Incorporating Person and Family Engagement in the Dialysis Facility- Evaluation Survey

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* 1. Do you think the level of this meeting was:

Too Complex

Appropriate

Too Simple

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*
2. On the whole, how would you rate the following aspects of this meeting?

	Excellent	Satisfactory	Poor	N/A
Content	Content Excellent	Content Satisfactory	Content Poor	Content N/A
Overall Quality of Speakers	Overall Quality of Speakers Excellent	Overall Quality of Speakers Satisfactory	Overall Quality of Speakers Poor	Overall Quality of Speakers N/A
Organization	Organization Excellent	Organization Satisfactory	Organization Poor	Organization N/A
Registration Procedure	Registration Procedure Excellent	Registration Procedure Satisfactory	Registration Procedure Poor	Registration Procedure N/A
Visual Aids	Visual Aids Excellent	Visual Aids Satisfactory	Visual Aids Poor	Visual Aids N/A
Webinar Experience	Webinar Experience Excellent	Webinar Experience Satisfactory	Webinar Experience Poor	Webinar Experience N/A

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* Please list topics you would like to see at future Heartland Kidney Network webinars or NANT meetings:

SESSION EVALUATION

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*
3. Please indicate your rating.
Session Title: "Incorporating Person and Family Engagement in the Dialysis Facility"

Objectives:
1.Define patient engagement
2.Describe the three levels of patient engagement
3.Describe the Network resources to improve person and family engagement
4.Select at least one patient engagement strategy to implement

Speakers:
DeeDee Velasquez-Peralta, LMSW, Patient Services Director
Ellie Vail Brent, MPH, Community Engagement Director
Sharlyn Bogner, MSN, RN, CNN, CCTC, CPHQ, Quality Improvement Director
Shane Perry, BS, Executive Director

	Excellent	Satisfactory	Poor
Met Stated Objectives	Met Stated Objectives Excellent	Met Stated Objectives Satisfactory	Met Stated Objectives Poor
Content was Related to Objectives	Content was Related to Objectives Excellent	Content was Related to Objectives Satisfactory	Content was Related to Objectives Poor
Met Personal Objectives	Met Personal Objectives Excellent	Met Personal Objectives Satisfactory	Met Personal Objectives Poor
Effectiveness of Teaching Methods	Effectiveness of Teaching Methods Excellent	Effectiveness of Teaching Methods Satisfactory	Effectiveness of Teaching Methods Poor
Speaker Effectiveness	Speaker Effectiveness Excellent	Speaker Effectiveness Satisfactory	Speaker Effectiveness Poor

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* Comments:

TEST YOUR KNOWLEDGE

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* 4. Patient engagement is.... (Mark all that apply)

includes patient activation

patients taking an active part in their own health care.

patient adherence to the treatment plan

shared responsibility between patients, their families and healthcare providers

includes shared decision making

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* 5. Identify the level of patient engagement for the following activities.

	Direct Patient Care	Organization Design and Governance	Laws and Policy
After reviewing the My Kidney Kit page on "Making my wishes known" Ms. Smith asks the social worker for more information on advance directives.	After reviewing the My Kidney Kit page on "Making my wishes known" Ms. Smith asks the social worker for more information on advance directives. Direct Patient Care	After reviewing the My Kidney Kit page on "Making my wishes known" Ms. Smith asks the social worker for more information on advance directives. Organization Design and Governance	After reviewing the My Kidney Kit page on "Making my wishes known" Ms. Smith asks the social worker for more information on advance directives. Laws and Policy
The PCT reviews the My Kidney Calendar tip of the week and offers additional information.	The PCT reviews the My Kidney Calendar tip of the week and offers additional information. Direct Patient Care	The PCT reviews the My Kidney Calendar tip of the week and offers additional information. Organization Design and Governance	The PCT reviews the My Kidney Calendar tip of the week and offers additional information. Laws and Policy
The Network Patient Representative works with the care team on a lobby day	The Network Patient Representative works with the care team on a lobby day Direct Patient Care	The Network Patient Representative works with the care team on a lobby day Organization Design and Governance	The Network Patient Representative works with the care team on a lobby day Laws and Policy
The physician and patient discuss his/her options for their dialysis treatment, reviewing the pros and cons and which would best fit their lifestyle.	The physician and patient discuss his/her options for their dialysis treatment, reviewing the pros and cons and which would best fit their lifestyle. Direct Patient Care	The physician and patient discuss his/her options for their dialysis treatment, reviewing the pros and cons and which would best fit their lifestyle. Organization Design and Governance	The physician and patient discuss his/her options for their dialysis treatment, reviewing the pros and cons and which would best fit their lifestyle. Laws and Policy
The dietician encourages patient involvement in a game to improve fluid gains which includes a bulletin board to share progress and ideas to manage fluid.	The dietician encourages patient involvement in a game to improve fluid gains which includes a bulletin board to share progress and ideas to manage fluid. Direct Patient Care	The dietician encourages patient involvement in a game to improve fluid gains which includes a bulletin board to share progress and ideas to manage fluid. Organization Design and Governance	The dietician encourages patient involvement in a game to improve fluid gains which includes a bulletin board to share progress and ideas to manage fluid. Laws and Policy
Patient representative attends a Quality Assurance and Performance Improvement team meeting to offer a patient perspective.	Patient representative attends a Quality Assurance and Performance Improvement team meeting to offer a patient perspective. Direct Patient Care	Patient representative attends a Quality Assurance and Performance Improvement team meeting to offer a patient perspective. Organization Design and Governance	Patient representative attends a Quality Assurance and Performance Improvement team meeting to offer a patient perspective. Laws and Policy
Patient involvement in the Network Patient Advisory Committee	Patient involvement in the Network Patient Advisory Committee Direct Patient Care	Patient involvement in the Network Patient Advisory Committee Organization Design and Governance	Patient involvement in the Network Patient Advisory Committee Laws and Policy
Mr. and Mrs. Ramirez attend his annual plan of care meeting.	Mr. and Mrs. Ramirez attend his annual plan of care meeting. Direct Patient Care	Mr. and Mrs. Ramirez attend his annual plan of care meeting. Organization Design and Governance	Mr. and Mrs. Ramirez attend his annual plan of care meeting. Laws and Policy

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* 6. Identify the Network resources available to improve patient engagement. (select all that apply)

My Life, My Choices: Knowledge is Power- My Kidney Kit

My Questions and Goals Brochures

Network Patient Representative program

Monthly clinic calls

"All About You Review" Plan of Care Toolkit

My Clinic Plan

Patient Engagement Showcase

Patient Adherence Workbook

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* 7. Of the patient engagement strategies described in the webinar, please select the strategies you will implement (at least one) in your facility within the next three months (by June 2017)

Use My Kidney Kit (2 pages per month with 10% of patient population per month)

Use the Teach-back Handout with Clinic Staff

Identify a Patient to Participate in the Network Patient Representative Program

Invite a Patient to Monthly QI Meetings

Identify a Patient to Help with a Network QIA

Use the "All About You Review" Plan of Care Toolkit

Review the My Clinic Plan with my Team

Use My Kidney Calendar to determine patient education topics for each month

Review the Patient Engagement Showcase for Ideas, and Develop an Activity

Report a Patient Engagement Activity using "Share How You Care" Link

Other (please specify)

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* Please share your name and contact information (REQUIRED BY NANT for CEUs)

Full Name (Type Exactly How You Want It To Appear On Your Certificate): *

Clinic Name (with CITY) - type N/A if not applicable

Email Address (NANT Certificate will be EMAILED ONLY) *

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* 1. Do you think the level of this meeting was:

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* 2. On the whole, how would you rate the following aspects of this meeting?

Question Title

* Please list topics you would like to see at future Heartland Kidney Network webinars or NANT meetings:

Question Title

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* Comments:

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* 4. Patient engagement is.... (Mark all that apply)

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* 5. Identify the level of patient engagement for the following activities.

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* 6. Identify the Network resources available to improve patient engagement. (select all that apply)

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* 7. Of the patient engagement strategies described in the webinar, please select the strategies you will implement (at least one) in your facility within the next three months (by June 2017)

Question Title

* Please share your name and contact information (REQUIRED BY NANT for CEUs)

*
2. On the whole, how would you rate the following aspects of this meeting?