NW2 2016 Needs Assessment

Please provide ESRD Network 2 with feedback that will help us assess our work and consider when developing future educational materials and quality improvement programs.

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* 1. Optional: name and contact information.

Name:

Facility:

Email Address:

Phone Number:

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* 2. Are you a Consumer, Provider, or Stakeholder?

Consumer (patient/family member/care partner)

Provider (facility staff/stakeholder)

Stakeholder (i.e. DOH Staff, Hospital Staff, Non-Profit Partner, OEM Staff)

Other (Please Specify):

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* 3. Are you a member of any of our Learning and Action Networks? (HAI/Transplant)

Yes

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* 4. Please rate and share your thoughts on the monthly e-Newsletter Provider Insider.

Poor

Fair

Average

Above Average

Excellent

N/A

Poor

Fair

Average

Above Average

Excellent

N/A

Comments/Suggestions

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* 5. Please rate and share your thoughts on the bi-monthly patient e-Newsletter Kidney Chronicles.

Poor

Fair

Average

Above Average

Excellent

N/A

Poor

Fair

Average

Above Average

Excellent

N/A

Comments/Suggestions

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* 6. Please rate the overall quality of our current Network Educational Materials/Programs?

Poor

Fair

Average

Above Average

Excellent

N/A

Poor

Fair

Average

Above Average

Excellent

N/A

Comments

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* 7. Please help us assess our Network Publications/Educational Materials by rating the usefulness/value of those that you have seen or used this year.

	Have Not Seen/Used	Poor	Fair	Average	Above Average	Excellent
“Vascular Access: A Guide for Patients” (trifold)	“Vascular Access: A Guide for Patients” (trifold) Have Not Seen/Used	“Vascular Access: A Guide for Patients” (trifold) Poor	“Vascular Access: A Guide for Patients” (trifold) Fair	“Vascular Access: A Guide for Patients” (trifold) Average	“Vascular Access: A Guide for Patients” (trifold) Above Average	“Vascular Access: A Guide for Patients” (trifold) Excellent
Hemodialysis Vascular Access (flyer)	Hemodialysis Vascular Access (flyer) Have Not Seen/Used	Hemodialysis Vascular Access (flyer) Poor	Hemodialysis Vascular Access (flyer) Fair	Hemodialysis Vascular Access (flyer) Average	Hemodialysis Vascular Access (flyer) Above Average	Hemodialysis Vascular Access (flyer) Excellent
“Fistula First Frequently Asked Questions for Patients and Families” (trifold)	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Have Not Seen/Used	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Poor	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Fair	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Average	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Above Average	“Fistula First Frequently Asked Questions for Patients and Families” (trifold) Excellent
“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet)	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Have Not Seen/Used	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Poor	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Fair	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Average	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Above Average	“Preparing for the Vascular Access Portion of Your Medicare Survey” (pamphlet) Excellent
“Vascular Access for Hemodialysis” (poster)	“Vascular Access for Hemodialysis” (poster) Have Not Seen/Used	“Vascular Access for Hemodialysis” (poster) Poor	“Vascular Access for Hemodialysis” (poster) Fair	“Vascular Access for Hemodialysis” (poster) Average	“Vascular Access for Hemodialysis” (poster) Above Average	“Vascular Access for Hemodialysis” (poster) Excellent
"The Right Access for YOU" (poster)	"The Right Access for YOU" (poster) Have Not Seen/Used	"The Right Access for YOU" (poster) Poor	"The Right Access for YOU" (poster) Fair	"The Right Access for YOU" (poster) Average	"The Right Access for YOU" (poster) Above Average	"The Right Access for YOU" (poster) Excellent
“Dialysis Facility Compare” (postcard)	“Dialysis Facility Compare” (postcard) Have Not Seen/Used	“Dialysis Facility Compare” (postcard) Poor	“Dialysis Facility Compare” (postcard) Fair	“Dialysis Facility Compare” (postcard) Average	“Dialysis Facility Compare” (postcard) Above Average	“Dialysis Facility Compare” (postcard) Excellent
“Get the Flu Shot” (CDC poster)	“Get the Flu Shot” (CDC poster) Have Not Seen/Used	“Get the Flu Shot” (CDC poster) Poor	“Get the Flu Shot” (CDC poster) Fair	“Get the Flu Shot” (CDC poster) Average	“Get the Flu Shot” (CDC poster) Above Average	“Get the Flu Shot” (CDC poster) Excellent
“Volunteer to be a PAC Representative” (Patient Pamphlet)	“Volunteer to be a PAC Representative” (Patient Pamphlet) Have Not Seen/Used	“Volunteer to be a PAC Representative” (Patient Pamphlet) Poor	“Volunteer to be a PAC Representative” (Patient Pamphlet) Fair	“Volunteer to be a PAC Representative” (Patient Pamphlet) Average	“Volunteer to be a PAC Representative” (Patient Pamphlet) Above Average	“Volunteer to be a PAC Representative” (Patient Pamphlet) Excellent
Kidney Chronicles (Patient Newsletter)	Kidney Chronicles (Patient Newsletter) Have Not Seen/Used	Kidney Chronicles (Patient Newsletter) Poor	Kidney Chronicles (Patient Newsletter) Fair	Kidney Chronicles (Patient Newsletter) Average	Kidney Chronicles (Patient Newsletter) Above Average	Kidney Chronicles (Patient Newsletter) Excellent
The PAC Speaks (Newsletter)	The PAC Speaks (Newsletter) Have Not Seen/Used	The PAC Speaks (Newsletter) Poor	The PAC Speaks (Newsletter) Fair	The PAC Speaks (Newsletter) Average	The PAC Speaks (Newsletter) Above Average	The PAC Speaks (Newsletter) Excellent
New York State Transplant Center Referral Guide (Pamphlet)	New York State Transplant Center Referral Guide (Pamphlet) Have Not Seen/Used	New York State Transplant Center Referral Guide (Pamphlet) Poor	New York State Transplant Center Referral Guide (Pamphlet) Fair	New York State Transplant Center Referral Guide (Pamphlet) Average	New York State Transplant Center Referral Guide (Pamphlet) Above Average	New York State Transplant Center Referral Guide (Pamphlet) Excellent
Speak Up! Patient Grievance (Poster)	Speak Up! Patient Grievance (Poster) Have Not Seen/Used	Speak Up! Patient Grievance (Poster) Poor	Speak Up! Patient Grievance (Poster) Fair	Speak Up! Patient Grievance (Poster) Average	Speak Up! Patient Grievance (Poster) Above Average	Speak Up! Patient Grievance (Poster) Excellent
Steps to More Effective Communications (Poster)	Steps to More Effective Communications (Poster) Have Not Seen/Used	Steps to More Effective Communications (Poster) Poor	Steps to More Effective Communications (Poster) Fair	Steps to More Effective Communications (Poster) Average	Steps to More Effective Communications (Poster) Above Average	Steps to More Effective Communications (Poster) Excellent
ACT Now Communications (Poster)	ACT Now Communications (Poster) Have Not Seen/Used	ACT Now Communications (Poster) Poor	ACT Now Communications (Poster) Fair	ACT Now Communications (Poster) Average	ACT Now Communications (Poster) Above Average	ACT Now Communications (Poster) Excellent
ACT Now Laminated Card for Staff	ACT Now Laminated Card for Staff Have Not Seen/Used	ACT Now Laminated Card for Staff Poor	ACT Now Laminated Card for Staff Fair	ACT Now Laminated Card for Staff Average	ACT Now Laminated Card for Staff Above Average	ACT Now Laminated Card for Staff Excellent
Why Am I So Cold at Dialysis (Poster)	Why Am I So Cold at Dialysis (Poster) Have Not Seen/Used	Why Am I So Cold at Dialysis (Poster) Poor	Why Am I So Cold at Dialysis (Poster) Fair	Why Am I So Cold at Dialysis (Poster) Average	Why Am I So Cold at Dialysis (Poster) Above Average	Why Am I So Cold at Dialysis (Poster) Excellent
Patients Guide To Immunizations (Trifold)	Patients Guide To Immunizations (Trifold) Have Not Seen/Used	Patients Guide To Immunizations (Trifold) Poor	Patients Guide To Immunizations (Trifold) Fair	Patients Guide To Immunizations (Trifold) Average	Patients Guide To Immunizations (Trifold) Above Average	Patients Guide To Immunizations (Trifold) Excellent

What materials have been the most useful to you in the past six months, and why?

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* 8. Do you have any topic or speaker suggestions for our 2017 Annual Meeting?

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* 9. What types of Resources/Programs would you like to have the Network source or develop?

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* 10. What time of day is the best for educational conference calls/webinars? (select all that apply)

I will not attend Conference Calls/Webinars

8:00-9:00 am

9:00-10:00 am

10:00-11:00am

11:00-Noon

Noon-1:00 pm

1:00-2:00 pm

2:00-3:00 pm

3:00-4:00 pm

4:00-5:00 pm

5:00-6:00 pm

4:00-5:00 pm

5:00-6:00 pm

6:00-7:00 pm

7:00-8:00 pm

Other (please specify)

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* 11. What day(s) of the week are best for conference calls? (select all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Other (please specify)

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* 12. Do you visit the Network website to look for ESRD resources? www.esrd.ipro.org

Yes

Comment:

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* 13. How do you feel the Network could better serve your needs? (select all that apply)

Written Materials

In Person Meetings

Conference Calls/Webinars

One on One Technical Assistance

Website Resources

Other (please specify)

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* 14. Was your facility enrolled in a CMS-mandated Quality Improvement Activity/ies in 2016? (select all that apply)

Vascular Access: Reduce Long Term Catheter use (Based on CROWNWeb data)

BSI Reduction: NHSN Reporting (Based on NHSN data)

Increasing Vaccination Rates and Reporting: Pneumococcal Pneumonia and Hepatitis B (Based on CROWNWeb data)

Grievances: Developing a Grievance Process and Increasing Communication (Based on Facility Grievance #s)

Improving ICH CAHPS Score: PD Awareness (Based on ICH CAHPS Score)

Decreasing Hypercalcemia (Based on ESRD QIP Score)

Promoting Transplant as a Treatment Option and Decreasing Racial Disparities in Transplant Referrals (Based on referral rates)

My facility was not involved in any Network QIAs in 2016

I don't know.

If yes, how was your experience?

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* 15. Do you have additional comments or suggestions?

Thank you for your time and consideration in providing your feedback. We are looking forward to working with you in the future!

The staff of the IPRO ESRD Network of New York