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Objectives of the Pilot Program:
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
Healthy Behaviour Interventions
Lipid Management
Additional Cardiovascular Risk Assessment and Management
Section 3: Reducing Cardiovascular and Residual Risk in Patients
1a. What guidance is required to ensure the management plan outlined in the Lipid Management section of the flow sheet is implemented?
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
Patient #2
Section 5: Patient Satisfaction (to be completed for both patients)
How would you rate the patient’s response to the discussion on the importance of achieving their LDL-C target? (Rank from 1 - Not positive, 3 - Positive to 5 - Very positive
How confident do you feel the patient is in managing their LDL-C and getting to target? (Rank from 1 - Not confident, 3 - Confident to 5 - Very confident
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:
The Post-MI Flow Sheet Page 1
The Post-MI Flow Sheet PAge 2
Patient Handout
Patient Handout page 1
Patient Handout page 2
Section 7: Clinical Implementation and Physician Adoption of the Tool
What recommendations do you have to support the implementation and adoption of the Tool with your peers and with health teams?
What are your recommendations to optimize the Tool's utilization, and what training /education would be required to support each of your recommendations?
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
Instructions Page 1
Instructions Page 2
Instructions Page 3
Please rate the clarity of the instructions for your colleagues using the tool for the first time (Rank from 1 - Not Very Clear to 5 - Very Clear
Abstract
What is the value of this document as background information for physicians? (Rank from 1 - Not very valuable, 3 - Valuable to 5 - Very valuable
cpdisup
