Qsource ESRD Networks Customer Satisfaction Survey

How are we doing?

We are a little over half-way through our contract year so this is a check-in to see how you think we are doing. We are committed to providing patients and dialysis facility staff with the best assistance and learning opportunities possible, so we welcome your comments. Please provide us feedback so we can improve our service to the ESRD community. Thank you.

*Please indicate which Network you are in: (Required.)

Network 10 (Illinois)

Network 12 (Missouri, Kansas, Iowa, Nebraska)

Medicare Provider Number/CCN Number

*Instructions: Using a rating scale from 1 (meaning "dissatisfied") through 5 (meaning "extremely satisfied") select your response to the following statements. If you feel the statement does not apply, you may select the N/A option for "Not Applicable".(Required.)

1 - dissatisfied

5 - extremely satisfied

N/A

1. Please rate the assistance and education received from the Network to decrease COVID-19 hospitalizations, hospital admissions, 30-day unplanned readmissions, and outpatient emergency department visits.

1 - dissatisfied

5 - extremely satisfied

N/A

2. Please rate the assistance and education received from the Network to decrease the need for blood transfusions, hemodialysis catheter infections, and peritonitis for patients living in and receiving dialysis in a nursing home.

1 - dissatisfied

5 - extremely satisfied

N/A

3. Please rate the assistance and education received from the Network to increase the use of a home dialysis modality.

1 - dissatisfied

5 - extremely satisfied

N/A

4. Please rate the assistance and education received from the Network to increase the use of rural telehealth/telemedicine.

1 - dissatisfied

5 - extremely satisfied

N/A

5. Please rate the assistance and education received from the Network to increase the number of patients that are added to the transplant waitlist and/or receive a kidney transplant.

1 - dissatisfied

5 - extremely satisfied

N/A

6. Please rate the assistance and education received from the Network to increase patient involvement in creating a life plan, QAPI, and peer mentoring.

1 - dissatisfied

5 - extremely satisfied

N/A

7. Please rate the assistance and education received from the Network to increase accuracy of depression screening and treatment for depression.

1 - dissatisfied

5 - extremely satisfied

N/A

8. Please rate the assistance and education received from the Network to increase vaccinations (flu, PPSV, COVID-19 and PCV 13)

1 - dissatisfied

5 - extremely satisfied

N/A

9. Please rate the customer service received from the Network during interactions.

1 - dissatisfied

5 - extremely satisfied

N/A

10. Please rate the Network's contribution to quality improvement initiatives in your organization.

1 - dissatisfied

5 - extremely satisfied

N/A

11. Please rate the Network's staff in terms of being qualified and knowledgeable.

1 - dissatisfied

5 - extremely satisfied

N/A

12. Please rate the Network's staff in terms of being available and responsive to your requests in a timely manner.

1 - dissatisfied

5 - extremely satisfied

N/A

13. Please rate your overall satisfaction with the performance of the Network.

1 - dissatisfied

5 - extremely satisfied

N/A

Any additional feedback you would like us to know?