Transplant Improvement Program for Success (TIPS)

(Survey revised 11/05/2019)

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* 1. Select your facility from the dropdown list. ALL 207 facilities selected for this project are included below. Please double-check your 6-digit CCN (Medicare Provider Number) and select the correct option for your facility. 

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* 2. Please check the month you are submitting the transplant data for (If you are entering more than one month worth of data, please enter each month separately).

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* 3. Please enter the total number of patients who are in step 1 for your facility this month. Only enter a numerical value (Example: "3" or "20"). Step 1 is defined as:
Patient interest in transplant

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* 4. Please enter the total number of patients who are in step 2 for your facility this month. Only enter a numerical value (Example: "3" or "20"). Step 2 is defined as:
Referral call to transplant center.

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* 5. Please enter the total number of patients who are in step 3 for your facility this month. Only enter a numerical value (Example: "3" or "20"). Step 3 is defined as:
First visit to transplant center.

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* 6. Please enter the total number of patients who are in step 4 for your facility this month. Only enter a numerical value (Example: "3" or "20"). Step 4 is defined as:
Transplant center work-up.

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* 7. Please enter the total number of patients who are in step 5 for your facility. Only enter a numerical value (Example: "3" or "20"). Step 5 is defined as:
Successful transplant candidate.

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* 8. Please enter the total number of patients who are in step 6 for your facility. Only enter a numerical value (Example: "3" or "20"). Step 6 is defined as:
On waiting list and/or evaluate potential living donor.

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* 9. Please indicate whether the Transplant Waitlist Project progress was or is being reviewed in detail during QAPI/QA this month. The expectation is to be addressed at least once a month and as needed.

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* 10. Please indicate who from your facility attended the most recent Transplant NCC Learning and Action Network (LAN) Call. These national calls are scheduled every other month (January, March, May, July, September, November). You can select more than one option if applicable.

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* 11. Have you utilized the New Transplant Toolkit Developed by the FORUM of ESRD Networks? This new resource was introduced in June and can be accessed by following this link https://www.esrdnetwork.org/sites/default/files/Kidney%20Transplant%20Toolkit%202019%200513%20combined.pdf

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* 12. Please describe how is your facility engaging with transplant centers, hospitals, nephrologists , and other stakeholders to identify barriers, overcome issues, and promote communication to improve transplant waitlisting.

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