NW2 Transplant QIA Kick-off 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 Transplant Quality Improvement Activity. Please review the Webinar Recording and/or webinar slides prior to competing this form.

Please complete by March 15, 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 QIA includes process review and QAPI reporting

Yes

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* 4. It is required for at least 1 staff member to attend bi-monthly National QIA LAN Calls (Schedule PDF)

Yes

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

At least a 2 percentage point improvement over the "Natural Trend" of Transplant UNOS Waitlist rates

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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* 6. Do you feel your facility can meet the QIA goal?

Yes

Comment

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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:

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* 3. This QIA includes process review and QAPI reporting

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* 4. It is required for at least 1 staff member to attend bi-monthly National QIA LAN Calls (Schedule PDF)

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

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* 6. Do you feel your facility can meet the QIA goal?

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