0539_Att D_Table of Changes in the Survey Instrument revised

0539_Att D_Table of Changes in the Survey Instrument revised.doc

Estimating the Capacity for National and State-Level Colorectal Cancer Screening through a Survey of Endoscopic Capacity (SECAPII) formerly known as "National Survey of Endoscopic Capacity" (SECAP)

0539_Att D_Table of Changes in the Survey Instrument revised

OMB: 0920-0539

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Table of Proposed Changes to the SECAP II Survey Instruments (2010 submission)


Questions to be dropped from the survey instrument previously approved for OMB 0920-0590 (based on initial approval of 0920-0539)

Questions to be added to the proposed SECAP II survey instrument (current reinstatement request for 0920-0539)

Capacity Questions (directly asking for numbers on current, past, potential volume or numbers used in calculating annual capacity)


Q2 – weeks/year site has normal operations

Q7 – # procedures in 2009

Q49 – procedural volumes based on electronic medical records

Questions Related to Capacity (e.g., # procedure rooms, limiting factors, steps to increase capacity, waiting time)


Q4 - # procedure rooms available for lower endoscopies

Q16 a-k – limiting factors, colonoscopies

Q17 primary limiting factor, colonoscopies

Q33 a-j – limiting factors, flexible sigmoidoscopies

Q34 primary limiting factor, flexible sigmoidoscopies

Other Questions (i.e., descriptive information about providers, polyps, incompletes, type of facility, etc.)

Q2 – all endoscopy sites in hospital

Q6 – medical specialty and # of physicians at site

Q19 – biopsy during a flexible sigmoidoscopy?

Q20 – action taken for polyps of various sizes during a flexible sigmoidoscopy

Q36 – waiting time for a colonoscopy referral appointment at another clinic

Q41 – to whom reimbursement sent when a non-physician endoscopist performs a flexible sigmoidoscopy or colonoscopy

Q42 – Q45, Q47 patient characteristics

Q49 – Q50 medical specialty/sub-specialty of physician respondent

Q51 race/ethnicity of physicians

Q8 – type of sedation used for colonoscopy, flexible sigmoidoscopies

Q9 – who typically monitors sedation

Q13 - % of colonoscopies for surveillance & diagnostic

Q22 – quality measures routinely monitored

Q26 – number of colonoscopies that are follow-up to a CTC

Q47 – professional services Medicare classification

Q48 – facility Medicare classification

Q53 – single/multi-specialty ASC?

Q55 – hospital department/lab serve outpatients only?

Q56 – hospital voluntary non-profit, government, or proprietary for profit facility?


File Typeapplication/msword
File TitleState SECAP Year 3 survey question numbers
AuthorBattelle
Last Modified ByThelma Elaine Sims
File Modified2010-05-05
File Created2010-05-05

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