ESRD Network 12- Webinar Evaluation

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* 1. Tell Us About You

Name & Title

Email Address

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* 2. Facility Medicare Number (6 digit number beginning with 16 -Iowa, 17 -Kansas, 26 -Missouri, 28 -Nebraska)

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* 3. What was the title of the webinar you viewed/attended?

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* 4. Rate the elements of the webinar.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Content was appropriate.	Content was appropriate. Strongly Agree	Content was appropriate. Agree	Content was appropriate. Neutral	Content was appropriate. Disagree	Content was appropriate. Strongly Disagree
Length was appropriate.	Length was appropriate. Strongly Agree	Length was appropriate. Agree	Length was appropriate. Neutral	Length was appropriate. Disagree	Length was appropriate. Strongly Disagree
Registration process and joining the webinar was easy.	Registration process and joining the webinar was easy. Strongly Agree	Registration process and joining the webinar was easy. Agree	Registration process and joining the webinar was easy. Neutral	Registration process and joining the webinar was easy. Disagree	Registration process and joining the webinar was easy. Strongly Disagree
Presenter(s) / Speaker(s) knowledgeable about the content.	Presenter(s) / Speaker(s) knowledgeable about the content. Strongly Agree	Presenter(s) / Speaker(s) knowledgeable about the content. Agree	Presenter(s) / Speaker(s) knowledgeable about the content. Neutral	Presenter(s) / Speaker(s) knowledgeable about the content. Disagree	Presenter(s) / Speaker(s) knowledgeable about the content. Strongly Disagree

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* 5. Rate the content of the webinar. Select one response per statement

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I found the webinar to be beneficial in reinforcing staff knowledge.	I found the webinar to be beneficial in reinforcing staff knowledge. Strongly Agree	I found the webinar to be beneficial in reinforcing staff knowledge. Agree	I found the webinar to be beneficial in reinforcing staff knowledge. Neutral	I found the webinar to be beneficial in reinforcing staff knowledge. Disagree	I found the webinar to be beneficial in reinforcing staff knowledge. Strongly Disagree
I am more confident with engaging patients about the subject matter after reviewing this webinar.	I am more confident with engaging patients about the subject matter after reviewing this webinar. Strongly Agree	I am more confident with engaging patients about the subject matter after reviewing this webinar. Agree	I am more confident with engaging patients about the subject matter after reviewing this webinar. Neutral	I am more confident with engaging patients about the subject matter after reviewing this webinar. Disagree	I am more confident with engaging patients about the subject matter after reviewing this webinar. Strongly Disagree
The webinar presenting information in a way that I found easy to understand.	The webinar presenting information in a way that I found easy to understand. Strongly Agree	The webinar presenting information in a way that I found easy to understand. Agree	The webinar presenting information in a way that I found easy to understand. Neutral	The webinar presenting information in a way that I found easy to understand. Disagree	The webinar presenting information in a way that I found easy to understand. Strongly Disagree
The webinar gave me a new perspective on this topic.	The webinar gave me a new perspective on this topic. Strongly Agree	The webinar gave me a new perspective on this topic. Agree	The webinar gave me a new perspective on this topic. Neutral	The webinar gave me a new perspective on this topic. Disagree	The webinar gave me a new perspective on this topic. Strongly Disagree

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* 6. After reviewing this webinar, what actions did you take (or plan to make)?

	I did this	I plan on doing this	I did not do this and don't plan on doing
Discuss this webinar with my QAPI Team or in our monthly QI Meeting.	Discuss this webinar with my QAPI Team or in our monthly QI Meeting. I did this	Discuss this webinar with my QAPI Team or in our monthly QI Meeting. I plan on doing this	Discuss this webinar with my QAPI Team or in our monthly QI Meeting. I did not do this and don't plan on doing
Review our policy/procedure.	Review our policy/procedure. I did this	Review our policy/procedure. I plan on doing this	Review our policy/procedure. I did not do this and don't plan on doing
Implement a change to the policy/procedures based on the information provided.	Implement a change to the policy/procedures based on the information provided. I did this	Implement a change to the policy/procedures based on the information provided. I plan on doing this	Implement a change to the policy/procedures based on the information provided. I did not do this and don't plan on doing
Use the webinar information to educate staff.	Use the webinar information to educate staff. I did this	Use the webinar information to educate staff. I plan on doing this	Use the webinar information to educate staff. I did not do this and don't plan on doing
Use the webinar information to educate and/or implement with patients.	Use the webinar information to educate and/or implement with patients. I did this	Use the webinar information to educate and/or implement with patients. I plan on doing this	Use the webinar information to educate and/or implement with patients. I did not do this and don't plan on doing
Incorporate elements from the webinar into your standardized staff training or patient orientation.	Incorporate elements from the webinar into your standardized staff training or patient orientation. I did this	Incorporate elements from the webinar into your standardized staff training or patient orientation. I plan on doing this	Incorporate elements from the webinar into your standardized staff training or patient orientation. I did not do this and don't plan on doing
Seek additional information on the topic.	Seek additional information on the topic. I did this	Seek additional information on the topic. I plan on doing this	Seek additional information on the topic. I did not do this and don't plan on doing

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* 7. Please share any additional comments or webinar topic suggestions you may have. If you represent multiple clinics please add additional CCN's here.

Thank you for taking the time to complete this assessment, your feedback will help us to evaluate the webinar and make improvements.