Sample survey instruments developed by ATMC Grantees

The following is a list of research instruments created by past and current ATMC Principal Investigators. If you wish to use all or a portion of any research instrument included in this section, please request permission from the author directly or from the Principal Investigator if no author is named.

Chart Review Instruments:

• Blue Cross Blue Shield of Colorado (PI: Lisa Latts)
• University of Pittsburgh (PI: Patricia Cluss)
• University of Washington (PI: Mark Doescher)
• Wisconsin Department of Health and Family Services (PI: Richard Carr)

Patient Survey/Exit Interview:

• Blue Cross Blue Shield of Colorado (PI: Lisa Latts)
• Massachusetts General Hospital (PI: Nancy Rigotti)
• University of Vermont (PI: Theodore Marcy)
• University of Washington (PI: Mark Doescher)
• Wayne State University – baseline (PI: Robert Burack)
• Wayne State University –exit interview (PI: Robert Burack)

Provider/Staff Survey:

• Massachusetts General Hospital (PI: Nancy Rigotti)
• Providence Health System (PI: Charles Bentz)
• University of Pittsburgh (PI: Patricia Cluss)
• University of Washington (PI: Mark Doescher)
• Wayne State University (PI: Robert Burack)

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Page Updated: August 13, 2008

Center for Tobacco Research and Intervention 
University of Wisconsin School of Medicine and Public Health
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Madison, WI 53711-2027

Commonly Used Acronyms
Robert Wood Johnson Foundation (RWJF)
Addressing Tobacco in Healthcare (ATHC)
Addressing Tobacco in Managed Care (ATMC)