A Surprise Behind Every Door: Research and Reflections on Making Healthcare Safer for Older Adults Coming Home from the Hospital Survey

For each statement provided below, please circle the number on the 1 to 5 scale that best reflects your opinions about today’s conference. Using the scale: 1= Strongly Disagree 2= Disagree 3= Somewhat Agree 4= Agree 5= Strongly Agree

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* I feel that as a result of this activity I will be better able to:

	Strongly DISAGREE	DISAGREE	Somewhat AGREE	AGREE	Strongly AGREE
Describe the importance of transitional care for older adults	Describe the importance of transitional care for older adults Strongly DISAGREE	Describe the importance of transitional care for older adults DISAGREE	Describe the importance of transitional care for older adults Somewhat AGREE	Describe the importance of transitional care for older adults AGREE	Describe the importance of transitional care for older adults Strongly AGREE
Identify barriers to safe transitions	Identify barriers to safe transitions Strongly DISAGREE	Identify barriers to safe transitions DISAGREE	Identify barriers to safe transitions Somewhat AGREE	Identify barriers to safe transitions AGREE	Identify barriers to safe transitions Strongly AGREE
Review stakeholder-developed strategies for safe care transitions	Review stakeholder-developed strategies for safe care transitions Strongly DISAGREE	Review stakeholder-developed strategies for safe care transitions DISAGREE	Review stakeholder-developed strategies for safe care transitions Somewhat AGREE	Review stakeholder-developed strategies for safe care transitions AGREE	Review stakeholder-developed strategies for safe care transitions Strongly AGREE

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* For each statement provided below, please check the number on the 1 to 5 scale that best reflects your opinions about today’s session.

	Strongly Disagree 1	Diagree 2	Somewhat Agree 3	Agree 4	Strongly Agree 5
There was enough time to cover the topic	There was enough time to cover the topic Strongly Disagree 1	There was enough time to cover the topic Diagree 2	There was enough time to cover the topic Somewhat Agree 3	There was enough time to cover the topic Agree 4	There was enough time to cover the topic Strongly Agree 5
I would recommend this session to my peers	I would recommend this session to my peers Strongly Disagree 1	I would recommend this session to my peers Diagree 2	I would recommend this session to my peers Somewhat Agree 3	I would recommend this session to my peers Agree 4	I would recommend this session to my peers Strongly Agree 5
The information was applicable to my daily activities	The information was applicable to my daily activities Strongly Disagree 1	The information was applicable to my daily activities Diagree 2	The information was applicable to my daily activities Somewhat Agree 3	The information was applicable to my daily activities Agree 4	The information was applicable to my daily activities Strongly Agree 5

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* What were the major strengths of today’s session?

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* Describe any perceived commercial bias.

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* Was today’s topic one that you would have identified as important to you?

Yes

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* Amount of time I spent at this activity:

15 minutes

30 minutes

45 minutes

60 minutes

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* Please share any additional comments and suggestions. Your feedback is extremely valuable to us.

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* Please indicate what type of certificate you are requesting:

CME (1.0 AMA PRA Category 1 Credit)

Certificate of Attendance

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* Please list your information below so we may send you a Certificate:

Name and Credentials

Company

State

Email Address