## Previsit questionnaire summary stats

**Events score**

Min=0, Max=24

Average response 10.59 Total # entries 285

**Called your PCP office**

Average response 0.61 Total # entries 286

0 = No 1 = Yes

**Called a specialist office**

Average response 0.5 Total # entries 286

0 = No 1 = Yes

**Car accident**

Average response 0.47 Total # entries 286

0 = No 1 = Yes

**Death of a spouse**

Average response 0.6 Total # entries 286

0 = No 1 = Yes

**Death of other close relative**

Average response 0.4 Total # entries 286

0 = No 1 = Yes

**Death of a friend**

Average response 0.43 Total # entries 286

0 = No 1 = Yes

**Death of a pet**

Average response 0.44 Total # entries 286

0 = No 1 = Yes

**ER visit**

Average response 0.42 Total # entries 286

0 = No 1 = Yes

**Fall**

Average response 0.42 Total # entries 286

0 = No 1 = Yes

**Hospital stay**

Average response 0.37 Total # entries 286

0 = No 1 = Yes

**Moved**

Average response 0.41 Total # entries 286

0 = No 1 = Yes

**New device (cane, walker, wheelchair)**

Average response 0.39 Total # entries 286

0 = No 1 = Yes

**New non-prescription medication**

Average response 0.41 Total # entries 286

0 = No 1 = Yes

**New prescription medication**

Average response 0.47 Total # entries 286

0 = No 1 = Yes

**Outpatient rehab**

Average response 0.42 Total # entries 286

0 = No 1 = Yes

**PCP visit**

Average response 0.44 Total # entries 286

0 = No 1 = Yes

**Rehab stay**

Average response 0.38 Total # entries 286

0 = No 1 = Yes

**Specialist visit**

Average response 0.47 Total # entries 286

0 = No 1 = Yes

**Stopped driving**

Average response 0.38 Total # entries 286

0 = No 1 = Yes

**Stopped a medication on your own**

Average response 0.24 Total # entries 86

0 = No 1 = Yes

**Surgery – elective**

Average response 0.38 Total # entries 286

0 = No 1 = Yes

**Surgery – emergency**

Average response 0.43 Total # entries 286

0 = No 1 = Yes

**Test done (blood, xray)**

Average response 0.49 Total # entries 286

0 = No 1 = Yes

**Urgent care visit**

Average response 0.41 Total # entries 285

0 = No 1 = Yes

**Issues score**

Min=0, Max=78

Average response 29.87 Total # entries 285

**Anxiety/stress**

Average response 1.79 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Caring for someone else**

Average response 1.35 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Chest pain or pressure**

Average response 1.35 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Constipation**

Average response 1.37 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Difficulty walking**

Average response 1.32 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Dizziness**

Average response 1.29 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Fear of death**

Average response 1.26 Total # entries 50

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Fear of disability or being a burden**

Average response 1.33 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Fear of falling**

Average response 1.32 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Indigestion/nausea**

Average response 1.26 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Loneliness/boredom**

Average response 1.24 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Low energy**

Average response 1.44 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Low mood**

Average response 1.26 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Managing your health problems**

Average response 1.16 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Managing your health problems**

Average response 1.16 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Managing your medications**

Average response 0.67 Total # entries 75

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Memory loss**

Average response 1.28 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Overall health/quality of life**

Average response 1.38 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Pain**

Average response 1.27 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Poor appetite**

Average response 1.2 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Poor sleep**

Average response 1.31 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Sex life**

Average response 0.6 Total # entries 75

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Shortness of breath**

Average response 1.37 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Unsteadiness**

Average response 1.28 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Urine leakage/incontinence**

Average response 1.25 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Weight loss**

Average response 1.31 Total # entries 286

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable

**Worries/regrets**

Average response 1.04 Total # entries 46

0 = Not a problem 1 = Somewhat a problem, but tolerable 2 = Significant problem, but tolerable 3 = Intolerable