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* 1. Your primary role within your organization

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* 2. Organization Name

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* 3. Please select the category that best reflects the primary role of your organization (select all that apply):

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* 4. Please indicate whether your organization is a membership organization:

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* 5. If yes, please estimate the number of members in your organization

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* 6. Please indicate whether your organization employs clinicians to provide patient care

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* 7. If yes, please estimate the number of clinicians in your organization:

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* 8. How would you rate the knowledge and use of PCORI-sponsored research within your staff? (check all that apply)

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* 9. How would you rate the knowledge and use of PCORI-sponsored research within your members or patients (check all that apply)

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* 10. Please indicate the extent to which you (or your organization) communicate information on patient-centered research outcomes to patients and/or caregivers:

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* 11. What do you think are the most important obstacles that prevent the sharing of patient-centered research outcomes with patients and caregivers? (check all that apply):

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* 12. Sharing with your organization:  PCPCC is considering a range of methods for disseminating results of patient-centered outcomes to our members.  Please indicate your TOP 3 CHOICES (check 3 boxes) for best options for PCPCC to communicate such information with your organization:

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* 13. Sharing with your own members/stakeholders: Please use the list below to indicate which of the following methods your organization currently uses to communicate with your members/key stakeholders

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* 14. Sharing with your own members/stakeholders: Please use the list below to indicate your TOP 3 CHOICES for best options for your organization to communicate the results of patient-centered outcomes research findings with your members or key stakeholders moving forward:

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* 15. Sharing with your own members/stakeholders: Please use the table below to indicate your TOP 3 CHOICES (check 3 boxes) for best options for your organization to communicate the results of patient-centered outcomes research findings with your members or key stakeholders moving forward:

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* 16. What is your preference for the frequency of receiving information on PCORI-supported research results from the PCPCC?

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* 17. Are there other organizations that you currently count on to inform you regularly of results of patient-centered outcomes research?

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* 18. If answer above is yes, what is valuable or useful about the way that such organizations disseminate results?

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* 19. Please indicate the importance of offering Continuing Medical Education (CME) credits when sharing patient-centered research outcomes with your members/key stakeholders:

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* 20. Are there other incentives you can identify that could help to disseminate this information?

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* 21. What other methods do you think may help or might prevent patients/caregivers from using patient-centered outcomes research information – e.g., ability to provide materials in different languages, cultural issues, time, IT access.

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* 22. Your name (optional)

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* 23. Additional comments:

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