1.Is your nursing home part of the Project ECHO program?

Yes

No

2.If no, please choose a reason why you are not participating.

Have not heard of Project ECHO

Don't have time and/or resources

Involved in other quality programs

Other (please specify)

3.If you are participating in Project ECHO, please rate your experience participating in the Network thus far (scale from very satisfied to very dissatisfied)

Very satisfied

Satisfied

Dissatisfied

Very dissatisfied

4.What is working well in your cohort? Please choose more than one response if applicable.

Topics/content

Open curriculum for current issues

Quality improvement moments

Case discussion

Attendee collaboration

Other (please specify)

5.In your opinion, what is the main benefit of joining the Network?

Quality improvement

Better infection control strategies

Ability to connect with others in a similar situation

Improves staff skills

Improves staff morale

The stipend

6.What topics do you want to cover in future sessions?

7.If you'd like more information about participating in Project ECHO, please contact Janine Finck-Boyle (jfinck-boyle@leadingage.org) or enter your contact information below.

Name

Company

City/Town

State/Province

ZIP/Postal Code

Email Address

8.What can be improved in your cohort?  Please select more than one response if applicable.

Topics/content

Open curriculum for current issues

Quality improvement moments

Case discussion

Attendee collaboration

Other (please specify)