- 1. Your Nomination - Please briefly describe in your own words the question about a health care test or treatment that interests or concerns you:
How about studying the impact of keeping information from patients? How about policy and procedures? Should hippa be more readable? Should a pateint know that there could be a non-designated record set of his or her health information, that he or she may have never know existed and that this fact is legal? Does keeping information from the patient help or hinder the outcomes of his or her treatment? Does allowing certain health care providers to okay release of information lead to increased costs? Does this increase and prolong recovery? Should this policy be reevaluated?
- 2. Why do you think your question is important? (you may select more than one category if appropriate)
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My question relates to a very common disease or problem
People with this disease or problem have considerable health or financial hardships
There is uncertainty about how well the test, treatment, or intervention works
There is significant potential for side effects/harms using this test, treatment, or intervention
Funding of this test, treatment, or intervention is uncertain or variable
There is unequal access or application of this health care intervention across providers
There is potential for cost savings from better information on this subject
This is a new technology/development
There is new evidence of clinical and/or cost effectiveness for this test, treatment, or intervention
Other
- 3. What illness or health condition is related to your question? (You can also specify a particular health-promoting activity, such as breast-feeding)
- 4. What group(s) or patients does your question apply to?
- 5. What is the specific purpose of the health care test or treatment you have a question about? (mark all that you think apply)
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Identification of a disease or condition:
Screening or diagnosis/identification for a particular disease, or risk assessment for a disease
Risks or harms that can come from a disease identification tool or test
Diagnostic tests and tools
Diagnosis of co-occurring diseases
Intervention (such as a drug treatment, therapy, device)
Management of a condition or particular system of care
Delivery of a health service
Referral
Risks or harms associated with treatment of a disease or condition
Prevention or health promotion
Specific population health concerns, such as ethnic group or gender
Other
Dont know
- 6. Does your question include a comparison of different health care approaches?
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No
If yes, please list what you would like to see compared:
- 7. Desired Health Improvements: If you question focuses on:
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Identification of a particular disease or condition, what improvements in identification or diagnosis would you like to see?
Treatment of a particular disease or condition, what improvements in patient symptoms or problems would you like to see?
- 8. Harms: Are there risks, side effects, or harms you are concerned about? If yes, please specify what those are:
- 9. Based on your answers to the previous questions, what research question(s) would you like to have answered?
- 10. Are there health-care focused, disease-focused, or patient-focused organizations that you see as being relevant to this issue? Who do you think we should contact as we consider your nomination?
- 11. Other Information About You (OPTIONAL) In order to help us understand the context of your health care question, it would be helpful to know more about you. The answers you give will not influence the progress of your suggestion. Thank you.
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a. Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
b. Is there any other information about you that is relevant to your question?
c. Are you making a suggestion as an individual or on behalf of an organization?
Individual
Organization
