Please provide updates and feedback by April 30, 2019 
Acronyms used in the form: VR (Vocational Rehabilitation); EN (Employment Network)

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* 2. Your name and contact information

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* 3. Your facility's current patient census:

Patient Engagement Activities

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* 4. Patient Involvement in QAPI Meetings: Please rank how beneficial patient involvement in QAPI discussions has been. (1 being the lowest and 4 being the highest)

QIA Activities

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* 5. How many patients and family members were educated on engaging in their care? (Hint: discussing work/school/VR could be considered engagement education)

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* 6. How many patients expressed interest in Ticket to Work?

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* 7. How many patients expressed interest in VR?

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* 8. Have you made any progress in your RCA Intervention? (Hint, are you working on your top barrier identified and using PDSA to see if it is working)

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* 9. Please share a sample of patient comments on your QIA activities/interactions (Both positive and Negative)

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* 10. Comments or Questions about this QIAs?

Thank you for completing the April QIA MSR for your facility.
 We appreciate your time and effort.
 
 Please click on "DONE" to submit your responses to the Network
  
Quality Improvement Team
 IPRO ESRD Network of New York
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