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Studies:

Incident Reporting Questionnaire for Nursing Home Administrators

CMS Direct Service Workforce Demonstration Evaluation

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Incident Reporting Questionnaire for Nursing Home Administrators

The purpose of this research is to examine the practices and policies of adverse event reporting in nursing home settings. In addition to querying all 50 State Departments of Health, we are requesting the assistance of nursing homes in order to collect information concerning adverse event reporting.

We are asking you to complete the following survey about these kinds of activities in your nursing home. As a token of our appreciation, we will send you an activated $20 Wal-Mart gift card. Please be sure to include your name and address on the final page of the survey so we can properly compensate you upon receiving your survey.

The information from these surveys will remain anonymous. Data will be summarized and the information will be secured in our electronic and paper files throughout the study. There are no foreseeable risks associated with you completing this survey.

Your participation is completely voluntary. Returning the questionnaire via electronic mail or standard mail indicates your consent. You may choose to not answer any question and simply leave it blank. If you are unable to complete the survey for any reason, please take a moment to indicate the reason(s) on the first page, and return the form. This will allow us to maintain more complete and accurate records.

The investigators for this study are Dr. Nicholas G. Castle at the University of Pittsburgh and Dr. Laura M. Wagner at Baycrest Centre for Geriatric Care. This study was funded by the Agency for Healthcare Research and Quality (AHRQ) and has been approved by The University of Pittsburgh Institutional Review Board (IRB) for the protection of human subjects.

The first version can be completed in Microsoft Word and sent to the address listed below or emailed to castlen@pitt.edu.The second version can be printed, completed by hand and sent to the address below.

Nick Castle, PhD

University of Pittsburgh

Graduate School of Public Health

Department of Health Policy & Management

A610 Crabtree Hall

Pittsburgh, PA 15261

Thank you for your participation!

Interactive Survey (Incident_Reporting_Survey_NHA Jan 24 20081(interactive))

Printable Survey (Incident_Reporting_Survey_NHA Jan 24 20081)

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CMS Direct Service Workforce Demonstration Evaluation

The following surveys will be used in a national evaluation of the Centers of Medicare and Medicaid Services (CMS) funded direct service community workforce demonstrations. This evaluation is being conducted through a collaboration between the RAND Corporation and the University of Pittsburgh.

This evaluation is designed to understand the impact of the CMS funded demonstrations designed to recruit and retain Direct Service Workers. We are writing to ask you to participate by completing the appropriate questionnaire.

Since we are attempting to complete this evaluation immediately, we would like to compensate those that complete agency surveys by July 18, 2008 with a $50 Wal-Mart gift card. Also, we would like to send a $10 Wal-Mart gift card to any Direct Service Workers that can complete their respective survey by the same date.

Please notify your workers that they will receive a $10 Wal-Mart gift card if they return their completed survey to the address listed below or they may email their surveys to castlen@pitt.edu. All surveys can be easily completed in Microsoft Word by clicking on checkboxes and gray boxes for short-answer questions.

If your agency participated in CMS demonstrations, the following surveys are for your agency and direct service workers (DSW). (Click on the hyperlink to access a copy of the survey in Microsoft Word) Also, if you think any of your consumers would be interested in completing a brief survey, please let us know and we will send surveys and business reply envelopes.

Agency Survey (
agency.intervention(interactive))
Direct Service Worker (DSW) (
DirectCareWorker.intervention(interactive))

If your agency completed an agency survey as a part of the control group, the survey for Direct Service Workers can be found below.

Direct Service Worker (Control Group) (
DirectCareWorker.control(interactive))

Nick Castle, PhD
University of Pittsburgh
Graduate School of Public Health
Department of Health Policy & Management
A610 Crabtree Hall
Pittsburgh, PA 15261

Phone: 412-624-3876
Fax: 412-624-3146

 




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