Form CFI 142 CFI 142 VA Outpatient Questionnaire

American Customer Satisfaction Index VHA Outpatient Veterans Affairs: Veterans Health Administration

PROG. NOTE: Move in CONTACT NAME from sample

[CONTACT NAME]: FNAME LNAME FROM SAMPLE

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May I speak with (RESTORE CONTACT NAME)?

Hello, I'm (NAME) calling on behalf of the CFI Group. We are conducting research on how satisfied users are with services provided by federal government agencies and private companies as part of the American Customer Satisfaction Index.

Today I want to ask you about services you may have received from the VA Medical Center. The purpose of the research is to help the Veterans Health Administration improve its services to veterans. Your name will be confidential, and I will ask you only about products and services you have recently purchased and used. Your participation is voluntary and poses no foreseeable risk to you. You may stop at any time or skip any question you do not wish to answer. Your opinions are important because you have been chosen randomly to represent consumers across the United States and your responses will be added to a growing database of evaluations of customer satisfaction used by researchers, companies, and government agencies to improve the products and services provided to you, the consumer. This interview will take 8-10 minutes and is authorized by Office of Management and Budget Control No. 1505-0191.

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PROG. NOTE: TERMINATE SCREEN

Those are all of the questions I have for you. Thank you for your interest in this project.

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Now, I am going to ask you some questions about the VA Medical Center with which you have had experience.

Q1. Before you recently used the VA Medical Center, you probably knew something about that VA Medical Center. Now think back and remember your expectations of the overall quality of the VA Medical Center. Please give me a rating on a 10 point scale on which "1" means your expectations were "not very high" and "10" means your expectations were "very high."

How would you rate your expectations of the overall quality of the VA Medical Center you recently visited?

[RECORD NUMBER 1-10]

DK

REF

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Now, let's think about who gives you your medical care at the VA Medical Center you recently visited…

Q2. Do you have an assigned provider or a team in charge of your medical care at that VA Medical Center?

1. Yes, one medical care provider or team

2. No

DK

REF

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Now, let’s talk about the kind of service you get at the VA Medical Center you recently visited…

Q3. How accessible and easy to use is that VA Medical Center for you? Use a 10-point scale again on which “1” means “very inaccessible and difficult to use” and “10” means “very accessible and easy to use.” How inaccessible or accessible is that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Q4. How courteous are the appointment personnel? On a 10 point scale on which “1” means “not at all courteous” and “10” means “very courteous,” how courteous are the appointment personnel?

[RECORD NUMBER 1-10]

DK

REF

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Q5. And how courteous are the medical providers? On a 10 point scale on which “1” means “not at all courteous” and “10” means “very courteous,” how courteous are those who provide your medical care?

[RECORD NUMBER 1-10]

DK

REF

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Q6. How professional are the medical providers in terms of being knowledgeable, helpful, and responsive? On a 10-point scale on which “1” means “not at all professional” and “10” means “very professional,” how professional are those who provide your medical care?

[RECORD NUMBER 1-10]

DK

REF

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Now, think about the pharmacy at the VA Medical Center you recently visited…

Q7. How long is the waiting time for you to obtain your prescriptions from the pharmacy located at that VA Medical Center. Please rate the waiting time for prescriptions on a 10-point scale on which “1” means “very slow” and “10” means “very fast.”

[RECORD NUMBER 1-10]

11 Did not use pharmacy

DK

REF

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Q10. Please consider all your experiences in the past two years with the VA Medical Center you recently visited. Using a 10-point scale, on which "1" means "not very high" and "10" means "very high," how would you rate the overall quality of that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Satisfaction includes many things. Let's move on and talk about your overall satisfaction with the VA Medical Center you recently visited.

Q11. First, please consider all your experiences to date with that VA Medical Center. Using a 10 point scale on which “1” means “very dissatisfied” and 10 means “very satisfied,” how satisfied are you with that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Q12. Considering all of your expectations, to what extent has that VA Medical Center fallen short of your expectations or exceeded your expectations? Using a 10-point scale on which "1" now means "falls short of your expectations" and "10" means "exceeds your expectations," to what extent has the VA Medical Center fallen short of or exceeded your expectations?

[RECORD NUMBER 1-10]

DK

REF

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Q13. Forget the VA Medical Center you recently visited for a moment. Now, I want you to imagine an ideal outpatient medical center. (PAUSE) How well do you think the VA Medical Center you recently visited compares with that ideal outpatient medical center? Please use a 10-point scale on which "1" means "not very close to the ideal," and "10" means "very close to the ideal."

[RECORD NUMBER 1-10]

DK

REF

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Next, I want you to think about any communication you may have had over the past year with the VA Medical Center you recently visited regarding complaints about your experience.

Q14. Have you complained to that VA Medical Center within the past year?

1. Yes

2. No

DK

REF

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{IF Q14 = 1 ASK Q14C-Q14D; OTHERWISE GO TO Q15}

Q14C. How well, or poorly, was your most recent complaint handled? Using a 10-point scale on which “1” means “handled very poorly” and “10” means “handled very well,” how would you rate the handling of your complaint?

[RECORD NUMBER 1-10]

DK

REF

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Q14D. How difficult or easy was it to make your most recent complaint? Using a 10-point scale on which “1” means “very difficult” and “10” means “very easy,” how difficult or easy was it to make a complaint?

[RECORD NUMBER 1-10]

DK

REF

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Q15. How likely is it that you will use the VA Medical Center you recently visited again in the future when you need medical care? On a 10 point scale on which “1” means “very unlikely” and “10” means “very likely,” how likely is it that you will use that VA Medical Center again?

[RECORD NUMBER 1-10]

DK

REF

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Q16. If asked, how willing would you be to say positive things about the VA Medical Center you recently visited to other veterans? On a 10 point scale on which “1” means “not at all willing” and “10” means “very willing,” how willing would you be to say positive things about that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Q17. Was your recent clinic visit scheduled or a “Walk-in”?

1. Scheduled

2. Walk-in

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(If Q17 =2 ask Q18, otherwise skip to next section)

Q18. Was this clinic visit a ”Walk-in” because of an emergency condition or illness?

1 Yes

2 No

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Now, we need to ask a few demographic questions for the ACSI consumer profile…

QD1. What is your age, please?

[RECORD NUMBER OF YEARS 1-150]

DK

REF

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QD2. What is the highest level of formal education you completed? (READ CODES 1-5)

3. Less than high school

4. High school graduate

5. Some college or associate degree

6. College graduate

7. Post-Graduate

DK

REF

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QD3. Are you of Hispanic, Latino or Spanish origin?

1. Yes

2. No

DK

REF

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QD4. Do you consider your race(s) as: (READ CODES 1-5; ACCEPT UP TO 5 MENTIONS)

1. White

2. Black/African American

3. American Indian/Alaska Native

4. Asian

5. Native Hawaiian or other Pacific Islander

6. Other race

DK

REF

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QD5. What was your total annual family income in 2005? (READ CODES 1-7 AS NECESSARY) (READ IF NECESSARY: Before taxes)

1. Under $20,000

2. $20,000 but less than $30,000

3. $30,000 but less than $40,000

4. $40,000 but less than $60,000

5. $60,000 but less than $80,000

6. $80,000 but less than $100,000

7. $100,000 or more

DK

REF

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QD6. Gender (By Observation)

1. Male

2. Female

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