
Patient
Other (please specify)
7.
Which best describes your current practice environment?
Private Practice
Hospital
Anticoagulation Clinic
Other (please specify)
8.
Do you practice mostly within the US or internationally?
I practice in the US.
I practice internationally.
9.
Which best describe how often you use other clinical decision support apps?
Daily
Weekly
Monthly
Yearly
Never
Please specify some of the apps you use:
10.
What suggestions do you have for improving the ICD/CRT Appropriate Use Criteria App?
