ACP Quality Connect Practice Assessment with Demographics

1. INTRODUCTION

The following practice assessment tool is designed to help you review the current quality improvement (QI) capacity in order to identify effective strategies for practice improvement. Your individual practice results will not be disclosed to anyone outside of the project leaders.

Answer each question from the perspective of your practice. For each question, select the response that best describes your current approach to care.

Question Title

* 1. Today's Date

Question Title

* 2. YOUR CONTACT INFORMATION
Provide your name, email address and phone number.

Your Name

Your Email Address

Your Phone Number

Question Title

* 3. YOUR PRACTICE INFORMATION
Provide your practice name, street address and phone number.

Practice Name

Practice Street Address

Practice City, State and Zip

Practice Phone Number

ACP CONTACT INFORMATION
For more information, please contact:
Selam Wubu Phone: 202-261-4583; Fax: 202-835-0443; Email: swubu@acponline.org

ACKNOWLEDGEMENT
This QI project is supported by an educational grant from Pfizer, Sanofi, Teva, and the CDC.

REFERENCES
• American College of Physicians (ACP) Practice Advisor. http://www.practiceadvisor.org.
• American Diabetes Association. Standards of Medical Care in Diabetes 2014. Diabetes Care Volume 37, Supplement 1, January 2014. Originally approved 1988. Most recent review/revision October 2013. DOI: 10.2337/dc14-S014.
• Bridges to Excellence (BTE) Diabetes Care Recognition Program Clinician Guide, BTE Health Care Incentives Improvement Institute (HCI3), Newtown, CT, Rev: 02/02/2012.
• Joly BM, Booth M, Mittal P, Shaler G. (2012). Measuring Quality Improvement in Public Health: The Development and Psychometric Testing of a QI Maturity Tool. Evaluation & the Health Professions, 35(2) 119-147.
• Knox L, Brach C. The Practice Facilitation Handbook: Training Modules for New Facilitators and Their Trainers. (Prepared by LA Net through a subcontract with the University of Minnesota under Contract No. HHSA290200710010 TO 3.) Rockville, MD: Agency for Healthcare Research and Quality; June 2013. AHRQ Publication No. 13-0046-EF.
• National Committee for Quality Assurance (NCQA) Diabetes Recognition Program. http://www.ncqa.org/tabid/139/Default.aspx.
• National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Public Health Reports, March – April 2014 (129) 115-123.

Question Title

* 1. Today's Date

Question Title

* 2. YOUR CONTACT INFORMATIONProvide your name, email address and phone number.

Question Title

* 3. YOUR PRACTICE INFORMATIONProvide your practice name, street address and phone number.

* 2. YOUR CONTACT INFORMATION
Provide your name, email address and phone number.

* 3. YOUR PRACTICE INFORMATION
Provide your practice name, street address and phone number.