Newsletter Needs Assessment Question Title * 1. In what state is your facility located? ME NH VT MA RI CT NY NC SC GA OH KY IN Other (please specify) Question Title * 2. What is your role at your facility? Medical Director Facility Administrator Nurse Manager Social Worker Dietician Technician Other (please specify) Question Title * 3. Are you reading our electronic newsletter Provider Insider? Yes No I don't know If no, why? (then skip to question 5) Question Title * 4. Do you find the information useful? Yes No If no, why? Question Title * 5. What information in Provider Insider do you find most useful in performing your role at your facility? (Ranking: 1 most useful to 8 least useful) 1 2 3 4 5 6 7 8 Data updates 1 2 3 4 5 6 7 8 Quality Improvement Activities 1 2 3 4 5 6 7 8 Addressing Patient Needs 1 2 3 4 5 6 7 8 CMS announcements 1 2 3 4 5 6 7 8 Emergency preparedness information 1 2 3 4 5 6 7 8 Upcoming events 1 2 3 4 5 6 7 8 ESRD QIP information 1 2 3 4 5 6 7 8 Patient education resources Question Title * 6. Is there any other information you would want us to include that would help you in your practice? Question Title * 7. Would you prefer receiving information contained in Provider Insider in another format? (Select all that apply) Social Media/Blog Posts Website I like getting it via e-mail Hard Copy Other please specify Question Title * 8. How often do you want to receive Provider Insider? Bi-Weekly Monthly Bi-Monthly Quarterly Done
