Patient Education Materials PI/QI Pre-Intervention Survey

Instructions: Responses to the following questions will be aggregated and used to optimize patient-education delivery. Please answer the following questions based on care you provided during visit with an acute complaint in the last few month. For reference, visits with acute care complaint may include acute, EST, and follow-up visits for chronic conditions. This excludes routine well-child visits.

Question Title

* 1. How often did you provide a written care plan at the end of the visit?

All of the time

Most of the time

Sometimes

Rarely

Never

Question Title

* 2. Check all that apply. I do not provide a written care plan at the end of pertinent visits because

I did not think a written plan was necessary

I did not think the specific patient/family would benefit from a written care plan

There was no written template readily available for me to use

I wasn’t sure what to include on a written plan

Not enough time before next patient

Equipment limitation

Another factor not on this list

Please briefly explain your response to this question.

Question Title

* 3. How often did your written care plans include high-quality, patient-centered, educational content specific to the diagnosis? (If you answered "Never" to question 1, please skip)

Always

Most of the time

Sometimes

Rarely

Never

Question Title

* 4. Check all that apply. I did not include high quality educational content within my written care plan because:

I was unsure of what diagnosis-specific, educational content to use

I had something in mind, but was unable to find it

Not enough time before next patient

Equipment limitation

The patient preferred an electronic version

I did not feel that diagnosis-specific education was needed

Another factor not on this list

Please briefly explain your response to this question

Patient Education Materials PI/QI Pre-Intervention Survey

Question Title

* 1. How often did you provide a written care plan at the end of the visit?

Question Title

* 2. Check all that apply. I do not provide a written care plan at the end of pertinent visits because

Question Title

* 3. How often did your written care plans include high-quality, patient-centered, educational content specific to the diagnosis? (If you answered "Never" to question 1, please skip)

Question Title

* 4. Check all that apply. I did not include high quality educational content within my written care plan because:

Question Title

* 5. Are there specific patient-centered education materials you have found to be helpful or would like to use? Please list below.

Question Title

* 6. How do you identify high-quality, patient-centered educational content?