NW2 Combined QIA Facility Feedback: 2018 Final Review Survey

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* 5. Please give the total numbers between 1/1/2018 and 9/30/2018 (YTD):

# of Patients LISTED on the UNOS Transplant List

# of Patients who BEGAN TRAINING for PD or HHD

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* 6. Did your staff engage patients in QIA activities?

Yes

Comment

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* 7. Please rate the Transplant QIA's impact on your facility's practice.

No change in transplant education practices

Some change in transplant education practices

Slight improvement in transplant education practices

Improvement in transplant education practices

Complete change in practice of transplant education

N/A

No change in transplant education practices

Some change in transplant education practices

Slight improvement in transplant education practices

Improvement in transplant education practices

Complete change in practice of transplant education

N/A

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* 8. Please rate the Home Therapies (HT) QIA's impact on your facility's practice.

No change in HT education/referral practices

Some change in HT education/referral practices

Slight improvement in HT education/referral practices

Improvement in HT education/referral practices

Complete change in practice of HT education/referral

N/A

No change in HT education/referral practices

Some change in HT education/referral practices

Slight improvement in HT education/referral practices

Improvement in HT education/referral practices

Complete change in practice of HT education/referral

N/A

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* 9. After the Education Station was established more patients asked about treatment options.

Strongly Agree

Agree

Disagree

Strongly Disagree

If disagree, please explain why.

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* 10. How did your facility setup the Education Station? Please describe.
e.g. poster board, waiting room display, peer mentor booth, lobby day event etc.

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* 11. Did the Education Station resources increase patient interest in being referred to a Transplant Center or Home Program to learn more about transplant or home therapies as a treatment option?

Yes

Did not have an Education Station/ Dispay

If no, please explain why not.

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* 12. Please rate your facility's SUCCESS in implementing the following TRANSPLANT QIA Interventions:

	Strongly disagree	Disagree	Agree	Strongly Agree
We formed a working relationship with transplant facility staff	We formed a working relationship with transplant facility staff Strongly disagree	We formed a working relationship with transplant facility staff Disagree	We formed a working relationship with transplant facility staff Agree	We formed a working relationship with transplant facility staff Strongly Agree
We engaged patients in the entering the transplant process	We engaged patients in the entering the transplant process Strongly disagree	We engaged patients in the entering the transplant process Disagree	We engaged patients in the entering the transplant process Agree	We engaged patients in the entering the transplant process Strongly Agree
We educated staff on the transplant process	We educated staff on the transplant process Strongly disagree	We educated staff on the transplant process Disagree	We educated staff on the transplant process Agree	We educated staff on the transplant process Strongly Agree
We utilized patients as peer navigators/peer mentors	We utilized patients as peer navigators/peer mentors Strongly disagree	We utilized patients as peer navigators/peer mentors Disagree	We utilized patients as peer navigators/peer mentors Agree	We utilized patients as peer navigators/peer mentors Strongly Agree
We utilized Network printed resources	We utilized Network printed resources Strongly disagree	We utilized Network printed resources Disagree	We utilized Network printed resources Agree	We utilized Network printed resources Strongly Agree
We utilized the entire IDT to educate patients/family members/care partners	We utilized the entire IDT to educate patients/family members/care partners Strongly disagree	We utilized the entire IDT to educate patients/family members/care partners Disagree	We utilized the entire IDT to educate patients/family members/care partners Agree	We utilized the entire IDT to educate patients/family members/care partners Strongly Agree
We regularly monitored patient transplant status	We regularly monitored patient transplant status Strongly disagree	We regularly monitored patient transplant status Disagree	We regularly monitored patient transplant status Agree	We regularly monitored patient transplant status Strongly Agree
We shared the transplant referral guide/exclusions list with patients/family members/care partners	We shared the transplant referral guide/exclusions list with patients/family members/care partners Strongly disagree	We shared the transplant referral guide/exclusions list with patients/family members/care partners Disagree	We shared the transplant referral guide/exclusions list with patients/family members/care partners Agree	We shared the transplant referral guide/exclusions list with patients/family members/care partners Strongly Agree

Comments

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* 13. Please rate your facility's SUCCESS in implementing the following Home Therapies QIA Interventions:

	Strongly disagree	Disagree	Agree	Strongly Agree
We educated ALL staff on PD	We educated ALL staff on PD Strongly disagree	We educated ALL staff on PD Disagree	We educated ALL staff on PD Agree	We educated ALL staff on PD Strongly Agree
We shared PD resources	We shared PD resources Strongly disagree	We shared PD resources Disagree	We shared PD resources Agree	We shared PD resources Strongly Agree
We reviewed and identified education strategies for home therapies education	We reviewed and identified education strategies for home therapies education Strongly disagree	We reviewed and identified education strategies for home therapies education Disagree	We reviewed and identified education strategies for home therapies education Agree	We reviewed and identified education strategies for home therapies education Strongly Agree
We promoted home therapies	We promoted home therapies Strongly disagree	We promoted home therapies Disagree	We promoted home therapies Agree	We promoted home therapies Strongly Agree
We utilized Network printed resources	We utilized Network printed resources Strongly disagree	We utilized Network printed resources Disagree	We utilized Network printed resources Agree	We utilized Network printed resources Strongly Agree
We developed home modality education for incident patients during the first 90 days of dialysis.	We developed home modality education for incident patients during the first 90 days of dialysis. Strongly disagree	We developed home modality education for incident patients during the first 90 days of dialysis. Disagree	We developed home modality education for incident patients during the first 90 days of dialysis. Agree	We developed home modality education for incident patients during the first 90 days of dialysis. Strongly Agree
We reviewed incident patient modality education timing/methods.	We reviewed incident patient modality education timing/methods. Strongly disagree	We reviewed incident patient modality education timing/methods. Disagree	We reviewed incident patient modality education timing/methods. Agree	We reviewed incident patient modality education timing/methods. Strongly Agree
We implemented staff use of MEI Match-D for home therapies education/evaluation.	We implemented staff use of MEI Match-D for home therapies education/evaluation. Strongly disagree	We implemented staff use of MEI Match-D for home therapies education/evaluation. Disagree	We implemented staff use of MEI Match-D for home therapies education/evaluation. Agree	We implemented staff use of MEI Match-D for home therapies education/evaluation. Strongly Agree

Comments

NW2 Combined QIA Facility Feedback:
2018 Final Review

Thank you in advance for sharing your facility feedback! (Only One Survey Per CCN)

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* 1. Please select your facility from the following list

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* 2. Your name

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* 3. Your Title

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* 4. Your e-mail address

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* 5. Please give the total numbers between 1/1/2018 and 9/30/2018 (YTD):

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* 6. Did your staff engage patients in QIA activities?

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* 7. Please rate the Transplant QIA's impact on your facility's practice.

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* 8. Please rate the Home Therapies (HT) QIA's impact on your facility's practice.

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* 9. After the Education Station was established more patients asked about treatment options.

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* 10. How did your facility setup the Education Station? Please describe.
e.g. poster board, waiting room display, peer mentor booth, lobby day event etc.

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* 11. Did the Education Station resources increase patient interest in being referred to a Transplant Center or Home Program to learn more about transplant or home therapies as a treatment option?

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* 12. Please rate your facility's SUCCESS in implementing the following TRANSPLANT QIA Interventions:

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* 13. Please rate your facility's SUCCESS in implementing the following Home Therapies QIA Interventions:

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* 14. Please share any thoughts on the 2018 QIAs, and suggestions for making QIAs more helpful and effective in 2019.

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* 15. What enhancements will your facility be making to the Education Station based on lessons learned or patient/staff feedback? Please describe.

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* 1. Please select your facility from the following list

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* 2. Your name

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* 3. Your Title

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* 4. Your e-mail address

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* 5. Please give the total numbers between 1/1/2018 and 9/30/2018 (YTD):

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* 6. Did your staff engage patients in QIA activities?

Question Title

* 7. Please rate the Transplant QIA's impact on your facility's practice.

Question Title

* 8. Please rate the Home Therapies (HT) QIA's impact on your facility's practice.

Question Title

* 9. After the Education Station was established more patients asked about treatment options.

Question Title

* 10. How did your facility setup the Education Station? Please describe. e.g. poster board, waiting room display, peer mentor booth, lobby day event etc.

Question Title

* 11. Did the Education Station resources increase patient interest in being referred to a Transplant Center or Home Program to learn more about transplant or home therapies as a treatment option?

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* 12. Please rate your facility's SUCCESS in implementing the following TRANSPLANT QIA Interventions:

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* 13. Please rate your facility's SUCCESS in implementing the following Home Therapies QIA Interventions:

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* 14. Please share any thoughts on the 2018 QIAs, and suggestions for making QIAs more helpful and effective in 2019.

Question Title

* 15. What enhancements will your facility be making to the Education Station based on lessons learned or patient/staff feedback? Please describe.

* 10. How did your facility setup the Education Station? Please describe.
e.g. poster board, waiting room display, peer mentor booth, lobby day event etc.