NW2 Transplant and Home Dialysis QIA Mid-Point Webinar
Post Assessment 2019

Please complete the following information.

This for is being used to assess understanding of purpose, facility role, and Network role in the 2019 Home Therapies Quality Improvement Activity. Please review the Webinar Recording and/or webinar slides prior to competing this form.

Please complete by July 31, 2019.

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* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

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* 2. Contact:

Name

Email Address

Phone Number

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* 3. This webinar was over 1 hour long

Yes

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* 4. These QIAs include process review and QAPI reporting

Yes

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* 5. It is required for at least 1 staff member to attend bi-monthly National QIA LAN Calls (Separate Home QIA and Transplant QIA calls) Schedule PDF

Yes

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* 6. The goal(s) of these QIA(s) is/are:

At least a 2 percentage point improvement over the "Natural Trend" of each QIA

Facility staff being aware of Treatment Option education resources

All Patients understating their treatment options

Standardizing the process of patient education on Treatment Options

All of the above

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* 7. Do you feel your facility can meet the QIA(s) goal?

Yes

Comment

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* 8. QIA facilities are REQUIRED to have a working relationship with:

Home Therapies Training Staff (if in HT QIA)

Transplant Center Staff (if in TX QIA)

Both Home Therapies and Transplant Center staff (If in both HT and TX QIAs)

No one, things are great as they are.

Comment

Question Title

* 1. Please select your facility from the dropdown list below (CMS Certification Number (CCN) and Facility name listed)

Question Title

* 2. Contact:

Question Title

* 3. This webinar was over 1 hour long

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* 4. These QIAs include process review and QAPI reporting

Question Title

* 5. It is required for at least 1 staff member to attend bi-monthly National QIA LAN Calls (Separate Home QIA and Transplant QIA calls) Schedule PDF

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* 6. The goal(s) of these QIA(s) is/are:

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* 7. Do you feel your facility can meet the QIA(s) goal?

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* 8. QIA facilities are REQUIRED to have a working relationship with:

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* 9. Do you have any other comments, questions, or concerns?