Diabetes CQI - Evaluation

Learning Objectives:

At the conclusion of this webinar, participants will be able to... 1. Describe the intent of the HRSA Diabetes Quality Improvement Initiative. 2. Develop a strategy for participating in the onsite Diabetes Performance Analysis activity. 3. Define the elements of a SMART goal. 4. Describe at least on e unique approach for improving diabetes outcomes for MSAW patients. 5. Access tools presented while conducting Diabetes Quality Improvement activities.

1. Did the training meet all of the stated learning objectives?*

1 - The learning objectives were not met 2 - The learning objectives were somewhat met 3 - The learning objectives were mostly met 4 - The learning objectives were completely met.

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2. The scholarship and expertise of Candace Kugel, FNP, CNM, MS?*

1 - Poor 2 - Slight 3 - Moderate 4 - Excellent

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3. The scholarship and expertise of Ed Zuroweste, MD?*

1 - Poor 2 - Slight 3 - Moderate 4 - Excellent

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4. Your overall satisfaction with this webinar training?*

1 - Dissatisfied 2 - Somewhat satisfied 3 - Mostly satisfied 4 - Completely satisfied

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5. The webinar presented new areas of knowledge, and/or new ideas/methods to implement.*

1 - Disagree 2 - Somewhat agree 3 - Mostly agree 4 - Completely agree

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6. The webinar contained information at a level commensurate with my training and experience.*

1 - Disagree 2 - Somewhat agree 3 - Mostly agree 4 - Completely agree

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7. How helpful was the information you learned today in enhancing the performance and operations of your health center?*

N/A - Not applicable 1 - Not helpful 2 - Somewhat helpful 3 - Mostly helpful 4 - Completely helpful

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8. If applicable, how do you plan to use the information you learned in your daily work?*

Please do not leave blank. Answer "N/A" if not applicable.

9. Was the content balanced and free of commercial bias?*

1 - Yes 2 - No

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10. Did the speaker(s) fully disclose any conflict of interest and discussion of off-label usage of medications and/or medial devices?*

1 - Yes 2 - No

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11. Do you or your organization have any specific need for training or technical assistance?*

If you do not have any training or technical assistance needs please reply "None"

12. What is the biggest challenge for your clinic in providing quality care to patients?*

If your clinic does not have any challenges, please reply "None"

13. Additional Comments*

If you do not have any additional comments, please reply "None"

14. Name (as it should appear on your certificate)*

15. Please identify the type of organization you represent.*

1 - PCA (Primary Care Association) 2 - Health Center 3 - HCCN (Health Center Controlled Network) 4 - State/Federal Government Agency 5 - Other / Not included in this list 6 - I'm not sure / Don't know

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16. Please identify the type of certificate you would like to receive.*

NOTE: TEXAS CHW CERTIFICATES ARE NOT AVAILABLE FOR THIS TRAINING. 1 - Continuing Medical Education (CME): Electronic copy 2 - Continuing Medical Education (CME): Hard copy 3 - Continuing Nursing Education (CNE): Electronic copy 4 - Continuing Nursing Education (CNE): Hard copy 5 - Texas CHW: Electronic copy 6 - Texas CHW: Hard copy 7 - Certificate of Attendance: Electronic copy 8 - Certificate of Attendance: Hard copy

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17. Address (Street address or P.O. Box)*

18. City*

19. State*

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20. Zip Code*

21. E-mail Address*

22. Phone Number

Please enter your phone number in one of the following formats: xxx - xxx - xxxx OR (xxx) xxx - xxxx

23. Please indicate the type of phone number you provided.

1 - Cell/ Mobile 2 - Home 3 - Work/Office

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THANK YOU FOR SUBMITTING YOUR EVALUATION! CERTIFICATES FOR THIS TRAINING WILL BE SENT OUT 1 - 2 WEEKS FROM THE TRAINING DATE.

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