Performance Indicator Data Collection Tool

PIMS Measures – no changes for 2021

New Measure

1: Service Utilization by State and Type of Organization Requesting Service

Service Utilization

• Total # of clients served

• Total # of repeat clients

• Direct

  • Total # of clients served via technical assistance (ie. consultation)

  • Total # of clients served via training

  • List each state in your region and total number of clients served in each

  • PIMS Form Example: State Acronym ____ Number of Clients Served via consultation____ via conference, meeting, or training ____

  • PIMS Form creates automated: Total Clients Served in TRC Region

  • PIMS Form creates automated: Total Clients Served in HRSA Region

• Indirect

  • Total # of clients served via education and outreach

Type of Organization Requesting Service

• Academic Institution/School

• Associations/Organizations (National, State or Regional)

  • Area Health Education Center (AHEC)

  • Rural Health Association

  • Other

• Clinic

  • Free Clinic ___

  • Federally Qualified Health Center (FQHC)

  • Rural Health Clinic (RHC)

  • Other

• Funders (Foundations/Health Plans)

• Hospital/Health System

  • Critical Access Hospital (CAH) (25 beds or less)

  • Small Rural Hospital (50 beds or less)

    • Medium Rural Hospital (50-99 beds)

    • Large Rural Hospital (100 or more beds)

    • Other

  • Health Resources and Services Administration (HRSA) Grant Funded Entity

  • Government Agency (Federal, State, Regional or Local)

    • Corrections

    • Health Department

    • Medicaid/Medicare

    • Mental Health

    • Public Health

    • Social Service

    • State Office of Rural Health (SORH)

    • VA

Tribal/IHS

• Other

• Legislator/Policy Maker /staffer(or office)

• Telehealth Resource Center

• Vendor

  • Clinical Service Provider ___

  • Technology

  • Telecommunications

  • Business solutions/consultants

  • Legal

  • Other

• Other (list other and provide total numbers)

2: TRC Technical Assistance Communication Method of Inquiry and Response

Method of Technical Assistance Inquiry

• Email

• 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 Inquiry

Category

• Financial (Reimbursement, Business Models, Grants)

• Policy/Legal

• Market Analysis

• About my TRC

• Broadband network infrastructure

• Readiness Assessment

• Distance Learning

  • Project ECHO

• Program Evaluation

• Strategic Planning

• Tools and Templates

• General Telehealth Information

• Clinical Service Program Development/Operations

  • Mental/Behavioral Health

• Equipment and Technology Assessment/Selection

• Other

4: Types of Services Provided by TRC

Training/Education and Outreach

• # of Conferences/Meetings ___

  • Total # of conferences/meetings hosted by TRC ____

  • Total # of participants ___

  • Total # of TRC presentations at conferences/meetings ____

• # of Trainings ___

  • Total # of trainings hosted by TRC ____

  • Total # of participants ___

• # of Webinars ___

  • Total # of webinars hosted by TRC ____

  • Total # of participants ___

  • Total # requested by HRSA

  • Total # requested by other Federal Agency ____

• # of Other ____

  • Describe other

Communications/Promotional Activities

• Exhibit booths at conferences

  • # of booths ___

  • # of contacts ___

  • # of hours managing exhibit ___

• General Media

  • # interviews ___ (decimal/fraction)

  • # articles ___ (decimal/fraction)

Tools/Materials/Resources

• Newsletter

  • # of newsletters ___

  • # of subscribers ___

• Website

  • # website visits ___

• Fact Sheets/One Pagers

  • # of fact sheets/one pagers ___

• Online Education

  • # Video Modules ___

    • # of views ____

  • # of Toolkits ____

    • # of views ____

  • # of Course Modules ____

    • # of people accessing ____

• Issue Briefs (# of issue briefs) ____ (decimal/fraction)

• Other (list type and #) ____