Physician-Public Report (P-PR) Survey

AHRQ's Public Report Surveys are designed to provide developers of Web-based public reports with information on how well their reports are meeting consumers' needs, and thereby inform redesign considerations. The primary aim of the surveys is to provide information on consumers' use and perceptions of any given public report Web site, but they also track views of other groups of people who visit a particular Web site. This survey focuses on physician reports.

Version 1.0

**Survey formatting notes:

Survey directions are in blue (i.e., anything blue is not visible in survey).
"Page x" refers to a new survey page.
Survey Pages 1 and 2 appear for all respondents. After Page 2, the survey branches to separate question sets for each Persona on Page 1. The answer to "What best describes you?" on Page 1 determines which question set is presented to the respondent. In the document below, each Persona-specific question set starts with a new header and new document page.
For Patients (including Health Care Professionals who indicate that they are "Choosing a @@0000 for myself") and Friend or Family Members, survey software can be programmed to show a subset of survey pages. For example, survey software can be programmed to show only three of the five question topics (Purpose of Visit, Topics of Interest, Using the Web site, What would you like added or changed, Demographic questions) and can be programmed to choose which three to show at random.
Piping-in: The answer to Item on Page 2 is used throughout the rest of the survey wherever @@0000 appears.

**Survey invitation [pops up upon arrival at the Web page where code for the popup is inserted].

We'd like your feedback.
Your participation in this 2-minute survey will help improve this nonprofit Web site, making it easier to find good medical care.

The survey will appear at the end of your Web site visit.

Take Our Survey No Thanks

All Web site visitors are being asked only once to participate in this survey and participation is voluntary. All results are strictly confidential and anonymously collected. If you have any questions about the survey, please contact us at: youremailhere@xxxx.org.

**If a visitor agrees to take the survey by clicking on "Take our survey," the survey window opens behind the open browser window and the visitor can continue the visit without further interruption. The survey window remains open to be completed later.

**Page 1 Thank you for agreeing to participate in our survey!
Please answer these questions after you complete your Web site visit.

**Item 1
**[This is a required question] What best describes you? I am a:
Patient (or an interested member of the public) **[branch to PATIENT questions]
Friend or family member of a patient **[branch to FRIEND OR FAMILY MEMBER questions]
Health care professional (for example, doctor, nurse, hospital executive) **[branch to HEALTH CARE PROFESSIONAL questions]
Employer or Labor Union representative **[branch to EMPLOYER OR LABOR UNION questions]
Insurer **[branch to INSURER questions]
Other (for example, media, advocate, elected official, researcher) **[branch to OTHER questions]

**Page 2
20% complete

**Item 1
**[This is a required question. The answer options should start with lower case letters as written below since the answer is piped into all subsequent occurrences of @@0000. If the answer is "other," the survey skips to the completion statement, with no further questions asked of the respondent.]

Are you looking for information about a doctor, a clinic, or a medical group?

A "clinic" is an office with multiple doctors all in the same location.
A "medical group" is a large network of doctors who do not necessarily work in the same location.

doctor
clinic
medical group
other: **[free text]

**Item 2
How would you rate your experience with using the Web site?

Poor					Excellent
1	2	3	4	5	6	7	8	9	10

**Item 3
How easy was it to use the Web site?
(for example, not too many clicks, easy to search the Web site)

Very Difficult					Very Easy
1	2	3	4	5	6	7	8	9	10

Health Care Professional

**Page 3
40% complete

Purpose of your visit

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
See my or my group's performance
See the performance of another physician or other group
Compare my or my group's performance to others' performance
Compare my or my group's charges to others' charges
Choose a @@0000 to make a patient referral
Choose a @@0000 for myself **[branch to HEALTH CARE PROFESSIONAL (CHOOSE A @@0000 FOR MYSELF)]
Get practical information about a @@0000 (phone number, location)
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today?
To:
(choose all that apply)
See my or my group's performance
See the performance of another physician or other group
Compare my or my group's performance to others' performance
Choose a @@0000 to make a patient referral
Choose a @@0000 for myself
Get practical information about a @@0000 (phone number, location)
No, I had no other reason
Other: **[free text]

**Page 4
60% complete

What would you like added or changed?

**Item 1
What additional information would make the Web site more useful? Information about:
(choose all that apply)
Quality measures that are not on the Web site
A @@0000 that is not on the Web site
Costs for patients (for example, medication costs or costs of a referral)
Methodology used to calculate performance measures (for example, risk adjustment methods)
Detailed results for each @@0000 (for example, sample size or 95% confidence intervals around their performance)
Individual doctor performance (for example, proportion of the doctor's diabetes patients who got the right test)
No other information
Other: **[free text]

**Item 2
What would make the Web site easier for you to use?
(choose all that apply)
Provide a different way of searching the Web site
Provide a different way of sorting the results on the Web site
Make the information easier to understand (for example, fewer technical terms)
Make it easier to compare @@0000s on one page (for example, show them side by side with only the information needed)
Make it easier to find a @@0000 by location
Make it easier to identify a good @@0000. How? **[free text]

**Item 3
Please list any quality measures or @@0000(s) that you would like to see on the Web site.
**[free text box]

**Item 4
Please write any additional comments about how the Web site could be more useful or easier to use.
**[free text box]

**Item 5
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Page 5
80% complete

A few last questions about you

**Item 1
Are you a:
(choose all that apply)
Physician **[branch to Specialty question, Page 22]
Nurse
Nurse practitioner **[branch to Specialty question, Page 22]
Pharmacist
Social worker
Executive
Quality manager
Other: **[free text]

**Item 2
In what setting do you primarily work?
Solo or small group practice (fewer than 10 providers)
Larger group practice (10+ providers)
Hospital
Other: **[free text]

**Item 3
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older

**Item 4
If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:
Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic)
Type of @@0000 (for example, pediatrician or pediatric clinics)
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
I did not use Google or another search engine
I do not know
Other: **[free text]

**Item 5
What is the ZIP Code at your primary workplace?

Employer/Labor Union

**Page 6
40% complete

**Item 1
Are you a(n):
Employer
Labor Union Representative

**Page 7
50% complete

**Item 1
Where do you work in your company?

** [to be shown only if answer above is "Employer"]

Human resources
Finance
Other senior management
Other:
**[free text]

**Item 2
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Choose @@0000(s) to include in the network for my employees or members
Learn about the quality of @@0000(s) for my employees or members
Learn about costs of @@0000(s) for my employees or members
Provide information to my employees or members
Choose a @@0000 for myself **[branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]
Get practical information about a @@0000 (phone number, location)
Other: **[free text]

**Item 3
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 4
Any comments?
**[free text box

**Item 5
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Choose @@0000(s) to include in the network for my employees or members
Learn about the quality of @@0000(s) for my employees or members
Learn about costs of @@0000(s) for my employees or members
Provide information to my employees or members
Choose a @@0000 for myself
Choose a @@0000 for my family or friends
Get practical information about a @@0000 (phone number, location)
No, I had no other reason
Other: **[free text]

**Item 6
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Item 7
Any comments?
**[free text box]

**Item 8
What would make the Web site more useful to you?
**[free text box]

**Item 9

If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:

Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic)
Type of @@0000 (for example, pediatrician or pediatric clinics)
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
I did not use Google or another search engine
I do not know
Other: **[free text]

**Item 10
What is the ZIP Code at your primary workplace?

Insurer

**Page 8
35% complete

Purpose of your visit

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Choose @@0000(s) to include in your network
Assess the quality of @@0000(s) in your network
Assess the cost of @@0000(s) in your network
Assess the quality of @@0000(s) outside your network
Assess the cost of @@0000(s) outside your network
Make decisions about pay for performance or other financial incentive programs
Provide information to your enrollees
Choose a @@0000 for yourself **[branch to PATIENT]
Choose a @@0000 for your family or friends ** [branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Choose @@0000(s) to include in your network
Assess the quality of @@0000(s) in your network
Assess the cost of @@0000(s) in your network
Assess the quality of @@0000(s) outside your network
Assess the cost of @@0000(s) outside your network
Make decisions about pay for performance or other financial incentive programs
Provide information to your enrollees
Choose a @@0000 for yourself
Choose a @@0000 for your family or friends
No, I had no other reason
Other: **[free text]

**Page 9
70% complete

What would you like added or changed?

**Item 3
Please list any quality measures or @@0000(s) that you would like to see on the Web site. **[free text box]

**Item 4
Please write any additional comments about how the Web site could be more useful or easier to use.

**[free text box]

**Item 5
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Item 6

If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:

Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic)
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
Type of @@0000 (for example, pediatrician or pediatric clinics)
I did not use Google or another search engine
I do not know
Other: **[free text]

**Item 7
What is the ZIP Code at your primary workplace?

Other

**Page 10
35% complete

**Item 1
Are you a: **[branch according to persona chosen below]
Member of the media (for example, TV, blog, print/online media)
Advocacy organization staff member
Elected official or government worker
Researcher
Foundation staff member
Legal professional
Other: **[free text]

Media

**Page 11
40% complete

**Item 1
What type of media do you work in?
TV
Print/online
Blog
Radio
Other: **[free text]

**Item 2
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in my community
Learn generally about health care quality issues in my community
Find out how much one would pay for care from a specific @@0000
Look for an angle on a story
Create a synopsis of a quality report for my audience
Choose a @@0000 for myself ** [branch to PATIENT]
Choose a @@0000 for my family or friends ** [branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 3
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 4
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in my community
Learn generally about health care quality issues in my community
Find out how much one would pay for care from a specific @@0000
Look for an angle on a story
Create a synopsis of a quality report for my audience
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 5
What would make the Web site more useful to you?
**[free text box]

**Item 6
If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:
Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic)
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
Type of @@0000 (for example, pediatrician or pediatric clinics)
I did not use Google or another search engine
I do not know
Other: **[free text]

**Item 7
What is the ZIP Code of your primary workplace?

Advocate

**Page 12
40% complete

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for the population I represent
Find out how much one would pay for care from a specific @@0000
Provide information to the population I represent
Choose a @@0000 for myself ** [branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about healthcare quality for the population I represent
Find out how much one would pay for care from a specific @@0000
Provide information to the population I represent
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 4
What would make the Web site more useful to you?
**[free text box]

**Item 5
If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:
Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic)
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
Type of @@0000 (for example, pediatrician or pediatric clinics)
I did not use Google or another search engine
I do not know
Other: **[free text]

**Item 6
What is the ZIP Code of your primary workplace?

Elected Official

**Page 13
40% complete

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for the population I represent
Find out how much one would pay for care from a specific @@0000
Provide information to the population I represent
Choose a @@0000 for myself **[branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for the population I represent
Find out how much one would pay for care from a specific @@0000
Provide information to the population I represent
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 4
What would make the Web site more useful to you?
**[free text box]

**Item 6
What is the ZIP Code of your primary workplace?

Researcher

**Page 14
40% complete

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Find out how much one would pay for care from a specific @@0000
Learn about the methodology used for the measures reported on the Web site
Choose a @@0000 for myself **[branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Find out how much one would pay for care from a specific @@0000
Learn about the methodology used for the measures reported on the Web site
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 4
What would make the Web site more useful to you?
**[free text]

**Item 6
What is the ZIP Code of your primary workplace?

Foundation Member

**Page 15
40% complete

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for a specific population
Find out how much one would pay for care from a specific @@0000
Choose a @@0000 for myself **[branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for a specific population
Find out how much one would pay for care from a specific @@0000
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 4
What would make the Web site more useful to you? **[free text box]

**Item 6
What is the ZIP Code of your primary workplace?

Lawyer

**Page 16
40% complete

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for a client
Find out how much one would pay for care from a specific @@0000
Provide information to a client
Choose a @@0000 for myself **[branch to PATIENT]
Choose a @@0000 for my family or friends **[branch to FRIEND OR FAMILY MEMBER]]
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Compare @@0000s
See how good a specific @@0000 is
Learn generally about the quality of the @@0000s in a community
Learn generally about health care quality issues
Learn about health care quality for a client
Find out how much one would pay for care from a specific @@0000
Provide information to a client
Choose a @@0000 for myself
Choose a @@0000 for a friend or family member
No, I had no other reason
Other: **[free text]

**Item 4
What would make the Web site more useful to you?
**[free text]

**Item 6
What is the ZIP Code of your primary workplace?

Health Care Professional(Choose A @@0000 For Myself)

**Page 17
35% complete

Topics of interest to you

**Item 1
When you are choosing a @@0000, are there any particular conditions you are concerned about?
(choose all that apply)
Heart disease (for example, heart attacks or heart failure)
Obstetrics and gynecology (for example, pregnancy)
Cancer
Pediatrics
Asthma
Pneumonia
Diabetes
None of the above
Other: **[free text]

**Item 2
What specific types of information are you looking for today?
(choose all that apply)
How patients rate their care (for example, how many patients would recommend the @@0000)
How often patients get the correct care (for example, how many people having a heart attack get the right medicine)
How often mistakes occur (for example, medication prescribing mistakes)
Other: **[free text]

**Item 3 What types of doctors are you interested in?
(choose all that apply)
Doctors providing routine pregnancy care
Doctors providing other routine care (for example, preventive or primary care)
Surgeons
Doctors other than surgeons providing specialty care (for example, cancer doctors or heart doctors)
Other:
**[free text]

**Page 18
50% complete

Using information from the Web site

**Item 1
How likely are you to use the Web site information now to choose a @@0000 or change @@0000s?
Very likely
Likely
Unlikely **[branch to Page 19]
Very unlikely **[branch to page 19]

**Item 2
How likely are you to use the Web site information to have a conversation with your doctor or other health care provider?
Very likely
Likely
Unlikely
Very unlikely

**Item 3
What do you like about the Web site?
(choose all that apply)
The number of @@0000s included
The type of @@0000s included
The range of conditions and treatments included
Information provided about quality of care (for example, whether the right treatments were given)
Information about how to talk to your doctor
Information about how to choose a doctor
Nothing (I do not like anything about the Web site)
Other:
**[free text]

**Page 19
55% complete

**Item 1
Why are you unlikely to use the information to choose a @@0000?
(choose all that apply)
I do not have a choice of @@0000s
I do not need to choose a @@0000 at this time
The Web site does not provide information specific to my personal health condition
The Web site does not provide information specific to the @@0000 that I want to know about
The information provided does not seem trustworthy
The information is confusing or difficult to understand
Other:
**[free text]

**Page 20
65% complete

What would you like added or changed?

**Item 2
What would make the Web site easier for you to use?
(choose all that apply)
Provide a different way of searching the Web site
Provide a different way of sorting the results on the Web site
Make the information easier to understand (for example, fewer technical terms)
Make it easier to compare @@0000s on one page (for example, show them side by side with only the information needed)
Make it easier to find a @@0000 in my neighborhood
Make it easier to identify a good @@0000. How? **[free text]

**Item 3
Please list any quality measures or @@0000(s) that you would like to see on the Web site. **[free text]

**Item 4
Please write any additional comments about how the Web site could be more useful or easier to use. **[free text]

**Item 5
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Page 21
75% complete

A few last questions about you

**Item 1 What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older

**Item 2
Are you male or female?
Male
Female

**Item 3
Are you of Hispanic or Latino descent?
Yes, Hispanic or Latino
No, not Hispanic or Latino

**Item 4
What is your race?
White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other

**Item 5
What is the highest grade or level of school that you have completed?
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4 year-college degree

**Item 6
What is your primary health insurance plan?
(choose one)
Private insurance (i.e., from your employer or purchased by you)
Medicare
Medicaid
No insurance
I don't know
Other: **[free text]

**Item 7
What is the ZIP Code of your primary residence?

**Item 8
Are you a:
(choose all that apply)
Physician **[branch to Specialty question, Page 22]
Nurse
Nurse practitioner **[branch to Specialty question, Page 22]
Pharmacist
Social worker
Executive
Quality manager
Other: **[free text]

**Page 22
95% complete

**Item 1
What is your specialty?
Internal Medicine
Family Medicine/General Practice
Pediatrics
Surgery
Psychiatry
Obstetrics/Gynecology
Other: **[free text]

Friend Or Family Member

**Page 23
30% complete

**Item 1
I am looking for information for a:
(choose all that apply)
Family member
Non-family member
Child (under 18 years)
Non-senior adult (18-65 years)
Senior (65+)
Non-English speaker. Please specify language spoken: **[free text]

**Page 24

Purpose of your visit

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Choose the best @@0000 or compare @@0000s
See how good a specific @@0000 is
Prepare for a talk with a doctor
Choose a @@0000 for myself **[branch to PATIENT]
Learn about a particular disease or treatment option
Get practical information about a @@0000 (phone number, location)
Find out how much one would have to pay for care from a specific @@0000
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Choose the best @@0000 or compare @@0000s
See how good a specific @@0000 is
Prepare for a talk with a doctor
Learn about a particular disease or treatment option
Get practical information about a @@0000 (phone number, location)
Find out how much one would have to pay for care from a specific @@0000
No, I had no other reason
Other: **[free text]

**Page 25
50% complete

Topics of interest to you

**Item 1
When you are choosing a @@0000 for your friend or family member, are there any particular conditions you are concerned about?
(choose all that apply)
Heart disease (for example, heart attacks or heart failure)
Obstetrics and gynecology (for example, pregnancy)
Cancer
Pediatrics
Asthma
Pneumonia
Diabetes
None of the above
Other: **[free text]

**Item 3
What types of doctors are you interested in?
(choose all that apply)
Doctors providing routine pregnancy care
Doctors providing other routine care (for example, preventive or primary care)
Surgeons
Doctors other than surgeons providing specialty care (for example, cancer doctors or heart doctors)
Other: **[free text]

**Item 4
What is your friend or family member's primary health insurance plan?
(choose one)
Private insurance (i.e., from his or her employer or that he or she purchased)
Medicare
Medicaid
No insurance
I don't know
Other:
**[free text]

**Page 26
60% complete

Using information from the Web site

**Item 1
How likely are you to use the Web site information now to help your friend or family member choose a @@0000 or change @@0000s?
Very likely
Likely
Unlikely **[branch to Page 27]
Very unlikely **[branch to Page 27]

**Item 2
How likely are you or your friend or family member to use the Web site information to have a conversation with a doctor or other health care provider?
Very likely
Likely
Unlikely
Very unlikely

**Item 4
If you searched using Google (or Yahoo, Bing, or other search engine) to get to the Web site, did you search for a:
Specific @@0000 (for example, Dr. Smith or Dr. Smith's clinic
Web site comparing @@0000s
Medical problem or treatment (for example, "high blood sugar" or "cancer surgery")
Type of @@0000 (for example, pediatrician or pediatric clinics)
I did not use Google or another search engine
I do not know
Other:
**[free text]

**Page 27
65% complete

**Item 1
Why are you unlikely to use the information to help your friend or family member choose a @@0000?
(choose all that apply)
My friend or family member does not have a choice of @@0000s
He or she does not need to choose a @@0000 or change @@0000s at this time
The Web site does not provide information specific to his or her personal health condition
The Web site does not provide information specific to the @@0000 he or she needs to know about
The information provided does not seem trustworthy
The information is confusing or difficult to understand
Other:
**[free text]

**Page 28
80% complete

What would you like added or changed?

**Item 1
What additional information would make the Web site more useful? Information about:
(choose all that apply)
How well the @@0000 treats patients with the specific condition my friend or family member has
Comments from people who have been the @@0000's patient
A @@0000 that is not on the Web site
How much my friend or family member would pay for care from a specific @@0000
Practical aspects of the @@0000 (for example, phone number, location)
No other information
Other:
**[free text]

**Item 2
What would make the Web site easier for you to use?
(choose all that apply)
Provide a different way of searching the Web site
Provide a different way of sorting the results on the Web site
Make the information easier to understand (for example, fewer technical terms)
Make it easier to compare @@0000s on one page (for example, show them side by side with only the information needed)
Make it easier to find a @@0000 in my friend or family member's neighborhood
Make it easier to identify a good @@0000. How?
**[free text]

**Item 3
Please list any additional @@0000(s) you would like to see on the Web site.
**[free text box]

**Item 4
Please write any additional comments about how to make the Web site more useful or easier to use.
**

**Item 5
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Page 29
90% complete

A few last questions about YOU

**Item 1
What is your age?
<18 years old
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older

**Item 2
Are you male or female?
Male
Female

**Item 3
What is the highest grade or level of school that you have completed?
8th grade or less
Some high school, but did not graduate
High school graduate or GED
Some college or 2-year degree
4-year college graduate
More than 4 year-college degree

**Item 4
What is the ZIP Code of your primary residence?

Patient (or interested member of the public)

**Page 30
30% complete

Purpose of your visit

**Item 1
What was the primary purpose of your visit to the Web site today? To:
(choose only one)
Choose the best @@0000 for myself or compare @@0000s
See how good my @@0000 is
Prepare for a talk with my doctor
Get information for my family or friends
Learn about a particular disease or treatment option
Get practical information about a @@0000 (phone number, location)
Find out how much I would have to pay for care from a specific @@0000
Other: **[free text]

**Item 2
Were you able to accomplish the primary purpose of your visit?
Definitely
Mostly
Only partially
Not at all

**Item 3
Did you have other reasons (in addition to the primary reason above) for your visit today? To:
(choose all that apply)
Choose the best @@0000 for myself or compare @@0000s
See how good my @@0000 is
Prepare for a talk with my doctor
Get information for my family or friends
Learn about a particular disease or treatment option
Get practical information about a @@0000 (phone number, location)
Find out how much I would have to pay for care from a specific @@0000
No, I had no other reason
Other: **[free text]

**Page 31
40% complete

Topics of interest to you

**Item 3
What types of doctors are you interested in?
(choose all that apply)
Doctors providing routine pregnancy care
Doctors providing other routine care (for example, preventive or primary care)
Surgeons
Doctors other than surgeons providing specialty care (for example, cancer doctors or heart doctors)
Other: **[free text]

**Page 32
50% complete

Using information from the Web site

**Item 1
How likely are you to use the Web site information now to choose a @@0000 or change @@0000s?
Very likely
Likely
Unlikely **[branch to page 33]
Very unlikely** [branch to page 33]

**Item 2
How likely are you to use the Web site information to have a conversation with your doctor or other health care provider?
Very likely
Likely
Unlikely
Very unlikely

**Page 33
55% complete

**Page 34
75% complete

What would you like added or changed?

**Item 1
What additional information would make the Web site more useful? Information about:
(choose all that apply)
How well the @@0000 treats patients with my specific condition
Comments from people who have been the @@0000's patient
A @@0000 that is not on the Web site
How much I would pay for care from a specific @@0000
Practical information about the @@0000 (for example, phone number, location)
No other information
Other: **[free text]

**Item 2
What would make the Web site easier for you to use?
(choose all that apply)
Provide a different way of searching the Web site
Provide a different way of sorting the results on the Web site
Make the information easier to understand (for example, fewer technical terms)
Make it easier to compare @@0000s on one page (for example, show them side by side with only the information needed)
Make it easier to find a @@0000 in my neighborhood
Make it easier to identify a good @@0000. How? **[free text]

**Item 3
Please list any additional @@0000(s) you would like to see on the Web site.
**

**Item 4
Please write any additional comments about how to make the Web site more useful or easier to use.
**

**Item 5
How likely are you to visit the Web site again?
Very likely
Likely
Unlikely
Very unlikely

**Page 35
85% complete

A few last questions about you

**Item 1
What is your age?
<18 years old
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older

**Item 2
Are you male or female?
Male
Female

**Item 3
Are you of Hispanic or Latino descent?
Yes, Hispanic or Latino
No, not Hispanic or Latino

**Item 4
What is your race?
White
Black or African-American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
Other

**Item 6
What is your primary health insurance plan?
(choose only one)
Private insurance (i.e., from your employer or purchased by you)
Medicare
Medicaid
No insurance
I don't know
Other: **[free text]

**Item 7
What is the ZIP Code of your primary residence?

Completion Event

Thank you for taking the survey!

Your participation will help us understand how to make the Web site better so that people can easily find information about how well doctors and medical groups take care of their patients.

If you have any questions about the survey, please contact us at: youremailhere@email.com

You may now return to [http://participatingwebsitehere.org] or simply close this window.

Current as of August 2011

** Denotes survey directions—not visible in survey.

Current as of August 2011

Internet Citation: Physician-Public Report (P-PR) Survey. August 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/physicianwebsurvey/physsurvey.html