Padres separados o divorciados 2

Allergy center Breast center Orthopedic center

Dermatology clinic Ear, nose, and throat clinic Wellness center

Eye clinic Emergency Diabetes program

Heart institute Hemodialysis Surgery clinic

Internal medicine Liver and digestive center Women’s health center

Medical check up Neurology Urology

Pediatrics Oncology clinic Radiology

Physical care and rehabilitation clinic

Pulmonary center Others ___________

47. What is your annual income (Thai Baht)?

30,000-39,999 40,000-49,999

50,000-59,999 60,000-69,999

70,000-79,999 80,000-89,999

90,000-99,999 100,000-149,999 150,000-199,999 More than 200,000

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Patient-Centered Care Survey—Patient Version

Research title: The Impact of Patient-Centered Care on Physician Satisfaction: Do Professional Culture and Patient Culture Matter?)

Purpose of the research: The purpose of this study is to better understand the relationship between patient-centered care culture, job satisfaction, and patient satisfaction.

What you will do in this research: As a participant, you will be asked to complete the survey that includes four parts. Part A and Part B involve several statements regarding to your hospital visit today with the focus on the meeting with your physician. You will be asked to rate your agreement on each statement. Part C concerns about your decision to visit the hospital. You will be asked to rate the importance of each statement. Part D asks about your satisfaction with different statement. Part E will ask in general about your hospital visit today. Part F contains general information about participants. Time required: Participation will take approximately 15 minutes of your time.

Voluntary consent: Your participation is voluntary. All information you provide is considered

confidential; your name will not be included or, in any other way associated with the data collected in the study. Furthermore, because our interest is the aggregate results of the entire group of participants, you will not be identified individually in any way in written reports of this research.

PART A: Consider your experience with the hospital visit today, please rate your agreement of the following statement. Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree 1. Your main problem has been discussed

today.

2. Your physician knows that this was one of your reasons for coming in today. 3. Your physician understands the important of your reason for coming in today.

4. Your physician understood you today. 5. You are satisfied with the discussion of your problem.

6. Your physician has explained the problem to you.

7. You agree with the physician's opinion about the problem.

131 8. You have opportunities to ask your

questions.

9. Your physician has asked about your goals for treatment.

10. Your physician has explained treatment to you.

11. Your physician has explored how manageable this (treatment) would be for you.

12. You and your physician have discussed your respective roles (Who is responsible for making decisions and who is responsible for what aspects of your care?)

13. Your physician has encouraged you to take the role you wanted in your own care. 14. Your physician cares about you as a person.

PART B: Please think about the doctor that you usually go to when you are sick or need advice about your health and indicate how much you agree or disagree with each statement.

Strongly Disagree Disagree Neither agree nor disagree Agree Strongly Agree 15. When there is more than one method

to treat a problem, I should be told about each one.

16. I believe that my doctor needs to know everything about my medical history to take good care of me.

17. I would rather have my doctor make decisions about what’s best for my health than to be given a whole lot of choices. 18. The important medical decisions should be made by my doctor, not by me.

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PART C: Consider your experience with the hospital visits, please rate how important are the following statements to you? Not important Slightly important Moderately important Important Extremely important 19. Physician visit when you feel the

need for medical care

20. Regular medical checkup with physicians

21. Private discussions with the physicians

22. Participation in discussions with the physicians

23. Information from physicians regarding your health and illness 24. Clarity of physicians’ information regarding your health and illness 25. Interpersonal relationship with physicians

26. Trust relationship with the physicians

27. Physicians’ competency 28. Time spent for physician visit(reverse)

29. Collaboration in making shared decisions about patient care

PART D: This section will inquire you about how satisfied are you with your hospital visit. How satisfied were you with the following:

Not at all satisfied Slightly satisfied Moderately satisfied Very satisfied Extremely satisfied 30. Personal attention of doctors

31. The expertise of doctors

32. The clarity of information given by doctors

33. The way information was transferred from one person to another

34. The degree of encouragement to be self –sufficient

133 35. The degree to which you could

participate in treatment decisions 36. The information provided about further treatment

37. Departmental visit 38. Hospital visit

PART E: This section concerns your opinion about your hospital visit today. Please check the response that best represents your opinion.

39. Using any number from 0 to 10, where 0 is the worst department possible and 10 is the best department possible, what number would you use to rate this department during your stay?

Worst department possible---Best Department possible

0 1 2 3 4 5 6 7 8 9 10

40. Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best possible, what number would you use to rate this hospital during your stay?

Worst hospital possible---Best hospital possible

0 1 2 3 4 5 6 7 8 9 10

PART F: Please answer the following demographic questions. 41. AGE

18-30 31-40 41-50

51-60 61 and over

42. SEX

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43. What is the highest grade or level of school that you have completed? < Bachelor’s degree Bachelor’s degree

> Bachelor’s degree Other_____________

44. How would you describe your current employment status? Employed full time for wages

Employed part time for wages Self-employed