1:
Service Utilization by Type of Organization Requesting Service
and Outcomes for Reporting Period
Category
Total
number of individual clients/departments requesting TRC services
and hours of client contact service provided, including
preparation time.
Total
number of new/first time
Total
number of repeat clients (those who received service in the past
– prior to the current reporting period – who are
returning for more/other services)
Total
number of hours of technical assistance provided including
preparation time
|
1:
Service Utilization by State and Type of Organization Requesting
Service
Service
Utilization
Type
of Organization Requesting Service
Academic
Institution/School
Associations/Organizations
(National, State or Regional)
Clinic
Funders
(Foundations/Health Plans)
Hospital/Health
System
Critical
Access Hospital (CAH) (25 beds or less)
Small
Rural Hospital (50 beds or less)
Health
Resources and Services Administration (HRSA) Grant Funded Entity
Government
Agency (Federal, State, Regional or Local)
Tribal/IHS
Legislator/Policy
Maker /staffer(or office)
Telehealth
Resource Center
Vendor
Other
(list other and provide total numbers)
|
2:
Method of Query for Reporting Period
Category
Email
Phone
Referral
from Another TRC
Social
Media (Twitter, Facebook, LinkedIn, etc.)
TRC
Initiated
Website
Other
|
2:
TRC Technical Assistance Communication Method of Inquiry and
Response
Method
of Technical Assistance Inquiry
Phone
In-Person
Contact at an event (ie. training, conference, meeting, other)
TRC
Website Form
Referral
from Another TRC
Social
Media (Twitter, Facebook, LinkedIn, etc.)
TRC
Initiated
Other
Method
Used to Respond to Inquiries
Email
Phone
Videoconference
In
Person Visit
Other
|
3:
Topic of Query for Reporting Period
Category
General
Information
Clinical
Service Program Development/Operations
Equipment
and Technology Assessment/Selection
Financial
(Reimbursement, Business Models, Grants)
Policy
Other
|
3:
Topic of Inquiry
Category
Financial
(Reimbursement, Business Models, Grants)
Policy/Legal
Market
Analysis
About
my TRC
Broadband
network infrastructure
Readiness
Assessment
Distance
Learning
Program
Evaluation
Strategic
Planning
Tools
and Templates
General
Telehealth Information
Clinical
Service Program Development/Operations
Equipment
and Technology Assessment/Selection
Other
|
4:
Types of Services Provided by TRC during the Reporting Period
Category
Training/Education
and Outreach
Events
Organize/Host
Conference or Training Event (# of Events, Total Direct Service
Hours, Total # of Participants)
Presentation
at Conferences/Meetings/Webinars (# of Presentations, Total
Direct Service Hours, Total # of Participants)
Other
Communications/Promotional
Activities
Exhibits
(# of hours, # of contacts)
Newsletter
(# of newsletters, # of subscribers)
Web
Site (# unique visitors, # of pages viewed by visitors)
Research
Publications (# of publications)
General
Media (# interviews/articles)
Social
Media
Facebook
(# of page likes, # of posts)
Twitter
(# of followers, # of tweets)
LinkedIn
(# of followers, # of posts)
Other
Technical
Assistance/Consultation
Method
Used to Respond to Queries
Email
(# responses)
Phone
(# responses)
Videoconference
(# responses)
In
Person Visit (# responses)
Group
Collaboration/Planning (# responses)
Client
Satisfaction Survey Results
The
following 4 questions come from the standardized Client
Satisfaction Questionnaire – CSQ-8 and ratings are on a 4
point scale)
How
would you rate the quality of service you received –
Excellent, Good, Fair, Poor (# respondents, average rating)
If
a colleague were in need of similar help, would you recommend our
program to him or her – No, definitely not, No, I don’t
think so, Yes, I think so, Yes definitely (# respondents,
average rating)
In
an overall, general sense, how satisfied are you with the
services you have received – Very satisfied, Mostly
satisfied, Indifferent or mildly dissatisfied, Quite dissatisfied
(# respondents, average rating)
If
you were to seek help again, would you come back to our program –
No, definitely not, No, I don’t think so, Yes, I think so,
Yes, definitely (# respondents, average rating)
Tools/Materials/Resources
(# developed, # distributed)
|
4:
Types of Services Provided by TRC
Training/Education
and Outreach
Communications/Promotional
Activities
Tools/Materials/Resources
|