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Georgia Chapter Firearm Injury Prevention Quality Improvement
Project Enrollment Request Form

Introduction

Thank you for your interest the Georgia Chapter of the American Academy of Pediatrics Firearm Injury Prevention Quality Improvement Project. This project will use the Plan Do Study Act process to achieve practice transformation. An application to the ABP will be submitted for MOC Part 4 and MOC Part 2 credits. 
 
Enrollment consideration will be based:
  • Practice Team participation in our Aug, 26th virtual Symposium. 
  • Practice benchmark data on 4 data measures from twenty 3-year-old visit charts by Aug. 18th
  • Physician Leader participation in monthly technical assistance calls with a Project Leader.
  • Data Manager monthly submission from ten 3-year-old visit charts between Sept. 2023 - Feb. 2024.
 
We look forward to reviewing your application for this complimentary educational opportunity. Thank you for completing this short application.
1.How many physicians from your practice will be participating in this project?
2.Please indicate where your practice is located:
3.Please rate your practice knowledge of the following:
Poor
Not so Good
Good
Very Good
Excellent
Quality Improvement to Achieve Practice Transformation
Completion of a Plan Do Study, Act Worksheet
Ability to pull documentation on anticipatory guidance from your patient's electronic health record.
4.Please provide the following practice information:
5.Please list the following for your Practice Physician Lead
6.Please provide the following for your Practice Data Manager:
7.By participating in this project, the Practice Physician Lead and the Practice Data Manager agree to participate in the Virtual Firearm Injury Prevention Symposium on Saturday, August 26, 2023.
8.Benchmark data from 20 three-year-old well visit charts is due by August 18, 2023. 
9.Active participation is required; Practice Physician Leads are expected to participate in monthly technical assistance calls and provide data on 10 three-year-old well visit charts between September 2023 - February 2024.