Instrument E

Title: NC MOST Health Care Provider Survey

Designer: Anthony Caprio, MD and Ellen Roberts, MPH, PhD. Please cite this reference in any work you do:

Caprio AJ, Rollins VP, Roberts E.Health care professionals' perceptions and use of the medical orders for scope of treatment (MOST) form in North Carolina nursing homes.J Am Med Dir Assoc. 2012 Feb;13(2):162-8.

Suitable for Quality Improvement? Yes, with modification to fit your state.

Suitable for research? Yes, although there may be an updated version available with future publications.

Description of Instrument:This written survey was designed to be completed by mail. Its purpose is to describe health care professionals’ experiences and attitudes towards North Carolina’s new MOST form. The survey is being undertaken at an early stage of MOST implementation to identify health professional’s degree of buy-in and their concerns about the program. The results of the statewide survey are not yet published, but the survey was based on face-to-face interviews with health professionals using Toolkit Instrument F, the NC MOST Provider Interview described in the Caprio et al 2012. The survey should prove very useful in designing and guiding statewide educational efforts.

How to use:

Step 1: Modify the form to suit your purposes. Some questions may not fit your state as this was designed to match North Carolina’s MOST form. Only keep items that you have a planned use for or believe may be important to have even though you are not sure what to do with them. Similarly, you may add items that are missing or that address questions that you are trying to answer. If you make a lot of changes to the survey, we recommend that you pilot test it with a small (10-15) group to ensure that it gets you the results you need.

Step 2: Select who you will send the survey to. The survey is designed for clinicians who use the MOST form. If you are a POLST paradigm program you may wish to survey your entire state or region. If you are a hospital or a nursing facility you may wish to only survey your clinicians. If you have a lot of clinicians, you may not need to survey them all. See the FAQ section on ‘Sampling’. In general, as long as you choose clinicians in a random fashion (for example, by choosing numbers out of a hat) and get a decent response rate to your survey (30-50%+ for QA and 50-75%+ for research) and survey enough clinicians so that you get to 30 usable responses (more for research), that may be enough for most QA purposes.

Step 3:There is a well described methodology for mailed surveys that is beyond the scope of this toolkit, but you should include a copy of your POLST paradigm form and a self-addressed, stamped envelope and plan on doing more than one mailing. It also helps to have as much institutional support as you can muster to encourage busy people to complete your survey.

Step 4: Analyze the results. Some of the results that you will get from this survey include:

  1. Respondents’ familiarity and experience with MOST.
  2. Respondents’ beliefs about how and when to use MOST.
  3. Respondents’ beliefs about how using MOST might impact communication.
  4. Concerns about and barriers to MOST.