CMS-10771 IPRO Collaborator - Community of Care Coalitions Survey

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Your Opinion Matters

We would appreciate if you would take a few minutes to complete the following questionnaire
regarding your experience working with IPRO's Community of Care Coalitions Initiative Team which
includes:
Sara Butterfield (Ohio, New York and New Jersey),
Fred Ratto (New York and New Jersey),
Gail Gresko (Ohio),
Brenda Maynor (New York and New Jersey) and
Cindy Stark (New York and New Jersey).
Your responses will be kept private to the extent provided by law. Information provided by you is
voluntary and your decision whether or not to participate in this survey will not affect
Medicare/Medicaid reimbursements to your organization. Thank you for your feedback.
The IPRO Community of Care Coalitions Initiative, under contract from the Centers for Medicare & Medicaid Services (CMS), is focused
on improving care continuity for Medicare beneficiaries by promoting seamless transitions from the hospital to nursing home care, home
health care or back to the community.
Please click on the "Next" button below and after each question. Please click "Done" at the end of the survey to capture your responses.
PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this voluntary information collection is TBD.
The expiration date is TBD. The purpose of this voluntary information collection request is to collect feedback about the Care Transitions
Program. The end goal of this effort is to collect actionable data to help improve the overall customer experience. The time required to
complete this voluntary information collection is estimated to average 10 minutes per response, including the time to review instructions
and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C426-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or
any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not
pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be
reviewed, forwarded, or retained. If you have questions about the survey please contact [email protected].

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Information About You

1. Who contributed in responding to this survey? (Check each that applies.)
Administrator

Managed Care Organization Representative

Case Manager

Medical Assistant

Community Pharmacist

Medical Director

Community Service Organization

Medical Records Director

County Representative

NHQI Liaison

Data Contact/Encounter Data Liaison

Nurse Manager

Director of Nursing

Office for the Aging Representative

Director, Patient Services

Office Manager

Emergency Medical Technician

Pharmacist

Facility Administrator

Physician

Head Nurse

QA/QM/UR/CM Director

Infection Control Specialist

Social Worker

IPRO Liaison

Behavioral Health Representative

IPRO HCQIP Liaison
Other (please specify)

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* 2. Is your organization involved in one of IPRO's Care Transition Coalitions?
Yes
No
Not sure

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Information About You

3. How long have you, the respondent (not your organization), been working with IPRO's Community of Care
Coalitions Initiative Team? If multiple people are responding jointly to this questionnaire, the respondent with
the longest working history with IPRO should select the appropriate answer. (Check only one box).
Less than 12 months
Between 12-24 months
More than 24 months

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

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Please indicate the extent you agree or disagree with the following statements on a scale of 1 to 6 with
1 being "Strongly Disagree" and 6 being "Strongly Agree," by checking the appropriate box.
* 4. My overall impression of my organization's working relationship with IPRO's Community of Care Coalitions
Initiative Team is positive.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

* 5. You rated IPRO unfavorably for the question, "My overall impression of my organization's working
relationship with IPRO's Community of Care Coalitions Initiative Team is positive." Please explain how we can
improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)

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Overall Impression

* 6. When contacting IPRO, I can easily reach a member of the IPRO Community of Care Coalitions Initiative
Team.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

* 7. You rated IPRO unfavorably for the question, "When contacting IPRO, I can easily reach a member of the
IPRO Community of Care Coalitions Initiative Team." Please explain how we can improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)

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Overall Impression

* 8. The IPRO Community of Care Coalitions Initiative Team is responsive in following up with questions or
issues I have.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

* 9. You rated IPRO unfavorably for the question, "The IPRO Community of Care Coalitions Initiative Team is
responsive in following up with questions or issues I have." Please explain how we can improve in this area.

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

* 10. I am treated respectfully and with courtesy by IPRO Community of Care Coalitions Initiative Team staff.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Overall Impression

* 11. You rated IPRO unfavorably for the question, "I am treated respectfully and with courtesy by IPRO
Community of Care Coalitions Initiative Team staff." Please explain how we can improve in this area.

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

12. IPRO's Community of Care Coalitions Initiative educational sessions (conferences, webinars) and
technical assistance and quarterly Coalition Leadership meetings are valuable to our organization and
professional staff to support vaccine education and care transitions improvement efforts.
Strongly Disagree

Disagree

Slighty Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

* 13. You rated IPRO unfavorably for the question, "IPRO's Community of Care Coalitions Initiative
educational sessions (conferences, webinars) and technical assistance and quarterly Coalition Leadership
meetings are valuable to our organization and professional staff to support vaccine education and care
transitions improvement efforts." Please explain how we can improve in this area.

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

14. IPRO's technical assistance and guidance on readmissions and evidence based interventions have been
valuable to our organization and professional staff in targeting reduction of avoidable re-hospitalizations and in
improving communication and care coordination across healthcare settings.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

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* 15. You rated IPRO unfavorably for the question, "IPRO's technical assistance and guidance on
readmissions and evidence based interventions have been valuable to our organization and professional staff
in targeting reduction of avoidable re-hospitalizations and in improving communication and care coordination
across healthcare settings." Please explain how we can improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

16. The Community of Care Coalitions Initiative section and COVID Blog (https://qi.ipro.org/blog) of the IPRO
web site (https://qi.ipro.org/focus-areas/care transitions/) are useful resources for readmission and care
transitions improvement information.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)

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IPRO Community of Care Coalitions Initiative Activities

* 17. You rated IPRO unfavorably for the question, "The Community of Care Coalitions Initiative section of the
IPRO web site (https://qi/ipro.org/focus-areas/care transitions/) and COVID Blog (https://qi.ipro.org/blog/) are
useful resources for readmission and care transitions improvement information." Please explain how we can
improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

18. IPRO’s Community of Care Coalitions Initiative Team effectively communicates project information and
CMS project updates in a timely manner to my organization.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

* 19. You rated IPRO unfavorably for the question, "IPRO’s Community of Care Coalitions Initiative Team
effectively communicates project information and CMS project updates in a timely manner to my
organization." Please explain how we can improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

20. The quarterly data reports provided by IPRO detailing my organization's readmission rate patterns and
trends are useful for review of our organization's progress on care transitions improvement efforts.
Strongly Disagree

Disagree

Slightly Disagree

Slightly Agree

Agree

Strongly Agree

N/A

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
IPRO Community of Care Coalitions Initiative Activities

* 21. You rated IPRO unfavorably for the question, "The quarterly data reports provided by IPRO detailing my
organization's readmission rate patterns and trends are useful for review of our organization's progress on
care transitions improvement efforts." Please explain how we can improve in this area.

DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Comments

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22. Please use the following area to provide your feedback on recommendations on how IPRO could improve
customer service to your organization.

23. Please use the following area to provide your feedback on any examples of exceptional customer service
and support received from our IPRO staff.

24. Would you like to be contacted by a member of the IPRO staff regarding your answers to this survey?
No
Yes (provide contact information below)

25. Please enter your contact information below. (Please complete if you wish to be contacted.)
Name:
Company:
Address:
Address 2:
City/Town:
State:

-- select state --

ZIP:
Country:
Email Address:
Phone Number:

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DRAFT IPRO Community of Care Coalitions Collaborator Survey (2022)
Comments

Thank you for completing this survey.

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