Form 10-10168 PIM Patient Letter

OMB Number 2900-0770

Estimated Burden: 30 mins

EXP Date: 08/31/2017

PACT Intensive Management National Evaluation: Patient Experience: Patient Letter

OMB 2900-0770

Estimated burden: 30 minutes

Expiration Date 08/31/2017

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average thirty (30) minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to achieve services. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

Dear Ms./Mr. [Insert Name],

We are contacting you as a VA patient receiving services from a PACT Intensive Management (PIM) team at [INSERT NAME OF VA]. We invite you to participate in an interview about your experiences with receiving services from PIM.

Purpose of interviews:

• Learn from your experiences in order to plan future VA programs

• Hear from you about whether and how the PIM team is helping you with your health and wellness concerns

• Understand how the VA can better serve your health and wellness needs

Who will be involved and what are we asking them to do:

• Patients receiving PIM services from 5 VA clinics across the country

• One 20-30 minute telephone interview in Fall or Winter 2015/2016.

If you are interested in participating, please reply to this email, or you may call Lisa Tarr, 818-891-7711 x36021. If we don’t hear from you, we will call you in a few days to ask if you are interested in participating in the interview.

As a VA patient, your perspective is important for helping us understand how the PIM teams are doing, and how VA might provide better care for patients like you.

Interviews will be conducted and data analyzed by Ph.D.-level qualitative researchers. Because we value your honest assessment, information you provide will be confidential.

For more information about these interviews, please see the Frequently Asked Questions included with this letter.

Sincerely,

Susan E. Stockdale, Ph.D.

PIM Patient Interview Director

Greater Los Angeles VA Healthcare System

Phone: 818-891-7711 x36018

Email: Susan.Stockdale@va.gov