Appendix A
Sample Questions
Perceived Access to CareI was able to get medical care whenever I needed it.
Places where I could get medical care were conveniently located.
If I had a question, I could reach a health care provider for help.
I had easy access to the medical specialist I needed.
Response options: strongly disagree, disagree, not sure, agree, strongly agree
Patient Satisfaction
Time spent waiting at the clinic or office to see the health care provider.
Time spent waiting at the clinic or office to see nurses or other treatment staff.
Amount of time spent with the health care provider.
Quality of care received.
Response options: very dissatisfied, dissatisfied, not sure, satisfied, very satisfied
Physical Health Status (SF-12v2®)
In general, would you say that your health is:
Responses options: excellent, very good, good, fair, poor
Does your health limit:
a. Moderate activities such as moving a table, pushing a vacuum cleaner, bowling, or playing golf
b. Climbing several flights of stairs
Response options: Yes-limited a lot, Yes-limited a little, No-not limited at all
During the past 4 weeks, how much did pain interfere with your normal work (including both work outside and inside the home and housework?
Response options: not at all, a little bit, moderately, quite a bit, extremely
Mental Health Status (SF-12v2®)
How much of the time in the last 4 weeks:
a. Have you felt calm and peaceful?
b. Did you have a lot of energy?
c. Have you felt downhearted and depressed?
Response options: all of the time, most of the time, some of the time, a little of the time, none of the time
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)?
Response options: all of the time, most of the time, some of the time, a little of the time, none of the time