HCCI Advanced SIM Procedures

Home-based procedures training course survey

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* 1. How many years have you been doing home visits?

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* 2. How many patient home visits have you completed in the past year?

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* 3. How many patient home visits have you completed in your lifetime?

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* 4. What zip code(s) do you conduct most home visits in? List below.

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* 5. How often do you perform the following procedures in the home setting:

	Weekly	Monthly	3-5 times/year	1-2 times/year	Never
Joint Injections/Aspirations	Joint Injections/Aspirations Weekly	Joint Injections/Aspirations Monthly	Joint Injections/Aspirations 3-5 times/year	Joint Injections/Aspirations 1-2 times/year	Joint Injections/Aspirations Never
Tracheostomy Changes	Tracheostomy Changes Weekly	Tracheostomy Changes Monthly	Tracheostomy Changes 3-5 times/year	Tracheostomy Changes 1-2 times/year	Tracheostomy Changes Never
Gastronomy Tube Changes	Gastronomy Tube Changes Weekly	Gastronomy Tube Changes Monthly	Gastronomy Tube Changes 3-5 times/year	Gastronomy Tube Changes 1-2 times/year	Gastronomy Tube Changes Never
Place/exchange/remove Foley catheters	Place/exchange/remove Foley catheters Weekly	Place/exchange/remove Foley catheters Monthly	Place/exchange/remove Foley catheters 3-5 times/year	Place/exchange/remove Foley catheters 1-2 times/year	Place/exchange/remove Foley catheters Never
Exchange/remove suprapubic catheters	Exchange/remove suprapubic catheters Weekly	Exchange/remove suprapubic catheters Monthly	Exchange/remove suprapubic catheters 3-5 times/year	Exchange/remove suprapubic catheters 1-2 times/year	Exchange/remove suprapubic catheters Never
Wound debridement	Wound debridement Weekly	Wound debridement Monthly	Wound debridement 3-5 times/year	Wound debridement 1-2 times/year	Wound debridement Never
Suturing	Suturing Weekly	Suturing Monthly	Suturing 3-5 times/year	Suturing 1-2 times/year	Suturing Never
Venipuncture/ draw blood	Venipuncture/ draw blood Weekly	Venipuncture/ draw blood Monthly	Venipuncture/ draw blood 3-5 times/year	Venipuncture/ draw blood 1-2 times/year	Venipuncture/ draw blood Never
Paracentesis	Paracentesis Weekly	Paracentesis Monthly	Paracentesis 3-5 times/year	Paracentesis 1-2 times/year	Paracentesis Never
Thoracentesis	Thoracentesis Weekly	Thoracentesis Monthly	Thoracentesis 3-5 times/year	Thoracentesis 1-2 times/year	Thoracentesis Never
Manage chest tubes	Manage chest tubes Weekly	Manage chest tubes Monthly	Manage chest tubes 3-5 times/year	Manage chest tubes 1-2 times/year	Manage chest tubes Never
Manage ventilator settings	Manage ventilator settings Weekly	Manage ventilator settings Monthly	Manage ventilator settings 3-5 times/year	Manage ventilator settings 1-2 times/year	Manage ventilator settings Never

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* 6. What other procedures do you perform in the home that are not listed above? Please list those and their frequency (e.g. 1-2 times /year, 3-5 times/year, etc.)

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* 7. If you do not perform the procedures above during home visits, please explain why.

	No patient needs	Lack of comfort in doing the procedure	Other
Joint Injections / aspirations	Joint Injections / aspirations No patient needs	Joint Injections / aspirations Lack of comfort in doing the procedure	Joint Injections / aspirations Other
Tracheostomy changes	Tracheostomy changes No patient needs	Tracheostomy changes Lack of comfort in doing the procedure	Tracheostomy changes Other
Gastronomy tube changes	Gastronomy tube changes No patient needs	Gastronomy tube changes Lack of comfort in doing the procedure	Gastronomy tube changes Other
Place/exchange/remove Foley catheters	Place/exchange/remove Foley catheters No patient needs	Place/exchange/remove Foley catheters Lack of comfort in doing the procedure	Place/exchange/remove Foley catheters Other
Exchange/remove suprapubic catheters	Exchange/remove suprapubic catheters No patient needs	Exchange/remove suprapubic catheters Lack of comfort in doing the procedure	Exchange/remove suprapubic catheters Other
Wound debridement	Wound debridement No patient needs	Wound debridement Lack of comfort in doing the procedure	Wound debridement Other
Suturing	Suturing No patient needs	Suturing Lack of comfort in doing the procedure	Suturing Other
Venipuncture/ Draw blood	Venipuncture/ Draw blood No patient needs	Venipuncture/ Draw blood Lack of comfort in doing the procedure	Venipuncture/ Draw blood Other
Paracentesis	Paracentesis No patient needs	Paracentesis Lack of comfort in doing the procedure	Paracentesis Other
Thoracentesis	Thoracentesis No patient needs	Thoracentesis Lack of comfort in doing the procedure	Thoracentesis Other
Manage chest tubes	Manage chest tubes No patient needs	Manage chest tubes Lack of comfort in doing the procedure	Manage chest tubes Other
Manage ventilator settings	Manage ventilator settings No patient needs	Manage ventilator settings Lack of comfort in doing the procedure	Manage ventilator settings Other

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* 8. If checked 'Other' for any of the procedures above, please describe:

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* 9. On a scale from 1 (least comfortable) to 5 (most comfortable), how comfortable do you feel performing the following procedures in the home setting?

	1	2	3	4	5
Joint Injections / Aspirations	Joint Injections / Aspirations 1	Joint Injections / Aspirations 2	Joint Injections / Aspirations 3	Joint Injections / Aspirations 4	Joint Injections / Aspirations 5
Tracheostomy changes	Tracheostomy changes 1	Tracheostomy changes 2	Tracheostomy changes 3	Tracheostomy changes 4	Tracheostomy changes 5
Gastronomy tube changes	Gastronomy tube changes 1	Gastronomy tube changes 2	Gastronomy tube changes 3	Gastronomy tube changes 4	Gastronomy tube changes 5
Place/exchange/remove Foley catheters	Place/exchange/remove Foley catheters 1	Place/exchange/remove Foley catheters 2	Place/exchange/remove Foley catheters 3	Place/exchange/remove Foley catheters 4	Place/exchange/remove Foley catheters 5
Exchange/remove suprapubic catheters	Exchange/remove suprapubic catheters 1	Exchange/remove suprapubic catheters 2	Exchange/remove suprapubic catheters 3	Exchange/remove suprapubic catheters 4	Exchange/remove suprapubic catheters 5
Wound debridement	Wound debridement 1	Wound debridement 2	Wound debridement 3	Wound debridement 4	Wound debridement 5
Suturing of wounds	Suturing of wounds 1	Suturing of wounds 2	Suturing of wounds 3	Suturing of wounds 4	Suturing of wounds 5
Venipuncture/ draw blood	Venipuncture/ draw blood 1	Venipuncture/ draw blood 2	Venipuncture/ draw blood 3	Venipuncture/ draw blood 4	Venipuncture/ draw blood 5
Paracentesis	Paracentesis 1	Paracentesis 2	Paracentesis 3	Paracentesis 4	Paracentesis 5
Thoracentesis	Thoracentesis 1	Thoracentesis 2	Thoracentesis 3	Thoracentesis 4	Thoracentesis 5
Manage chest tubes	Manage chest tubes 1	Manage chest tubes 2	Manage chest tubes 3	Manage chest tubes 4	Manage chest tubes 5
Manage ventilator settings	Manage ventilator settings 1	Manage ventilator settings 2	Manage ventilator settings 3	Manage ventilator settings 4	Manage ventilator settings 5

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* 10. How did you learn to perform these procedures?

	Formal, in-person training (school, clerkship, residency)	Online videos, courses	N/A (Do not perform this procedure)	Other
Joint Injections / Aspirations	Joint Injections / Aspirations Formal, in-person training (school, clerkship, residency)	Joint Injections / Aspirations Online videos, courses	Joint Injections / Aspirations N/A (Do not perform this procedure)	Joint Injections / Aspirations Other
Tracheostomy changes	Tracheostomy changes Formal, in-person training (school, clerkship, residency)	Tracheostomy changes Online videos, courses	Tracheostomy changes N/A (Do not perform this procedure)	Tracheostomy changes Other
Gastronomy tube changes	Gastronomy tube changes Formal, in-person training (school, clerkship, residency)	Gastronomy tube changes Online videos, courses	Gastronomy tube changes N/A (Do not perform this procedure)	Gastronomy tube changes Other
Place/exchange/remove Foley catheters	Place/exchange/remove Foley catheters Formal, in-person training (school, clerkship, residency)	Place/exchange/remove Foley catheters Online videos, courses	Place/exchange/remove Foley catheters N/A (Do not perform this procedure)	Place/exchange/remove Foley catheters Other
Exchange/remove suprapubic catheters	Exchange/remove suprapubic catheters Formal, in-person training (school, clerkship, residency)	Exchange/remove suprapubic catheters Online videos, courses	Exchange/remove suprapubic catheters N/A (Do not perform this procedure)	Exchange/remove suprapubic catheters Other
Wound debridement	Wound debridement Formal, in-person training (school, clerkship, residency)	Wound debridement Online videos, courses	Wound debridement N/A (Do not perform this procedure)	Wound debridement Other
Suturing of wounds	Suturing of wounds Formal, in-person training (school, clerkship, residency)	Suturing of wounds Online videos, courses	Suturing of wounds N/A (Do not perform this procedure)	Suturing of wounds Other
Venipuncture/ draw blood	Venipuncture/ draw blood Formal, in-person training (school, clerkship, residency)	Venipuncture/ draw blood Online videos, courses	Venipuncture/ draw blood N/A (Do not perform this procedure)	Venipuncture/ draw blood Other
Paracentesis	Paracentesis Formal, in-person training (school, clerkship, residency)	Paracentesis Online videos, courses	Paracentesis N/A (Do not perform this procedure)	Paracentesis Other
Thoracentesis	Thoracentesis Formal, in-person training (school, clerkship, residency)	Thoracentesis Online videos, courses	Thoracentesis N/A (Do not perform this procedure)	Thoracentesis Other
Manage chest tubes	Manage chest tubes Formal, in-person training (school, clerkship, residency)	Manage chest tubes Online videos, courses	Manage chest tubes N/A (Do not perform this procedure)	Manage chest tubes Other
Manage ventilator settings	Manage ventilator settings Formal, in-person training (school, clerkship, residency)	Manage ventilator settings Online videos, courses	Manage ventilator settings N/A (Do not perform this procedure)	Manage ventilator settings Other

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* 11. If checked 'Other' for any of the procedures above, please describe:

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* 12. On a scale from 1 (least important) to 5 (most important) which procedures you think are the most important for a home care physician to know?

	1	2	3	4	5
Joint Injections / Aspirations	Joint Injections / Aspirations 1	Joint Injections / Aspirations 2	Joint Injections / Aspirations 3	Joint Injections / Aspirations 4	Joint Injections / Aspirations 5
Tracheostomy changes	Tracheostomy changes 1	Tracheostomy changes 2	Tracheostomy changes 3	Tracheostomy changes 4	Tracheostomy changes 5
Gastronomy tube changes	Gastronomy tube changes 1	Gastronomy tube changes 2	Gastronomy tube changes 3	Gastronomy tube changes 4	Gastronomy tube changes 5
Place/exchange/remove Foley catheters	Place/exchange/remove Foley catheters 1	Place/exchange/remove Foley catheters 2	Place/exchange/remove Foley catheters 3	Place/exchange/remove Foley catheters 4	Place/exchange/remove Foley catheters 5
Exchange/remove suprapubic catheters	Exchange/remove suprapubic catheters 1	Exchange/remove suprapubic catheters 2	Exchange/remove suprapubic catheters 3	Exchange/remove suprapubic catheters 4	Exchange/remove suprapubic catheters 5
Wound debridement	Wound debridement 1	Wound debridement 2	Wound debridement 3	Wound debridement 4	Wound debridement 5
Suturing of wounds	Suturing of wounds 1	Suturing of wounds 2	Suturing of wounds 3	Suturing of wounds 4	Suturing of wounds 5
Venipuncture/ draw blood	Venipuncture/ draw blood 1	Venipuncture/ draw blood 2	Venipuncture/ draw blood 3	Venipuncture/ draw blood 4	Venipuncture/ draw blood 5
Paracentesis	Paracentesis 1	Paracentesis 2	Paracentesis 3	Paracentesis 4	Paracentesis 5
Thoracentesis	Thoracentesis 1	Thoracentesis 2	Thoracentesis 3	Thoracentesis 4	Thoracentesis 5
Manage chest tubes	Manage chest tubes 1	Manage chest tubes 2	Manage chest tubes 3	Manage chest tubes 4	Manage chest tubes 5
Manage ventilator settings	Manage ventilator settings 1	Manage ventilator settings 2	Manage ventilator settings 3	Manage ventilator settings 4	Manage ventilator settings 5

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* 13. Are there any other procedural skills you feel are necessary for a home care physician or advanced care provider to be able to perform in the home setting? Please explain.

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* 14. Would you be interested in attending a one day, hands-on simulation training focused on these skills for home care physicians and advanced care providers?

Yes

Maybe

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* 15. What do you think is a fair price to pay for such a course?

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* 16. What is your sex?

Female

Male

Prefer not to say

Other

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* 17. What is your age?

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* 18. What year did you graduate from your medical (e.g. MD/DO/NP/PA/RN) school?

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* 19. What is your medical profession?

Medical Doctor (MD)

Osteopathic Doctor (DO)

Physician Assistant (PA)

Nurse Practitioner (NP)

Registered Nurse (RN)

Other (please specify)

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* 20. What is your medical specialty?

Internal Medicine

Family Medicine

Geriatrics

Palliative Care

Pediatrics

Neurology

Other (please specify)