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* 1. Please provide your contact information.

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* 2. What is the highest level of Quality Improvement (QI) education/experience that you have?

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* 3. Select all that apply:

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* 4. On a scale of 0 to 10, what is your overall ranking of the usefulness of EPoSSI in planning your QI project?

0 5 10
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i We adjusted the number you entered based on the slider’s scale.

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* 5. How familiar are you with the following components of EPoSSI?

  Very familiar Somewhat familiar Neutral Not very familiar Not at all familiar
Choosing improvement team
Detailing the problem
Developing project aims
Choosing an intervention
Planning implementation
Planning project monitoring
Planning end-of-project decision making
Launching and monitoring QI project

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* 6. Are there criteria in EPoSSI that you feel are not necessary (or applicable) to planning a QI project? If yes, which ones and why?

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* 7. Are there criteria you feel should be added to EPoSSI? If so, please describe.

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* 8. Select the statement that best applies to you when working on a QI project.

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* 9. If you have any feedback/suggestions regarding EPoSSI, please elaborate below.

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* 10. I would be interested in providing additional detailed feedback on EPoSSI.

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