For fiscal year: _____/____/____ to _____/____/____
Month Date Year Month Date Year
NOTE: Project summary and introduction. To be provided by individual grantees.
A. General
Questions
We’d like to start by asking you
some general questions about the management information system (MIS) at [EAP name].
A1._ Does your MIS consist of a single data
system, or multiple data systems? Are
you familiar with all data systems comprising your MIS? _____________________________________
_______________________________________________________________
A2._ What software do you use to maintain
your MIS (e.g., MS Access, DBase, SAS, MS Excel, custom software)? _____________________________________________________
_______________________________________________________________
A3._ Do counselors enter the data directly
into a computerized database, or are data entered by data entry personnel from
hard copy forms? ___________________________________
_______________________________________________________________
A4._ Do you have experience creating data
files or data extracts from your MIS?
By a data extract, we mean writing all records for a given individual to
an electronic file, not creating a report summarizing activity for a group of
clients. _______________________________________________
_______________________________________________________________
A5._ If you were to provide us with a data
file, what type of file could you provide us (e.g., block ASCII, MS Excel,
DBase)? _________________________________________________
_______________________________________________________________
B.
Integration with Outside Providers
A key aspect of evaluating workplace
interventions is understanding how EAP use affects other types of health care
utilization. To understand this, we
would like to track the health care services received by [EAP name] clients as a result of their EAP contact. So now we’d like to ask you a few questions
to find out how much information from various providers you have, and how that
data may differ from the other data you might provide us.
B1._ Can you tell us if a client was referred
by the EAP to an external provider? ___
_______________________________________________________________
B2._ Can you tell us the number of external
providers to which a client was referred?
_______________________________________________________________
B3._ Can you tell us if the client went to
those providers, and if so for how many visits?
_______________________________________________________________
B4._ Can you tell us if the external
providers to which a client was referred were covered by the client’s health
insurance?________________________________________________
_______________________________________________________________
B5._ Can you provide us with information on
the type of external providers to which a client was referred? By type of provider, we mean broad
categories such as social worker, psychologist, or addiction specialist. _______________________________________________________________
_______________________________________________________________
B6._ Can you provide us with information on
the type of treatment given by external providers? By type of treatment, we mean broad categories such as inpatient
alcohol treatment or outpatient mental health counseling. ____________________________________________________
_______________________________________________________________
C.
Confidentiality—Patient Identifying Information
Because of the sensitive nature of
our data request, we want to be sure that we protect the confidentiality of the
involved patients. So now we’d like to
ask you some questions about patient identifying information and
confidentiality issues.
C1. Part of our research requires that we
receive patient-level data from you and merge that with patient-level data from
other sources. In order to do this, we
need to use a patient identifier that uniquely distinguishes one patient from
another. The client’s Social Security
number might be an example of such an identifier. Can you provide us with such an identifier? What do you call that identifier?
_______________________________________________________________
C2. What assurances of confidentiality do you
require to release this identifier to us?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
D. Data
Availability
Next, we’d like to ask you some
questions about the availability of certain broad types of data. By availability, we mean that you would be
able to provide us with the data in an electronic file.
D1. Can you provide us data on specific cases? That is, could you generate an electronic
file that has one record per case? By a
case, we mean a single treatment episode for a single client such that some
clients may have multiple cases. ___________________________________
_______________________________________________________________
If not, what level of data can you provide us? __________________________
_______________________________________________________________
D2. Although we want to examine individual
cases, it is important that we understand how these cases combine to form a
single client’s treatment history. Can
you provide us with information that links multiple cases to a single
client? ___________________________________
_______________________________________________________________
D3. Can you provide us with data on non-case
contacts with a worksite? By non-case
contacts, we mean activities such as discussions with supervisors not related
to a specific client, supervisor training sessions, or health promotion
fairs. _________________________________
_______________________________________________________________
_______________________________________________________________
E.
Available Data Fields
Now we’d like to ask you about the
availability of specific data fields.
Which of the following data elements do you have?
Client Demographic Data
Data Variables
|
Available Electronically?
|
Notes
|
|
Unique
client ID
|
|
|
|
Link to
employee
|
|
Can be the same as the unique ID if the
client is the employee, if the client is a dependent of the employee, this
field should identify the employee.
|
|
Employee’s
worksite
|
|
|
|
Date of
birth
|
|
|
|
Sex
|
|
|
|
Race/ethnicity
|
|
|
Client Demographic Data (continued)
Data Variables
|
Available Electronically?
|
Notes
|
|
Education
|
|
|
|
Marital
status
|
|
|
|
Relation
to employee
|
|
E.g., spouse, child
|
Case History Data
|
Case
open date
|
|
|
|
Source
of referral to the EAP
|
|
E.g. supervisor, self, spouse, etc.
|
|
Presenting
problem
|
|
|
|
Primary
diagnoses
|
|
|
|
Number
of contacts with the client by type
|
|
E.g., number of counseling sessions,
number of telephone consultations, etc.
|
|
Number
of contacts with the supervisor regarding the client
|
|
|
|
Services
provided by the EAP
|
|
E.g., short-term counseling, legal aid,
financial counseling, etc.
|
Case History Data (continued)
Data Variables
|
Available Electronically?
|
Notes
|
|
Number
of external providers referred to
|
|
|
|
Type of
each external provider
|
|
E.g., social worker, psychologist,
psychiatrist, etc.
|
|
Treatment
modality of each external provider
|
|
E.g., inpatient, outpatient, self-help
|
|
Number
of visits to each external provider
|
|
|
|
External
providers’ participation in the employee’s health insurance plan
|
|
E.g., covered with a co-pay, covered
with a deductible and coinsurance, not covered, etc.
|
|
Client’s
compliance with EAP treatment recommendations
|
|
|
Non-Case Data
Data Variables
|
Available Electronically?
|
Notes
|
|
Date of
non-case contact with supervisor
|
|
|
|
Supervisor’s
worksite or employer
|
|
|
|
Issues
discussed during supervisor contact
|
|
|
|
Dates of
supervisor training sessions
|
|
|
|
Worksite
at which training occurred
|
|
|
|
Number
of attendees at each session
|
|
|
|
Number
of EAP staff at training session
|
|
|
|
Dates of
other worksite activities
|
|
|
|
Description
of activity
|
|
|
|
Worksite
at which activity occurred
|
|
|
|
Number
of attendees at each activity
|
|
|
|
Number
of EAP staff at activity
|
|
|
So that we can better understand the
information you’ve just given me, please send me a test file with the data
items we’ve just discussed for approximately 100 cases. This test file is the best way for me to
verify my understanding of your data system.
Could you please send this test file to me at:
Grantee contact
address line 1
address line 2
address line 3
Do you have any questions regarding
this test file?
__________________________________________________________________
__________________________________________________________________
F.
Historical Records
An important part of understanding a
population’s willingness to use an EAP is the historical EAP utilization rate
for that population. Obtaining
historical data will allow us to determine this utilization rate. Also, historical data allow us to examine
changes in the treatment patterns of the EAP with regard to changes in the
managed care contracts of the employer.
Thus, we’d like to collect historical data going back at least 5
years.
F1._ Does your current data system include
historical information for the last 5 years?
a) Yes.
Does your data go back even farther?
How far back? ____________
b) No. How far back does your data go? _____________________________
F2._ Is there any reason why some historical
data may be lost between now and the start of any data collection, because of
routine or periodic data purges, for example?
_______
_______________________________________________________________
G. Transferring
Data
Finally, we’d like to ask some
questions about transferring the data from [EAP
name] to us. Because the data files
we are requesting may be large, we would prefer to receive compressed data
files on a single electronic medium such as tape or CD ROM.
G1. Could you write the data files to tape or
diskette? If so, please list all
formats for both tape and diskette (e.g., 8 mm tape or 3.5” diskette). Please include CD ROM if you can write data
to that medium.
_______________________________________________________________
_______________________________________________________________
G2. Are you familiar with file compression
utilities such as PKZip? Please list
all utilities you have used. _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
G3. Are you familiar with any backup
utilities such as Microsoft backup?
Please list all utilities you have used. _________________________________________________________
_______________________________________________________________
_______________________________________________________________
To facilitate our understanding of
your data system, we’d like to see a printed list of all data fields available
on your MIS (including definitions of those fields and definitions of any codes
used). Could you please include this
list with the test file we discussed above?
Do you have any questions concerning this interview, the test file, or
the list of available data fields that we’ve requested?
Thank you for your time. This interview has been very helpful.
__________________________________________________________________
__________________________________________________________________
Notes
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
