Form D1 Appendix D1. HSA Survey

EVALUATION of Learning Health Systems K12 Training Program

Appendix D1. Health System Advisor (HSA) Survey

May 18, 2020

Form Approved
OMB No. XXX-XXXX
Exp. Date XX/XX/20XX

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. Public reporting burden for the collection of information is estimated to average XX minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer, Attention: PRA, Paperwork Reduction Project (XXXX-XXXX), AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

Introduction

Thank you for completing this survey as part of the research being conducted by 2M Research (2M) for the Agency for Healthcare Research and Quality (AHRQ). The purpose of the survey is to learn about your views on the role of research and stakeholder engagement in research carried out in your health system.

The survey should take less than 10 minutes to complete.

Please answer as openly and honestly as possible. There are no right or wrong answers. You can refuse to answer any questions you do not want to answer. Your participation in this study is voluntary, and you may stop at any time. There will be no negative consequences if you choose to stop or if you choose not to participate at all.

All interview data will be treated in a secure manner and will not be disclosed, unless otherwise compelled by law. The information that 2M collects will be aggregated and summarized for reporting to AHRQ and the public.

The survey can be closed and continued at another time (i.e., the form does not need to be completed in one sitting). Before you close out of your browser (and the survey), you must answer all questions on that page and save your responses by clicking the “Submit” button. To complete your survey, return to the same browser on the same device. If you receive an error when trying to return to the survey or if the survey times out, please click on the survey link previously emailed to you.

Please complete this survey by [DATE].

If you experience technical difficulties while completing this survey, please contact AHRQ’s IT liaison at survey@ahrq.hhs.gov. If you have questions about this study, please contact Dr. Amy Windham, the evaluation director, at awindham@2mresearch.com or 703-214-1512.

Item	Question	Response options
Page 1: Introductory screen	The first set of survey questions asks you to rate your level of agreement with statements related to research carried out in your health system. The scale ranges from “Strongly disagree” to “Strongly agree.”
1	Research carried out in your health system should influence patient care in your health system.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
2	Research carried out in your health system should improve patient outcomes or patient experience of care in your health system.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
3	Research carried out in your health system should reduce the cost of care in your health system.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
4	Research carried out in your health system should increase efficiency of care delivery in your health system.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
Page 2:
5	Research carried out in your health system should strengthen the health system’s reputation.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
6	Research carried out in your health system should generate financial support for more research in your institution.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
7	Research carried out in your health system should provide research staff with opportunities for career advancement.	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
8	Research may be carried out in your health system for the sole purpose of contributing to the scientific knowledge base (even if it does not directly influence patient care or hospital operations).”	Strongly disagree Somewhat disagree Neutral Somewhat agree Strongly agree Not applicable/Prefer not to answer
Page 3: Transition screen	The next questions ask you to rate how important certain aspects of patient, family, and other stakeholder involvement are to research carried out in your health system. The scale ranges from “Not at all important” to “Very important.”
9	How important is it to you for patients and families to participate in determining the research topics that are carried out in your health system?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
10	How important is it to you for patients and families to provide input on the execution of research conducted in your health system?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
11	How important is it to you for patients and families to review the results of research conducted in your health system and provide input on the implications of those results?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
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12	How important is it to you for stakeholders, from within your health system to participate in determining the research conducted in your health system?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
13	How important is it to you for stakeholders from within your health system to provide input on executing research conducted in your health system?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
14	How important is it to you for stakeholders from within your health system to review the results of research conducted in your health system and provide input on the meaning or implications of those results?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
15	How important is it to you for stakeholders from within your health system to provide input on how the research results generated in your health system are used by your health system?	Not at all important Slightly important Important Fairly important Very important Not applicable/Prefer not to answer
Closing screen	Thank you! We appreciate the time you have taken to answer our questions. Your input is very valuable.