Seiling and Surrounding Area Telephone Survey Form and Results
Transcript of Seiling and Surrounding Area Telephone Survey Form and Results
Seiling and Surrounding Area Telephone Survey Form and Results
Oklahoma Office of Rural Health
Oklahoma Cooperative Extension Service
Oklahoma State University
July 2005
Dewey County
Major County
Woodward County
AE-05112
Seiling and Surrounding Area Telephone Survey Form and Results
Community Health Engagement Process documents available online at: www.okruralhealthworks.org
R. David Shelton, Assistant State Extension Specialist, OSU, Stillwater 405-744-4857, Fax 405-744-9835, [email protected]
Larysa Rybak, Assistant State Extension Specialist, OSU, Stillwater
405-744-6083
Gerald A. Doeksen, Extension Economist, OSU, Stillwater 405-744-6083
Stan Ralstin, Area Extension Rural Development Specialist, Enid
580-237-7677
Michael L. Weber, Dewey County Extension Director, Taloga 580-328-5351
Alexandria Hart-Smith, Regional Health Consultant, OK Office of Rural Health, OKC
405-945-9197
Val Schott, Director, OK Office of Rural Health, OKC 405-945-9197
Oklahoma Office of Rural Health Rural Health Policy & Research Center
Oklahoma Osteopathic School of Medicine Oklahoma State University
Oklahoma Cooperative Extension Service Rural Development
Oklahoma State University
July 2005
Response Frequency Percent73663, Seiling 62 31%73859, Vici 60 30%73654, Leedey 23 11%73658, Oakwood 14 7%73853, Mutual 12 6%73838, Chester 11 5%73860, Waynoka 11 5%73835, Camargo 7 3%73667, Taloga 2 1%
Total 202 100%
Q1. What is your zip code?
31%
30%
11%
7%
6%
0% 10% 20% 30% 40%
73663, Seiling
73859, Vici
73654, Leedey
73658, Oakwood
73853, Mutual
Seiling Area Telephone Survey Results 1
Response Frequency PercentYes 179 89%No 23 11%
Total 202 100%
225*109 Respondents answered don't know/refused.
Q2a. Do you use a family doctor for most of your routine health care?
No11%
Yes89%
Seiling Area Telephone Survey Results 2
Response Frequency PercentSeiling Clinic 8 35%No routine care 8 35%Emergency room/Hospital 5 22%Blue Cross/Blue Shield 1 4%County health department 1 4%
Total 23 100%
Q2b. If "no" to Q2a, what kind of medical provider do you use for routine care?
4%
4%
35%
35%
22%
0% 10% 20% 30% 40%
Seiling Clinic
No routine care
Emergencyroom/Hospital
Blue Cross/BlueShield
County healthdepartment
Seiling Area Telephone Survey Results 3
Response Frequency PercentSeiling 88 44%Woodward 38 19%Enid 14 7%Elk City 10 5%Vici 9 5%Okeene 7 4%Leedey 6 3%Waynoka 5 3%Watonga 4 2%Oklahoma City 4 2%Shattuck 4 2%Clinton 3 2%Alva 3 2%Yukon 2 1%Mutual 1 1%Edmond 1 1%Weatherford 1 1%
Total 200 100%
Q3a-1. Which city do you go to for most of your family's routine health care needs?
44%
19%
7%
0% 10% 20% 30% 40% 50%
Seiling
Woodward
Enid
Seiling Area Telephone Survey Results 4
Response Frequency Subtotal Percent SubtotalsCities inside MSA 109 54%Seiling 88 43%Vici 9 5%Leedey 6 3%Waynoka 5 3%Mutual 1 1%
Cities outside MSA 91 46%Woodward 38 19%Enid 14 7%Elk City 10 5%Okeene 7 4%Watonga 4 2%Oklahoma City 4 2%Shattuck 4 2%Clinton 3 2%Alva 3 2%Yukon 2 1%Edmond 1 1%Weatherford 1 1%
Total 200 200 99% 100%
Q3a-2. Which city do you go to for most of your family's routine health care needs?
Cities inside Medical Service
Area54%
Cities outside Medical Service
Area46%
Cherokee County Telephone Survey Results 5
Response Frequency PercentCloser/Convenient location 52 46%Have used for Years/Personal relationship 27 24%Specialist 14 12%Approved provider 11 10%Better doctors/Quality care 6 5%Referral 2 2%New to area 1 1%Don't go to hospital 1 1%
Total 114 100%
Q3b. Why do you or your family use a doctor for routine health care needs outside of the Seiling area?
46%
24%
12%
10%
5%
0% 10% 20% 30% 40% 50%
Closer/Convenientlocation
Have used forYears/Personal
relationship
Specialist
Approved provider
Better doctors/Qualitycare
Seiling Area Telephone Survey Results 6
Response Frequency PercentYes 30 86%No 5 14%
Total 35 100%
70*109 Respondents answered don't know/refused.
Q4a. Have you or someone else in your household been to a doctor in the Seiling area in the past 18 months?
No14%
Yes86%
Seiling Area Telephone Survey Results 7
Response Frequency PercentSatisfied 30 100%Dissatisfied 0 0%
Total 30 100%
60*109 Respondents answered don't know/refused.
Q4b. How satisfied were you or someone in your household with the quality of care received in the Seiling area?
Satisfied100%
Seiling Area Telephone Survey Results 8
Response Frequency PercentGood service/Good care 16 53%Good doctors 9 30%No reason 5 17%
Total 30 100%
Q4c. Why do you say that you were satisfied?
No reason17%
Good service/Good
care53%
Good doctors30%
Seiling Area Telephone Survey Results 9
Response Frequency PercentYes 104 78%No 30 22%
Total 134 100%
Q5a. Do you think there are enough doctors in the Seiling area?
Yes78%
No22%
Seiling Area Telephone Survey Results 10
Response Frequency PercentSmall community 40 38%Current number meets needs 35 34%Good service/Care 17 16%No reason 12 12%
Total 104 100%
Response Frequency PercentCannot meet needs 15 50%Long wait 6 20%Poor service/Care 4 13%Not financially feasible 3 10%No reason 2 7%
Total 30 100%
Q5b. Why do you say there are enough doctors?
Q5c. Why do you say there are not enough doctors?
Seiling Area Telephone Survey Results 11
Response Frequency PercentYes 109 54%No 93 46%
Total 202 100%
2
Q6a. Have you or someone else in your household been to a specialist in the past 18 months?
Yes54%
No46%
Seiling Area Telephone Survey Results 12
Response City/Town Frequency Percent
CardiologistOKC/Edmond (15), Elk City (2), Enid (2), Amarillo, TX (1), Woodward (1), Seiling (1) 22 17%
OncologistEnid (5), OKC/Edmond (5), Clinton (1), Elk City (1), Okeene (1), Houston, TX (1) 14 11%
Orthopedist OKC/Edmond (7),Woodward (4), Pratt, KS (1), Enid (1) 13 10%
OB/GYN Enid (5), OKC/Edmond (4), Seiling (1) 10 8%
Neurologist/Neurosurgeon OKC/Edmond (6), Enid (4) 10 8%
Surgeon Enid (5), OKC/Edmond (4), Woodward (1) 10 8%
Optometrist/Ophthalmologist OKC/Edmond (4), Enid (1), Seiling (1), Woodward (1) 7 5%
Gastrologist OKC/Edmond (4), Enid (3) 7 5%
Internal MedicineShattuck (2), Enid (1), OKC/Edmond (1), Elk City (1), Woodward (1) 6 5%
Pulmonologist OKC/Edmond (3), Woodward (1), Enid (1) 5 4%
Dermatologist OKC/Edmond (3), Elk City (1) 4 3%
Ear, Nose, & Throat Woodward (3), OKC/Edmond (1) 4 3%
Urologist OKC/Edmond (2), Pueblo, CO (1), Woodward (1) 4 3%
Rheumatologist OKC/Edmond (3) 3 2%
Podiatrist Enid (1), Seiling (1) 2 2%
Nephrologist Enid (1), Seiling (1) 2 2%
Diabetic OKC/Edmond (2) 2 2%
Alzheimers Enid (1) 1 1%
Pediatrician Woodward (1) 1 1%
Radiologist Woodward (1) 1 1%
Dietitian Enid (1) 1 1%
Personal OKC/Edmond (1) 1 1%
Total 130 100%
Q6b. What type of specialist have you or someone in your household been to and in what city does this specialist practice?
Seiling Area Telephone Survey Results 13
Response Frequency PercentOne 54 27%Two 87 43%Three 23 11%Four 18 9%Five or more 20 10%
Total 202 100%
Q7. How many people are living in your household?
27%
43%
11%
10%
9%
0% 10% 20% 30% 40% 50%
One
Two
Three
Four
Five or more
Seiling Area Telephone Survey Results 14
Response Frequency PercentEmployer/Previous employer 74 39%Medicare 51 27%No health insurance 26 14%Medicare supplement 15 8%Self-paid plan 13 7%Medicaid or Sooner Care 7 4%VA benefits 3 2%Native American benefits 2 1%Champus/TriCare program 1 1%
Total 192 100%
*109 Respondents answered don't know/refused.
Q8a. What type of health insurance covers you?
39%
27%
14%
7%
8%
0% 10% 20% 30% 40%
Employer/Previousemployer
Medicare
No health insurance
Medicare supplement
Self-paid plan
Seiling Area Telephone Survey Results 15
Response Frequency PercentEmployer/Previous employer 61 45%Medicare 24 18%No health insurance 19 14%Self-paid plan 12 9%Medicare supplement 9 7%Medicaid or Sooner Care 8 6%VA benefits 2 1%Native American benefits 1 1%Champus/TriCare program 1 1%
Total 137 100%
Q8b. What type of health insurance covers your family?
6%
9%
7%
14%
18%
45%
0% 10% 20% 30% 40% 50%
Employer/Previousemployer
Medicare
No health insurance
Self-paid plan
Medicare supplement
Medicaid or SoonerCare
Seiling Area Telephone Survey Results 16
Response Frequency PercentToo expensive 24 92%Not needed 2 8%
Total 26 100%
Q9. Why do you not have insurance for yourself?
Too expensive92%
Not needed8%
Seiling Area Telephone Survey Results 17
Response Frequency PercentYes 91 45%No 111 55%
Total 202 100%
404*109 Respondents answered don't know/refused.
Q10. Have you or someone else in your household used the services of a hospital in the past 18 months?
No55%
Yes45%
Seiling Area Telephone Survey Results 18
Response City/Town Frequency PercentSeiling Municipal Hospital Seiling 26 29%Woodward Regional Medical Center Woodward 18 20%Oklahoma City Area Hospitals OKC 17 19%Enid Area Hospitals 15 16%
Integris Bass Baptist Health Center Enid (8)St. Mary's Regional Medical Center Enid (6)Surgery Center of Enid Enid (1)
Okeene Municipal Hospital Okeene 3 3%Great Plains Regional Medical Center Elk City 2 2%Newman Memorial Hospital Shattuck 2 2%Integris Clinton Regional Hospital Clinton 2 2%Share Memorial Hospital Alva 2 2%Stillwater Medical Center Stillwater 1 1%Jackson County Memorial Hospital Altus 1 1%Roger Mills Memorial Hospital Cheyenne 1 1%Pratt Regional Medical Center Pratt, KS 1 1%
Total 91 100%
Q11. At which hospitals were services received?
29%
20%
19%
16%
0% 10% 20% 30%
Seiling
Woodward
Oklahoma City
Enid
Seiling Area Telephone Survey Results 19
Response Frequency PercentEmergency room 8 36%Laboratory (blood) tests 5 23%Radiology 5 23%Inpatient stay 2 9%Home health services 1 5%Outpatient procedures 1 5%
Total 22 100%
Q12. What hospital services were used at Seiling Memorial Hospital?
36%
23%
23%
9%
0% 10% 20% 30% 40%
Emergency room
Laboratory (blood)tests
Radiology
Inpatient stay
Seiling Area Telephone Survey Results 20
Response Frequency PercentSatisfied 25 96%Dissatisfied 1 4%
Total 26 100%
52*109 Respondents answered don't know/refused.
13a. How satisfied were you or someone in your household with the services you received at Seiling Municipal Hospital?
Dissatisfied4%
Satisfied96%
Seiling Area Telephone Survey Results 21
Response Frequency PercentQuality of care 13 52%Quick service/Little wait 9 36%Personal relationship/Used for years 3 12%
Total 25 100%
Response Frequency PercentPoor care 1 100%
Total 1 100%
Q13b. Why do you say that you were satisfied?
Q13c. Why do you say that you were dissatisfied?
Seiling Area Telephone Survey Results 22
Response Frequency PercentYes 28 31%No 63 69%
Total 91 100%
182*109 Respondents answered don't know/refused.
Q14a. Have you or your family used the emergency room services at Seiling Municipal Hospital in the past 18 months?
No69%
Yes31%
Seiling Area Telephone Survey Results 23
Response Frequency PercentRespiratory therapy/Breathing 4 24%Trauma care 4 24%Routine illness 3 18%X-Ray 3 18%Cardiac evaluation/Heart 2 12%Laboratory 1 6%
Total 17 100%
Q14b. What type of emergency room services have you or your family used in the past 18 months at the Seiling Municipal Hospital?
24%
24%
18%
18%
0% 10% 20% 30%
Respiratorytherapy/Breathing
Trauma care
Routine illness
X-Ray
Seiling Area Telephone Survey Results 24
Response Frequency PercentSatisfied 26 93%Dissatisfied 2 7%
Total 28 100%63 Individuals did not respond
56
15a. How satisfied were you or someone in your household with the services you received at the emergency room in Seiling Municipal
Hospital?
Frequency, 0
Dissatified7%
Satisfied 93%
Seiling Area Telephone Survey Results 25
Response Frequency PercentQuality of care 18 69%Prompt/Good service 7 27%Caring/Courteous employees 1 4%
Total 26 100%
Response Frequency PercentPoor service 2 100%
Total 2 100%
Q15c. Why do you say that you were dissatisfied?
Q15b. Why do you say that you were satisfied?
Seiling Area Telephone Survey Results 26
Response Frequency PercentClose/convenient location 15 23%Referral 13 20%Personal relationship/Previous expirience 13 20%No local specialists 11 17%Quality of care 10 16%Native American benefits 1 2%Don't go to doctor 1 2%
Total 64 100%
100*109 Respondents answered don't know/refused.
Q16. You mentioned that you or someone else in your household received care at a hospital other than Seiling Municipal Hospital, why
did you or your family member choose this/these hospital(s)?
23%
20%
20%
17%
16%
0% 10% 20% 30%
Close/convenientlocation
Referral
Personalrelationship/Previous
expirience
No local specialists
Quality of care
Seiling Area Telephone Survey Results 27
Response Frequency PercentLaboratory (blood) tests 10 23%Radiology 7 16%Inpatient surgery 7 16%Emergency room 6 14%Inpatient stay 6 14%Outpatient surgery 4 9%Specialty doctor 2 5%Birthing services 1 2%
Total 43 100%
Q17. What hospital services were used there?
23%
16%
14%
14%
9%
0% 5% 10% 15% 20% 25%
Laboratory (blood)tests
Inpatient surgery
Emergency room
Inpatient stay
Outpatient surgery
Seiling Area Telephone Survey Results 28
Response Frequency PercentCardiology services 5 17%Specialty services 5 17%Elderly services 4 14%Optometry services 4 14%Dental services 3 10%Home health services 2 7%Mental health/Counseling services 2 7%Orthopedic services 2 7%Surgery services 2 7%
Total 29 100%
Q18. What additional health care services do you feel are needed in the Seiling area?
17%
17%
14%
14%
0% 10% 20%
Cardiology services
Specialty services
Elderly services
Optometry services
Seiling Area Telephone Survey Results 29
Response Frequency PercentYes 10 5%No 192 95%
Total 202 100%
404*109 Respondents answered don't know/refused.
Q19. Have you or someone else in your household used the services of the Seiling Nursing Home in the past 18 months?
No95%
Yes5%
Seiling Area Telephone Survey Results 30
Response Frequency PercentSatisfied 5 83%Dissatisfied 1 17%
Total 6 100%
12*109 Respondents answered don't know/refused.
Q20a. How satisfied were you or someone in your household with the services you received at Seiling Nursing Home?
Satisfied83%
Dissatisfied17%
Seiling Area Telephone Survey Results 31
Response Frequency PercentConfidence/Quality care 2 100%
Total 2 100%
Response Frequency PercentLack of quality care 1 100%
Total 1 100%
Q20c. Why do you say that you were dissatisfied?
Q20b. Why do you say that you were satisfied?
Seiling Area Telephone Survey Results 32
Q21. If you used a nursing home other than the Seiling Nursing Home within the past 18 months, why did you or your family member choose this/these nursing home(s)?
No valid responses received
Seiling Area Telephone Survey Results 33
Response Frequency PercentYes 174 95%No 10 5%
Total 184 100%
368*109 Respondents answered don't know/refused.
Q22. Does your community provide adequate ambulance services?
No5%
Yes95%
Seiling Area Telephone Survey Results 34
Response Frequency PercentNo concerns 73 40%Rising costs 36 20%ER/Ambulance services 16 9%Facilities 12 7%Distance to assistance 12 7%Poor quality of care/Service 11 6%Need for more doctors 11 6%Insurance 6 3%Specialists 5 3%
Total 182 100%
Q23. What concerns you most about health care in your community?
20%
9%
7%
7%
40%
0% 10% 20% 30% 40%
No concerns
Rising costs
ER/Ambulance services
Facilities
Distance to assistance
Seiling Area Telephone Survey Results 35
Response Frequency PercentAge 18 - 20 4 2%Age 21 - 30 11 6%Age 31 - 40 18 9%Age 41 - 50 35 18%Age 51 - 60 39 20%Age 61 - 70 46 23%Age 71 - 80 24 12%Age 81 or over 22 11%
Total 199 100%
Q24. What is your age?
2%
6%
9%
18%
20%
23%
12%
11%
0% 5% 10% 15% 20% 25%
Age 18 - 20
Age 21 - 30
Age 31 - 40
Age 41 - 50
Age 51 - 60
Age 61 - 70
Age 71 - 80
Age 81 or over
Seiling Area Telephone Survey Results 36
Response Frequency PercentCaucasian 191 95%Native American 4 2%Hispanic 3 2%Asian 1 1%
Total 199 100%
207*109 Respondents answered don't know/refused.
Q25. What is your ethnicity?
Hispanic2%
Native American
2%
Asian1%
Caucasian95%
Seiling Area Telephone Survey Results 37
Response Frequency PercentMale 64 32%Female 138 68%
Total 202 100%
200%
340*109 Respondents answered don't know/refused.
Q26. Gender of respondent.
Male32%
Female68%
Seiling Area Telephone Survey Results 38
SEILING AREA SURVEY Page 1 of 7 Survey Date: May 9-20, 2005
NOTE TO INTERVIEWER: All questions are optional and respondent may of course choose not to answer.
Introduction and screener: Hello. My name is ________________ with _______. We are an independent research company and today/this evening, we are conducting a brief consumer survey on the topic of healthcare in your community for the Seiling Area Health Planning Committee. This committee is reviewing the health care situation in the Seiling area. It is very important that we include the opinion of you or someone in your household in this brief but important survey. Please provide as much information as possible to help us improve health care in your area, however, during any point in the survey process if you feel uncomfortable answering the question being asked you may decline and continue to the next question. Qualifier: May I ask, are you over the age of 18?
Yes No (Ask to speak to someone over the age of 18. TERMINATE if there is no one over the age of 18
living in the household) 1. What is your zip code? (Read list if necessary.)
73835, Camargo 73658, Oakwood 73838, Chester 73663, Seiling 73853, Mutual 73667, Taloga 73859, Vici 73860, Waynoka 73654, Leedey Other__________(TERMINATE)
2a. Do you use a family doctor for most of your routine health care?
Yes (Skip to Q.3a) No
(Do not read) Don’t Know / Refused (Skip to Q.3a) 2b. What kind of medical provider do you use for routine care? (Record exact response below. Probe for
clarification.)
Emergency room/Hospital Specialist County Health Department Other (Specify) _____________________
3a. Which city do you go to for most of your family’s routine health care needs? (DO NOT READ LIST)
Clinton Seiling (Skip to Q.4a) (Do not read) Don’t Know / Refused Fairview Watonga Other (Specify)_______________ Enid Weatherford Okeene Woodward
SEILING AREA SURVEY Page 2 of 7 3b. Why do you or your family use a doctor for routine health care needs outside of the Seiling area?
(RECORD VERBATIM RESPONSES. Probe for clarification.) Closer/Convenient Location County Health Department Have used for Years/Personal relationship Specialist Approved provider for insurance/Health benefits program Other (Specify) _____________________________
4a. Have you or someone else in your household been to a doctor in the Seiling area in the past 18 months?
Yes
No (Skip to Q.5a) (Do not read) Don’t Know / Refused (Skip to Q.5a)
4b. (If seen a family doctor in the Seiling area in the past 18 months, ask 4b; otherwise, skip to Q.5a)
How satisfied were you or someone in your household with the quality of care received in the Seiling area? Would you say that you were…(READ LIST)?
Satisfied Dissatisfied (Do not read) Don’t Know / Refused (skip to Q.5a)
4c. Why do you say that? (RECORD VERBATIM RESPONSES. Probe for clarification.)
____________________________________________________ ____________________________________________________
5a. Do you think there are enough doctors in the Seiling area?
Yes No (Do not read) Don’t Know / Refused (skip to Q.6a)
5b. Why do you say there are enough doctors? (RECORD VERBATIM RESPONSES. Probe for
clarification.) ____________________________________________________ ____________________________________________________
5c. Why do you say there are not enough doctors? (RECORD VERBATIM RESPONSES. Probe for
clarification.) ____________________________________________________ ____________________________________________________
6a. Have you or someone else in your household been to a specialist in the past 18 months?
Yes No (Skip to Q.7) (Do not read) Don’t Know / Refused (Skip to Q.7)
SEILING AREA SURVEY Page 3 of 7 6b. What type of specialist have you or someone in your household been to and in what city does this specialist
practice?
Type of Doctor (Specialist) City
7. How many people are living in your household? (Record response below)
____________________ (If respondent is the only person living in household, ask for “you” only in Q.8) 8. What type of health insurance covers you and your family? (READ LIST. ASK FOR “YOU” AND
“FAMILY” (if applicable). Can provide more than one response) You Family Insurance through Employer/ Previous Employer Medicare Medicare Supplement Medicaid or Sooner Care Champus/TriCare Program VA benefits Self-Paid Plan Native American Benefits
*Do Not Have Health Insurance Other ___________________ 9. If respondent does not have health insurance, ask Q9; otherwise, skip to Q.10
Why do you not have health insurance for yourself? (Do not read list)
Too expensive Pre-existing medical condition Other (Specify) ______________________________________ (Do not read) Don’t Know / Refused
10. Have you or someone else in your household used the services of a hospital in the past 18 months? Yes
No (Skip to Q.14a) (Do not read) Don’t know / Refused (Skip to Q.18)
SEILING AREA SURVEY Page 4 of 7 11. At which hospital(s) were services received? (Do not read list unless prompt is needed)
Fairview Hospital, Fairview Great Plains Regional Medical Center, Elk City Integris Bass Baptist Health Center, Enid Integris Clinton Regional Hospital, Clinton Newman Memorial Hospital, Shattuck Oklahoma City Area Hospitals Okeene Municipal Hospital, Okeene Seiling Municipal Hospital, Seiling* Share Memorial Hospital, Alva Southwestern Memorial Hospital, Weatherford St. Mary’s Regional Medical Center, Enid Watonga Municipal Hospital, Watonga Woodward Regional Medical Center, Woodward Other (Specify)_________________ (Do not read) Don’t Know / Refused
12. (If Seiling Municipal Hospital mentioned at Q.11, ask; otherwise, skip to Q.14) What hospital services
were used at Seiling Municipal Hospital? (Do not read list unless prompt is needed)
Colonoscopy Physical Therapy Emergency Room* Radiology (X-ray, Mammogram)
Inpatient Stay Respiratory Therapy Home Health Services Dietary Services
Laboratory (Blood) Tests Specialty Doctor Outpatient Procedures Other _______________
Outpatient Surgery (Do not read) Don’t know / Refused 13a. How satisfied were you or someone in your household with the services you received at Seiling Municipal
Hospital? Would you say you were… (Read list)
Satisfied Dissatisfied (Do not read) Don’t Know / Refused (skip to Q.14a)
13b. Why do you say that? (RECORD VERBATIM RESPONSES. Probe for clarification.)
____________________________________________________ ____________________________________________________
14a. Have you or your family used the emergency room services at Seiling Municipal Hospital in the past 18
months?
Yes No (Skip to Q.16) (Do not read) Don’t know / Refused (Skip to Q.16)
SEILING AREA SURVEY Page 5 of 7 14b. What type of emergency room services have you or your family used in the past 18 months at the Seiling
Municipal Hospital? (Do not read list unless prompt is needed)
Cardiac Evaluation/Heart Trauma Care Laboratory X-Ray (Radiology) Obstetrics (OB) Other ____________________________ Respiratory Therapy/Breathing (Do not read) Don’t know / Refused Routine Illness
15a. How satisfied were you or someone in your household with the services you received at the emergency
room in Seiling Municipal Hospital? Would you say you were… (Read List)
Satisfied Dissatisfied (Do not read) Don’t Know / Refused (skip to Q.16)
15b. Why do you say that? (RECORD VERBATIM RESPONSES. Probe for clarification.)
____________________________________________________ ____________________________________________________
16. (If any hospital other than Seiling Municipal Hospital mentioned at Q.11, ask; otherwise, skip to Q.18) You mentioned that you or someone else in your household received care at a hospital other than Seiling Municipal Hospital, why did you or your family member choose this/these hospital(s)? (RECORD VERBATIM RESPONSES. Probe for clarification.) _____________________________________________________________________________________
17. What hospital services were used there? (Do not read list unless prompt is needed)
Birthing Services Radiology (X-ray, CT, Mammogram) Emergency Room Respiratory Therapy
Inpatient Stay Dietary Services Inpatient Surgery Specialty Doctor
Laboratory (Blood) Tests Other _______________ Outpatient Surgery (Do not read) Don’t know / Refused Physical Therapy 18. What additional health care services do you feel are needed in the Seiling area? (Do not read list unless
prompt is needed and allow for top 3 choices)
Cardiology Services Optometry Services Dental Services Orthopedic Services
Dietary Services Urology Services Elderly Services Specialty Services
Home Health Services Surgery Services Hospice Services Other _______________ Mental Health/Counseling Services (Do not read) Don’t know / Refused Oncology Services
SEILING AREA SURVEY Page 6 of 7 19. Have you or someone else in your household used the services of the Seiling Nursing Home in the past 18
months?
Yes No (Skip to Q.22) (Do not read) Don’t know / Refused (Skip to Q.22)
20a. How satisfied were you or someone in your household with the services you received at Seiling Nursing
Home? Would you say you were… (Read list)
Satisfied Dissatisfied (Do not read) Don’t Know / Refused (skip to Q.22)
20b. Why do you say that? (RECORD VERBATIM RESPONSES. Probe for clarification.)
______________________________________________________________________________________
21. If you used a nursing home other than the Seiling Nursing Home within the past 18 months, why did you or your family member choose this/these nursing home(s)? _______________________________________________________________________________________
22. Does your community provide adequate ambulance services? Yes
No (Do not read) Don’t know / Refused
23. What concerns you most about health care in your community? (RECORD VERBATIM RESPONSES)
_____________________________________________________________________________________ The last few questions are for classification purposes only… 24. What is your age?
18-20 21-30 31-40 41-50 51-60 61-70 71-80 81+
(Do not read) Don’t know / Refused
SEILING AREA SURVEY Page 7 of 7 25. What is your ethnicity?
Caucasian Asian Hispanic
African American Native American Other _________________ (Do not read) Don’t know / Refused
26. INTERVIEWER: RECORD ANSWER BASED ON OBSERVATION ONLY. DO NOT ASK.
Male Female Unknown (Can’t Tell)
That completes the survey. Thank you for your time!