Please provide as much information as you would like. You do not need to complete all prompts or provide institution-specific details. This information will be reviewed by the Toolkit Workgroup. We will alert you prior to sharing this with ADGAP members.

Question Title

* 1. Contact Information

Question Title

* 2. Proposed new program / idea or expansion of existing service:

Question Title

* 3. Demographics (setting of care, geographic location, size of institution, staffing):

Question Title

* 4. Arguments for change and factors considered (e.g., value proposition, economic analysis, assessment of (potential) risk-based contracts):

Question Title

* 5. Tools/Resources (e.g., IHI age-friendly health systems calculator, formulas, data used, existing literature):  

Please note if any tool/resource was of particular value in making a successful case.

Question Title

* 6. Key stakeholders involved and their roles (e.g., departments/divisions/centers, presenters, sponsors, decision makers, external/community). You may also include a champion or specific person you brought on board for change: 

Question Title

* 7. Approach to engaging stakeholders and garnering their support (including champions, allies, supporters, opponents): 

Question Title

* 8. Economics (e.g., personnel cost, upfront investment):  

Question Title

* 9. Challenges faced and approach to addressing challenges:

Question Title

* 10. Any additional information you think would be helpful (e.g., tips for others): 

Question Title

* 11. Upload a File

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

T