Incorporating Person and Family Engagement in the Dialysis Facility- Webinar 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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* 3. Please list topics you would like to see from NANT meetings:

SESSION EVALUATION

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* 4.
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.Share CMS objectives for facility level patient engagement

Speakers:
DeeDee Velasquez-Peralta, LMSW, Patient Services Manager
Allison Wayment, MS, Patient Services Specialist

	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

Comments:

TEST YOUR KNOWLEDGE

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* 5. Patient engagement.... (Mark all that apply)

includes patients being fully informed and asking questions to make their decisions

patients complying with their treatment plan

includes the patient, family, and providers actively involved in the patient's care as part of a team

shared responsibility between patients, their families and healthcare providers

is different than patient-centered care

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* 6. 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, together the social worker and patient discuss options and set goals.	After reviewing the My Kidney Kit page on "Making my wishes known" Ms. Smith asks the social worker for more information on advance directives, together the social worker and patient discuss options and set goals. 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, together the social worker and patient discuss options and set goals. 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, together the social worker and patient discuss options and set goals. 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
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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* 7. Identify the Network resources available to improve patient engagement. (select all that apply)

Monthly clinic calls

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

Network Patient Representative program

Patient Adherence Workbook

My Clinic Plan

Network Patient Engagement webinar series

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* 8. Identify the benefits to the Network Patient Representative of being involved.

Sense of purpose

Feeling of connection to the facility's patients and staff

Volunteering is beneficial to health

All of the above.

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* 9. Of the three CMS objectives for facilities described in the webinar, please select the objective your facility(ies) will focus on in 2018.

#1 CMS objective for dialysis facilities: establish patient groups

#2 CMS Objective for dialysis Facilities: engaging patients and families in QAPI and Governance.

#3 CMS objective: Dialysis facilities will develop policy and procedures related to patient, family and caregiver participation in the patient’s care.

CONTACT AND FACILITY INFORMATION

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* 10. 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):

Email Address (NANT Certificate will be EMAILED ONLY to this address)

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* 11. Please enter the CNN (6 digit Medicare certification number beginning with (16-IA, 17-KS, 26-MO, 28-NE) for each clinic you are attending for. This is required to document your facility participation in Network projects.

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