Promoting Excellence : Provider Survey (Parts 1 and 2)

Children's Hospital: Provider Survey (Parts 1 and 2)

This survey assesses knowledge, attitudes, skills and behaviors before and after an educational intervention.

Evaluation Tools - Provider Assessment

Children's Hospital and Regional Medical Center
Pediatric Palliative Care Project
Mail Stop CM - 11
4800 Sand Point Way, N.E.
Seattle, WA 98105

Beth McKinstry
[email protected]

How the grantee used this instrument:
Physician self-administers Part I at or immediately following the enrollment clinic visit; Physician responds to a telephone interview of Part II (or self-reports) every three months.

pediatric, physician attitudes, physician survey, provider behavior, provider confidence

To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.

Developed specifically for this project by the project team.

To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer.
pdf PDF 256 KB / 4 pages (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted September 2003

Children's Hospital and Regional Medical Center overview page

# CHRMC5, type:provider_assessment

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families. Visit for more resources.

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