Co-Management Satisfaction Survey

1. Which Co-Management Tool-Kit did you use today?
2. How did or how will you use this Co-Management Tool-Kit?
3. How did you learn of Connecticut Children's Co-Management plans?
4. Have you viewed the web-based CME module for this condition?
5. If yes, please rank how satisfied you are with the online CME for this condition:
6. Please rate how satisfied you are with the clarity of the materials in this tool-kit:
7. Please rate how satisfied you are with the usefulness of the tool-kit:
8. Please rank your overall satisfaction with each of the tool-kit components:
Very satisfiedSatisfiedNeutralDissatisfiedVery dissatisfiedNot applicable (N/A)
Protocol (algorithm)
Initial Visit Template
Follow-up Visit Template
9. Please rate the tool-kit in terms of ease of use:
10. Did this tool-kit change the care you delivered in any of the following areas:
Initial Management
Follow-up Management
Initial Diagnostic Testing
Referral to Subspecialists
11. If 'yes' to any of the above, please feel free to comment further:
12. Did use of this tool-kit allow you to initiate treatment sooner?
13. Did use of this tool-kit increase your confidence in your approach to the patient?
14. How many providers are in your practice?
15. Do other providers in your practice participate in Co-Management?
16. Did you deviate in any way from this Co-Management plan?
17. If 'yes', please describe your reason for deviating from this protocol:
18. Please feel free to provide us with any additional comments or feedback, including recommendations for other conditions for Co-Management:
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