Interim Feedback on the Collaborative's Value and Structure from Organizations Participating in the National Health Plan Collaborative to Reduce Disparities

Sponsored by: Agency for Health Care Research and Quality (AHRQ)
Conducted by: Mathematica Policy Research, Inc.

Completed by: _______________________________ Title: ________________________________

Organization: _____________________________________________________________________

Address: ________________________________________________________________________

Telephone: (|  |  |  |)-|  |  |  |-|  |  |  |  |  | (Area - Code Number)

Date of Completion: |  |  | / |  |  | /| 2| 0| 0| 5| (Month/Day/Year)

Prepared by Mathematica Policy Research, Inc.

When answering questions 1 through 9, please think about the last 6 months of the collaborative with regard to disparities.

In questions 10 through 17, we are interested in your organization's experience with other organizations in the collaborative. For each question, please leave blank the rating of your own organization.

10. In general, prior to the start of your organization's participation in the collaborative...

11. During the past six months—outside of formal collaborative meetings—how frequently have people from your organization who are involved in the collaborative communicated or been in contact with people in the organizations listed below?

12. Overall, how important was each organization's work through the collaborative in attaining the goals of your organization with respect to disparities?

13. To what extent has each organization carried out its responsibilities and commitments involving disparities in regard to the collaborative during the past six months?

14. To what extent do you feel the relationship between your organization and each of the other organizations with respect to disparities is productive?

15. During the past six months, to what extent has your organization changed or influenced the activities of each of these other organizations with respect to disparities?

16. During the past six months, to what extent has each of these other organizations changed or influenced the activities of your organization with respect to disparities?

17. Which organizations provide good ideas for dealing with disparities at meetings of the collaborative?

18. Please use the space below to indicate anything else you want to add relative to the questions above.

Prepared by Mathematica Policy Research, Inc.