2020 VR QIA Monthly Report - April

Form Due by May 14, 2020

Please submit only one report per facility. Data on your submission should reflect what happened in the month of April 2020.

Question Title

* 1. Select your facility from the drop down list.
(list is sorted by CCN = CMS Certification Number)

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* 2. Enter your name and phone number.

Name

Email Address

Phone Number

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* 3. How many VR eligible patients do you currently have in your facility in the reporting month?
(enter numerical value)
-- Eligibility Criteria for VR: (1) Between 18 through 54 years of age; (2) Blind or have a disability AND receive SSDI or SSI benefits; (3) not currently employed, in school, or receiving specialized training

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. How many patients between 18 and 54 years of age, if any, have you referred to VR or EN services in the reporting month?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 5. How many patients between 18 and 54 years of age, if any, had an appointment with VR/EN during the reporting month -- including telephone and virtual check ins?

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 6. How many patients between 55 and 64 years of age has an appointment with Employment Network (or Vocational Rehabilitation) services this month -- including telephone and virtual check ins?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

Patient and Family Engagement Assessment

Facilities will include patients and/or family members/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body

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* P1. Does your facility include patients and/or family members/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body of the facility?

Yes

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* P2. My facility took the following actions to impact this goal during the reporting month:

Reviewed Network resources (please elaborate in the "other" field)

Identified patient/family member/caregiver to participate in QAPI

Discussed patient involvement during QAPI team meeting to plan for patient/family member/caregiver attendance

Provided patient with invitation to participate

Had a patient/family member/caregiver attend the QAPI team meeting

Developed policy / procedure for patient/family member/caregiver attendance to the QAPI team meeting

None of the above

Other (please specify)

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* P3. What other resources would be helpful for you to meet the PFE Goals?
(please include your name and email address so we can follow up with you)

Resource / Activity Review -- For April Reporting

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* R1. Did you, or someone from your facility staff, attend the "Supporting Gainful Employment" webinar, with guest speaker: the National Employment Network Association (NENA)?
The webinar was hosted by Qsource ESRD Networks on April 30. Here is a link to the recording: https://attendee.gotowebinar.com/recording/38308491222459650

Yes, our facility attended live

Yes, our facility viewed the recording online

No, our facility did not attend the webinar, but we plan to watch the recording before the end of the month

I found the presentation beneficial

I have already reached out to NENA to refer patients

I still have questions for the Network or for NENA
(use this box to submit your question -- please include your name and email address so we can follow up with you)

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How to Check Your Patient Roster

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* R2. Rate the benefits of the resource tool -- How to Check Your Patient Roster (in CROWNWeb)
(select all that apply)

The staff discussed the availability of the resource in a staff huddle

The facility staff reviewed the resource to get ideas on how to operationalize it

This resource tool was easy to understand

This resource was liked by staff

My facility shared this resource in a common area for staff to review at their own convenience

I shared the resource with another clinic or my regional leadership

I have not yet shared the resource but plan to

I did not find this resource to be beneficial and I do not plan to use it

Monthly Wrap Up

Question Title

* What support do you need from your ESRD Network to help with the Vocational Rehabilitation QIA initiative? (please include your name and email address so we can follow up with you)

2020 VR QIA Monthly Report - April

Form Due by May 14, 2020

Question Title

* 1. Select your facility from the drop down list.(list is sorted by CCN = CMS Certification Number)

Question Title

* 2. Enter your name and phone number.

Question Title

Question Title

* 4. How many patients between 18 and 54 years of age, if any, have you referred to VR or EN services in the reporting month?

Question Title

* 5. How many patients between 18 and 54 years of age, if any, had an appointment with VR/EN during the reporting month -- including telephone and virtual check ins?

Question Title

* 6. How many patients between 55 and 64 years of age has an appointment with Employment Network (or Vocational Rehabilitation) services this month -- including telephone and virtual check ins?

Question Title

* P1. Does your facility include patients and/or family members/caregivers in the Quality Assurance Performance Improvement (QAPI) Program and/or governing body of the facility?

Question Title

* P2. My facility took the following actions to impact this goal during the reporting month:

Question Title

* P3. What other resources would be helpful for you to meet the PFE Goals?(please include your name and email address so we can follow up with you)

Question Title

Question Title

How to Check Your Patient Roster

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* R2. Rate the benefits of the resource tool -- How to Check Your Patient Roster (in CROWNWeb)(select all that apply)

Question Title

* What support do you need from your ESRD Network to help with the Vocational Rehabilitation QIA initiative? (please include your name and email address so we can follow up with you)

* 1. Select your facility from the drop down list.
(list is sorted by CCN = CMS Certification Number)

* P3. What other resources would be helpful for you to meet the PFE Goals?
(please include your name and email address so we can follow up with you)

* R2. Rate the benefits of the resource tool -- How to Check Your Patient Roster (in CROWNWeb)
(select all that apply)