Feedback Questionnaire Post-MI Flow Sheet

Objectives of the Pilot Program:

  • Establish baseline clinical experience with flow sheets
  • Validate the content included in the post-MI Flow Sheet
  • Confirm prompts in the post-MI Flow Sheet will ensure that patient achieved target LDL-C below 1.8 mmol/L
  • Outline clinical use of the Tool with two post-MI patients
  • Provide feedback on patient satisfaction on clinical visit and/or patient handout
  • Determine how to optimize clinical implementation and physician adoption of the Post-MI Flow Sheet
  • Provide feedback on supporting documents

Section 1: Current Experience with Chronic Disease Management (CDM) Flow Sheets

Please indicate which of the following chronic disease management (CDM) flow sheets you use in your practice. For each flow sheet selected, please identify the format that you routinely use (select all that apply).

Section 2: Post-MI Flow Sheet Content

Patient Details

Picture1Patient Details

Healthy Behaviour Interventions

Picture1Healthy Behaviour Interventions

Lipid Management

Picture1Lipid Management

Additional Cardiovascular Risk Assessment and Management

Picture1Additional Cardiovascular Risk Assessment and Management

Section 3: Reducing Cardiovascular and Residual Risk in Patients

Lipid Management

Picture1Lipid Management

Section 4: Use in Clinical Practice (to be completed for both patients)

Please respond to the following questions for each of the two patients that you have utilized the Tool with.

Patient #1

Invalid Input

Patient #2

Section 5: Patient Satisfaction (to be completed for both patients)

Patient #1

Patient #2

Invalid Input

Section 6: Clinical Utility of the Tool

Please provide your feedback on the clinical utility of: (1) the Post-MI Flow Sheet; (2) the Patient Handout

The Post-MI Flow Sheet:

Picture1The Post-MI Flow Sheet Page 1

Picture1The Post-MI Flow Sheet PAge 2

Patient Handout

Picture1Patient Handout page 1

Picture1Patient Handout page 2

Section 7: Clinical Implementation and Physician Adoption of the Tool

Section 8: Supporting Documents

Please provide your feedback on each of the following Supporting Documents: (1) Instructions for Basic EMR Integration and Importing templates or stamps; (2) Abstract; (3) Patient Handout

Picture1Instructions Page 1

Picture1Instructions Page 2

Picture1Instructions Page 3