Evaluation Form: Diabetes CQI
Learning Objectives
Learning Objectives
At the conclusion of this webinar, participants will be able to... 1. Describe an overview of the HRSA Diabetes Quality Improvement Initiative goasl; 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 one 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?
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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 fully met
2. The scholarship and expertise of Candace Kugel, FNP, CNM, MS?
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1 - None 2 - Slight 3 - Moderate 4 - Excellent
3. Your overall satisfaction with this webinar training?
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1 - Dissatisfied 2 - Somewhat satisfied 3 - Mostly satisfied 4 - Completely satisfied
4. The webinar presented new areas of knowledge, and/or new ideas/methods to implement.
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1 - Disagree 2- Somewhat agree 3 - Mostly agree 4 - Completely agree
5. The webinar contained information at a level commensurate with my training and experience.
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1 - Disagree 2- Somewhat agree 3 - Mostly agree 4 - Completely agree
6. How helpful was the information you learned today in enhancing the performance and operations of your health center or organization?
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N/A - Not applicable 1 - Not helpful 2 - Somewhat helpful 3 - Mostly helpful 4 - Completely helpful
7. If applicable, how do you intend to use the information learned in your daily work?
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If you have nothing to enter please type "N/A"
8. Was the content balanced and free of commercial bias?
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1 - Yes 2 - No
9. Did the speaker(s) fully disclose any conflict of interest and/discussion of off-label usage of medications and/or medical devices?
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1 - Yes 2 - No
10. Please mention one thing you learned during this webinar training.
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If you have nothing to enter please type "N/A"
11. Are there any additional resources, technical assistance, or training that would be helpful to you or your organization?
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If you have nothing to enter please type "N/A"
12. What is the biggest challenge for you or your organization in providing quality care or services?
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If you have nothing to enter please type "N/A"
13. Please state any additional comments, questions, or suggestions below.
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If you have none enter "N/A"
CERTIFICATES FOR THIS TRAINING WILL BE SENT ELECTRONICALLY 1 - 2 WEEKS POST WEBINAR DATE.
14. Name (as it should appear on your certificate)
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15. Mailing Address (street # or P.O. Box)
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16. City
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17. State
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18. Zip Code
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19. Please identify the type of certificate you would like to recieve.
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NOTE: TEXAS CHW CERTIFICATES WILL NOT BE MADE AVAILABLE FOR THIS TRAINING. 1 - Continuing Medical Education (CME) 2 - Continuing Nursing Education (CNE) 3 - Texas CHW Ceritifcate 4 - Certificate of Attendance
20. Email Address
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21. Phone Number
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Please enter your phone number in one of the following formats: (123) 456-7890 or 123-456-7890
22. Please indicate the type of phone number you provided.
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1 - Cell/Mobile 2 - Home 3 - Work/Office
ON BEHALF OF MIGRANT CLINICIANS NETWORK, WE THANK YOU FOR YOUR PARTICIPATION!
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