Missouri Foundation for Health’s

“Better Self-Management of Diabetes” Program

Provider Satisfaction with Patient Self-Management Support

We are interested in how you and your clinic staff are helping patients develop strategies to manage their chronic illnesses (i.e., self-management support). Please circle one response for each question. Your survey responses will be anonymous.

1.How satisfied are you with how well you and your staff are helping your patients manage their chronic illness?

Not at all
Satisfied / Somewhat
Satisfied / Very
Satisfied / Extremely
Satisfied

2.How satisfied do you think your patients are with how you are helping them manage their chronic illness?

Not at all
Satisfied / Somewhat
Satisfied / Very
Satisfied / Extremely
Satisfied

3.How satisfied are you with how well you and your staff are involving patients in their own care?

Not at all
Satisfied / Somewhat
Satisfied / Very
Satisfied / Extremely
Satisfied

4.How satisfied are you that your patients’ self-management goals and plans are assessed in a standardized manner?

Not at all
Satisfied / Somewhat
Satisfied / Very
Satisfied / Extremely
Satisfied

5.How satisfied are you that the self-management tools and protocols your clinic is using are making a difference in your patients’ clinical outcomes?

Not at all
Satisfied / Somewhat
Satisfied / Very
Satisfied / Extremely
Satisfied

Instructions for Administering “Provider Satisfaction with Patient Self-Management Support” Quality Improvement Survey

As part of the Missouri Foundation for Health’s Better Self-Management of Diabetes (BSMOD) program, we ask that you distribute this survey once every 6 months to members of your “core self-management team” over the course of this project. The BSMOD evaluation team will ask you to provide a summary of this information (a summary reporting form and dates for reporting this and other tracking information will be sent in a separate communication). We will send you reminders when these summary findings are due. Here are some additional points about administering this survey:

  • There are no requirements around how many team members complete this survey – it is up to you, but respondents should represent your “core self-management team.”
  • Be sure to include yourself in the survey!
  • Ideally, the survey should be re-administered to the same team members over time to gauge changes.
  • Use the document, Self-Management Support Summary Tracking Form, for reporting your summary data back to us (again, you will receive this in a separate communication). We will send you e-mail reminders when these forms are due.
  • If you would like to add questions to this survey, please feel free to do so! You might be interested in learning other things unique to your setting. It will not be necessary to send us summary data on your added questions, though.
  • For project sites with multiple clinics, it is up to you to decide whether you’d like to share the summary data with us by clinic or aggregated across clinics. In other projects, some sites with multiple clinics thought the aggregate data was not as useful as the clinic-specific data. If you choose to submit the data to us for each of your clinics, please provide a unique name or number for each clinic so that you and we can track results over time.
  • Please make every effort to ensure anonymity of survey responses.

Developed for use with the Better Self-Management of Diabetes Program, funded by the Missouri Foundation for Health, 2007.