PA AIM Initiative _ Expression of Interest Question Title * 1. Your Name Question Title * 2. Your PA PQC Hospital AHN – Forbes Hospital AHN – Jefferson Hospital AHN – Saint Vincent Hospital AHN – West Penn Hospital Commonwealth Health – Moses Taylor Hospital Conemaugh Memorial Medical Center Crozer-Keystone Health System - Crozer-Chester Medical Center Crozer-Keystone Health System - Delaware County Memorial Hospital Doylestown Hospital Einstein Medical Center Montgomery Einstein Medical Center Philadelphia Evangelical Community Hospital Geisinger – Bloomsburg Hospital Geisinger – Community Medical Center Geisinger – Holy Spirit Hospital Geisinger – Lewistown Hospital Geisinger – Medical Center, Danville Geisinger – Wyoming Valley Hospital Guthrie – Robert Packer Hospital Birthing Center Holy Redeemer Hospital Jefferson Health – Abington Hospital Jefferson Health – Thomas Jefferson University Hospital Lehigh Valley Health Network – Cedar Crest Lehigh Valley Health Network – Muhlenberg Lehigh Valley Health Network – Pocono Lehigh Valley Health Network - Schuylkill Main Line Health – Bryn Mawr Hospital Main Line Health – Lankenau Medical Center Main Line Health – Paoli Hospital Main Line Health – Riddle Hospital Mount Nittany Health System - Mount Nittany Medical Center Penn Medicine – Chester County Hospital Penn Medicine – Hospital of the University of Pennsylvania Penn Medicine – Lancaster General/Women and Babies Penn Medicine – Pennsylvania Hospital Penn State Health: Milton S. Hershey Medical Center and Children’s Hospital Punxsutawney Area Hospital St. Clair Hospital St. Luke’s University Health Network – Allentown St. Luke’s University Health Network – Bethlehem St. Luke's University Health Network – Anderson Temple Health – Temple University Hospital Tower Health Medical Group - Reading Hospital UPMC – Altoona UPMC – Charles Cole UPMC – Children's Hospital of Pittsburgh UPMC – Hamot UPMC – Horizon UPMC – Magee Womens Hospital UPMC – Northwest UPMC – Pinnacle Carlisle UPMC – Pinnacle Hanover UPMC – Pinnacle Harrisburg UPMC – Pinnacle Lititz UPMC – Pinnacle Memorial in York UPMC - Susquehanna Soldiers + Sailors UPMC - Susquehanna Williamsport Washington Health System Wayne Memorial Hospital WellSpan Ephrata Community Hospital WellSpan Gettysburg Hospital WellSpan Good Samaritan Hospital WellSpan Summit Health Chambersburg Hospital WellSpan Summit Health Waynesboro Hospital WellSpan York Hospital Question Title * 3. Is your PA PQC hospital team interested in joining the PA PQC's AIM initiative to adopt a combined version of the AIM Severe Hypertension and Racial/Ethnic Disparities Bundle? Yes No Question Title * 4. If you answered "yes" to Q3:Who are your champions to adopt the AIM Severe Hypertension and Racial/Ethnic Disparities Bundles? Please list as many champion roles as you can, and your team will expand over time. (In each row, please write their First Name, Last Name, Credentials, Title/Role, Organization, and Email Address) Women's Health Provider Champion Data Collection Champion Administrative Champion (Key Contact for Follow-up and Coordination) Community Resource Champion Patient/Family Champion Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Multi-disciplinary QI Team Members Done