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Profession

What activities did you attend at the event?

KEYNOTE ADDRESS: Tuesday September 1, 2009 9:00 - 10:15 a.m

BREAKOUT SESSIONS: Tuesday September 1, 2009 10:30 - 11:45 a.m

BEST PRACTICES: Tuesday September 1, 2009 1:30 - 2:30 pm

*NO CREDIT* OPEN SPACE SESSION: Tuesday September 1, 2009 2:45 - 3:45 p.m

*NO CREDIT* STORYBOARD SESSION: Tuesday September 1, 2009 3:45 - 5:00 p.m

BREAKOUT SESSION: Wednesday September 2, 2009 8:15 - 9:45 a.m.

GENERAL SESSION: Wednesday September 2, 2009 10:00 - 11:00 a.m

ROUNDTABLE SESSIONS: Wednesday September 2, 2009 11:00 - 12:00 p.m

Agreement

By completing this form, you attest that you have participated in all selected activities in thier entirety.

I agree

Please rate the following:

The program was relevant to my work.

Content matched stated objectives.

Usefulness of handouts/AV.

Quality of facilities.

How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?

If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain:

Please rate the speaker(s) as a group. You will have the opportunity to elaborate on an individual speaker in the following question.

This session was beneficial to you and your practice.

Objective 1: Discuss the evidence and practice to support strategies for improving patient outcomes for patients with CVD ( and patients with a co-morbidity of Diabetes)

The above objective will increase my professional competence.

The above objective will result in changes to performance in my professional practice.

The above objective will result in improved patient outcomes.

If you have additional comments regarding the session or individual speaker(s) - e.g. teaching ability, expertise, organization of materials, etc. - please use the space below:

Objective 2: Evaluate prototypes that have been tested and found to be effective among rural clinics.

The above objective will increase my professional competence.

The above objective will result in changes to performance in my professional practice.

The above objective will result in improved patient outcomes.

Objective 3: Discuss the "nuts and bolts" information and models that are replicable to assist with bridging the disparities between quality and cost that exists as a barrier to patient care.

The above objective will increase my professional competence.

The above objective will result in changes to performance in my professional practice.

The above objective will result in improved patient outcomes.

Apply these techiques and other materials/resources during work with patients.

Utilize UB-PAP, 5 'As' of Self Management Support and Core Interventions for Motivational Interviewing.

Discuss how to Initiate dialogue with patients about maladaptive behavior by relying on core questions of UB-PAP.

Discuss the multiple definitions and uses of Electronic Health Record to gauge your organization's curren understanding of the topic.

Discuss the Electronic Health Record coninuum and strategies with your organiation toward developing a plan.

Design and Develop a plan toward Electronic Health Rccord.

Discuss a plan for spread with your team.

Review the required CVD measures as well as the overview of evidence.

Integrate co-morbidity of depression into care for plan for patients with chronic illness.

Organize your team member responsible for CVD readiness for reporting to begin your CVD reporting process once back at your clinic.

Explore the use of technology avalable to them, including a review of the Help Desk and Virtual Office.

Identify valuable information form peers in terms of best practices to replicate and take back to your clinic.

Evaluate usefulness of a particular model to your environment based on peer information.

Integrate a strategy for replication.

Re-organize your clinical practice toward improvement in trends for clinical outcome measures for patients with Diabetes and CVD.

Utilize and replicate examples of tips and toolsets focused on clinical change tested and improvement of care for Diabetes and CVD patients.

Itergrate Process Re-design at their clinics.

Replicate hands-on instruction learned back at their practice site.

Re-organize workflow for improved patient care in terms of being more effective and efficient and also in the use of optilmizing the IT system.

Utilize examples of tips and toolsets focused on clinical change tested and improvement of care for Diabetes and CVD patients.

Re-organize their clinical practice toward improvement in trends for clinical outcome measures for patients with Diabetes and CVD.

Discuss the Patient Centered Medical Home Model (PCMH), including joint principles (How they evolved and what role is being played in the testing of the model currently)

Identify key features of a PCMH practice and approach.

Discuss implementation of PCMH in rural practices and other efforts.

Identify unanswered questions on Medical Home model.

Construct a model tailored to their own organization using "nuts and bolts" information gained from this session.

Identify unanswered questions on General Topics not covered up to this point at the conference or topics that need more informaiton through peer sharing (such potential topics include clinical, information systems and registries, etc).

Discuss "nuts and bolts" information for use at your clinic sites.

Create a list of tools and activities currently underway to assist the journey.

Explain how to test adaptive behavior change among patients.

Discuss the use of the national goals to create a series of timelines.

Objective 4: Explain the techniques that would result in improvement of patient outcomes and support modification of patient behaviors to positively affect their own health

The above objective will increase my professional competence.

The above objective will result in changes to performance in my professional practice.

The above objective will result in improved patient outcomes.

The above objective will increase my professional competence.

The above objective will result in changes to performance in my professional practice.

The above objective will result in improved patient outcomes.

Please answer the following:

Do you believe this activity was appropriate for the scope of your professional activities?

Was the educational content scientifically sound?

Was the educational content free of commercial bias?

Was the mode of education effective to learning?

If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?

If you answered "No" to any of the above questions, please explain.

Were you solicited by sales personnel in an educational room while you attended this educational activity?

If you answered "Yes" to the above question, please explain.

How much did you learn as a result of this educational program?

What did you learn during this activity that you intend to integrate into your practice?

My professional competence would be improved if I had training on:

My professional performance would be improved if I had training on:

My patient outcomes would be improved if I had training on:

Are you interested in basic, intermediate or advanced level trainings?

What barriers might you have that would interfere with implementation of new information learned from this training?

How can this training be improved to better impact competence, performance and/or patient outcomes?

Additional comments: