AIM Biannual Reporting Survey –
[SEASON YEAR]
Start of Block: Demographics
T1 Thank
you for completing the [SEASON YEAR] AIM Biannual Reporting Survey!
The purpose of this survey is to collect data to evaluate the reach
of the AIM program, identify state and jurisdiction teams' technical
assistance needs, and determine needed improvements to the program.
Unless otherwise specified, please answer all
questions.
Q1 Which state or jurisdiction do you represent?
▼ Alaska ... Wyoming
Q2
What is your name?
________________________________________________________________
Q3
What
is your email address?
Please enter a valid email.
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End of Block: Demographics
Start of Block: Participating Facilities
T2 This section focuses on birthing facilities participating in AIM with your state or jurisdiction team.
Q4
As of
[END OF REPORTING PERIOD], what is the total number of
birthing facilities in your state or jurisdiction?
This
field only accepts numbers.
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Q4a How many of these facilities are hospitals? _________
Q4b How many of these facilities are freestanding birth centers (i.e. not a labor and delivery unit within a hospital)? _______
Q5
To the best of your knowledge, who else is participating in patient safety bundle implementation in your state or jurisdiction, beyond labor and delivery units in birthing hospitals?
Non-birthing hospitals (hospitals without a labor and delivery unit)
Operating rooms
Critical care or intensive care units
EMS/first responders
Urgent cares
Blood banks
EDs (within birthing facilities)
EDs (freestanding)
Outpatient clinics
Substance use disorder
Mental health
Other (comment)
Q6
How
does your state or jurisdiction team define birthing facility for
reporting to AIM?
Information provided gives
contextual information on how birthing facilities data are reported
to AIM.
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Q7
Of
your state or jurisdiction's [NUMBER OF BIRTHING FACILITIES FROM Q4]
birthing facilities, how many participate in AIM with your
state or jurisdiction team as of [END OF REPORTING PERIOD]?
For the purposes of reporting to AIM, please define a
facility as participating in AIM if it meets any of the following
criteria:
• Formally plans to begin
implementation of quality improvement (QI) projects based on AIM
patient safety bundles (PSBs) with your state or jurisdiction team
• Currently implements QI projects based on AIM PSBs
with your state or jurisdiction team, including pilot projects
• Is sustaining QI projects based on AIM PSBs with your
state or jurisdiction team
• Is otherwise engaged
in AIM QI activities with your state or jurisdiction team.
This field only accepts numbers.
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Q8
Of
your state or jurisdiction's [NUMBER OF FACILITIES POPULATED
FROM Q7] participating birthing facilities, how many began
participating in AIM with your state or jurisdiction team between
[DATE RANGE FOR DATA COLLECTION PERIOD]?
For the purposes of reporting to AIM, please define a facility as participating in AIM if it meets any of the following criteria:
Formally plans to begin implementation of quality improvement (QI) projects based on AIM patient safety bundles (PSBs) with your state or jurisdiction team
Currently implements QI projects based on AIM PSBs with your state or jurisdiction team, including pilot projects
Is sustaining QI projects based on AIM PSBs with your state or jurisdiction team
Is otherwise engaged in AIM QI activities with your state or jurisdiction team.
This field only accepts numbers.
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Q9
How
many birthing facilities stopped participating in AIM
with your state or jurisdiction team due to permanent hospital
or OB department/Labor & Delivery unit closures between [DATE
RANGE FOR DATA COLLECTION PERIOD]?
This field
only accepts numbers.
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Q10
How
many birthing facilities stopped participating in AIM with
your state or jurisdiction team due to temporary hospital
closures or suspensions of OB/Labor & Delivery services between
[DATE RANGE FOR DATA COLLECTION PERIOD]?
This
field only accepts numbers.
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Q11
How many
birthing facilities stopped participating in AIM with your
state or jurisdiction team due to reasons other than temporary
or permanent closures between [DATE RANGE FOR DATA COLLECTION
PERIOD]?
This field only accepts numbers.
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SKIP PATTERN - Display This Question:
If If How many birthing facilities stopped participating in AIM with your state or jurisdiction team due to reasons other than temporary or permanent closures between [DATE RANGE FOR DATA COLLECTION PERIOD]?... Text Response Is Greater Than 0
Q12
Please
share why facilities stopped participating in AIM with your
state-based team for reasons other than temporary or
permanent closures.
Please be as detailed and
specific as possible in your response.
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The
following questions ask you to reflect on your state or jurisdiction
team's goals and progress regarding birthing facility participation
in AIM. Please be as detailed as possible in your
responses.
Questions 13 and 14 will be asked when
states initially enroll in AIM and no more than every other year
after enrollment.
Q13
What are your
state or jurisdiction team's strategies for enrolling birthing
facilities in AIM? Do you intend to engage all birthing facilities in
AIM? If not all, which facilities do you focus engagement efforts on
and why?
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Q14
What is your
strategy for engaging with birthing facilities not currently
participating in AIM?
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End of Block: Participating Facilities
Start of Block: Patient Safety Bundles
T3 This section focuses on AIM patient safety bundle implementation in your state or jurisdiction.
Q15
As of [INSERT DATE], which AIM patient safety bundle(s) is your team currently implementing with participating facilities?
This may include active implementation or sustaining implementation with participating facilities. Select all that apply.
Obstetric Hemorrhage
Severe Hypertension in Pregnancy
Safe Reduction of Primary Cesarean Birth
Cardiac Conditions in Obstetric Care
Sepsis in Obstetric Care
Postpartum Discharge Transition
Perinatal Mental Health Conditions
Care for Pregnant and Postpartum People with Substance Use Disorder
⊗We are not currently implementing any AIM patient safety bundles
Q16
As of [INSERT DATE], how many facilities are participating in implementing each patient safety bundle?
This may include active implementation or sustaining implementation with participating facilities.
Possible validation – check that the number of facilities implementing a single bundle doesn’t exceed the total facilities participating in Q7. Allow respondents to go backwards in the survey to correct numbers if needed.
Obstetric Hemorrhage: ____ birthing facilities
Severe Hypertension in Pregnancy: ____ birthing facilities
Safe Reduction of Primary Cesarean Birth: ____ birthing facilities
Cardiac Conditions in Obstetric Care: ____ birthing facilities
Sepsis in Obstetric Care: ____ birthing facilities
Postpartum Discharge Transition: ____ birthing facilities
Perinatal Mental Health Conditions: ____ birthing facilities
Care for Pregnant and Postpartum People with Substance Use Disorder: ____ birthing facilities
Q17
Which AIM patient safety bundle(s) does your team plan to begin implementing in the next six months?
Select all that apply.
Obstetric Hemorrhage
Severe Hypertension in Pregnancy
Safe Reduction of Primary Cesarean Birth
Cardiac Conditions in Obstetric Care
Sepsis in Obstetric Care
Postpartum Discharge Transition
Perinatal Mental Health Conditions
Care for Pregnant and Postpartum People with Substance Use Disorder
⊗We do not currently plan to begin implementing any additional AIM patient safety bundles in the next six months.
Q18
How does your state or jurisdiction decide which patient safety bundles to implement (including, if applicable, the data sources you use to inform the decision)?
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End of Block: Patient Safety Bundles
Start of Block: Live Births
T4 This
section focuses on live births among facilities participating with
your state or jurisdiction team. [Section is asked annually in the
first survey of the year]
Q18
How
many live births occurred in the [NUMBER OF PARTICIPATING
BIRTHING FACILITIES] birthing facilities participating in AIM with
your state or jurisdiction team?
Reporting
criteria:
Report aggregate live birth data among all facilities participating in AIM with your state or jurisdiction team.
Use birth certificate data for reporting.
Use the most recent full calendar year of data when reporting.
Use occurrent births among participating facilities when reporting. Occurrent births refer to births that occurred in the state or jurisdiction your team represents, regardless of the person who gave birth’s status as a state or jurisdiction resident.
Finalized data are preferred, but provisional data are accepted.
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Display This Question:
If If How many live births occurred in the [NUMBER OF PARTICIPATING BIRTHING FACILITIES] birthing facilities participating in AIM with your state or jurisdiction team? Reporting criteria: Re... Text Response Is Greater Than 0
Q19
Which calendar year did you use to report live births among facilities participating in AIM with your state or jurisdiction team?
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Display This Question:
If If How many live births occurred in the [NUMBER OF PARTICIPATING BIRTHING FACILITIES] birthing facilities participating in AIM with your state or jurisdiction team? Reporting criteria: Re... Text Response Is Greater Than 0
Q20
Did you use finalized or preliminary birth certificate data to report live births among facilities participating in AIM with your state or jurisdiction team?
We used finalized birth certificate data
We used preliminary birth certificate data
We did not use birth certificate data to report live births (please explain) __________________________________________________
Display This Question:
If If How many live births occurred in the [NUMBER OF PARTICIPATING BIRTHING FACILITIES] birthing facilities participating in AIM with your state or jurisdiction team? Reporting criteria: Re... Text Response Is Greater Than 0
Q21
Did you use all births, regardless of residence, to report live births among facilities participating in AIM with your state or jurisdiction team?
All births, regardless of residence, refer to occurrent births, which are births that occurred in the state or jurisdiction your team represents, regardless of the person who gave birth’s status as a state or jurisdiction resident.
Resident births refer to births by people who are residents of the state or jurisdiction your team represents.
We used resident births only
We used all births, regardless of residence
Other __________________________________________________
Q22
Please
share any barriers you experience accessing vital records information
in your state.
Please be as detailed and
specific as possible in your response.
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End of Block: Live Births
Start of Block: Facility Engagement
T5 This
section focuses on learning and technical assistance opportunities
your state or jurisdiction team organized for its clinical/facility
teams participating in AIM.
Q23
Between
[DATE RANGE FOR SURVEY COLLECTION PERIOD], which of the following
types of educational activities did your state or jurisdiction team
offer to clinical/facility teams?
Select all that
apply.
1:1 or Small Group Technical Assistance
Conferences or Summits
Webinars
Peer Mentorship or Learning
Simulation and Drill Training
Other __________________________________________________
⊗We did not offer any educational activities to clinical/facility teams during this reporting period.
Q24
Between
[DATE RANGE FOR DATA COLLECTION PERIOD], has your state or
jurisdiction team encountered any barriers to offering educational
activities to clinical/facility teams?
Select all that
apply.
Lack of resources - State or jurisdiction team
Lack of resources - Clinical/facility teams
Lack of engagement, other reasons - Clinical/facility teams __________________________________________________
Difficulty planning and coordinating educational activities - State or jurisdiction team
Other __________________________________________________
⊗We have not encountered barriers offering educational activities to clinical/facility teams during this reporting period
End of Block: Facility Engagement
Start of Block: AIM Resource Utilization
T6 This
section focuses on your state or jurisdiction team's use of newly
developed resources and communications preferences.
Q25
Which
of the following AIM resources has your state or jurisdiction team
used to support your work? [The list of AIM resources in the
response options will be updated for each survey to include the
relevant AIM resources at the time the survey is released.]
Select all that you have used.
Patient Safety Bundle Change Packages
Patient Safety Bundle Resource Listings
Patient Safety Bundle Implementation Webinars
Patient Safety Bundle Introduction Videos
AIM for Patient Safety: Bundles at the Bedside Video
Technical Assistance Presentation Webinars
AIM Clinical Champions
Social Media Toolkit
Q26
Which
of the following AIM resources were you not aware of?
Response options will be the same as those included in Q 25
and will be updated each survey to include recent resources.
Q27 (Optional)
How could we improve our communication about new AIM resources?
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Q28
Please
rank how you prefer to receive communications from AIM.
Click and drag each category to rank by preference. 1 is
most preferred, 5 is least preferred.
______ Monthly Newsletter
______ Website Announcements
______ Social Media Posts
______ Standing Meetings and Check Ins
______ Direct Emails from Program Staff
Q29 (Optional)
Please share any other feedback on AIM resources and communications.
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End of Block: AIM Resource Utilization
Q30
What supports does your team need to adapt implementation of AIM patient safety bundle elements based on facility resources or level of care?
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Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | AIM Biannual Reporting Survey - Winter 2023 |
Author | Qualtrics |
File Modified | 0000-00-00 |
File Created | 2024-07-23 |