Skip to main content
Off canvas
Page 1 of 3

2017 HealthInsight Nursing Home Quality Award

View the detailed criteria and instructions
(will launch in a new window/tab)

Please complete all four pages of this application to be considered for the 2017 HealthInsight Nursing Home Quality Award. If completing online, the tab key may be used to navigate to the next field. You must complete the entire form at one time, as your application cannot be saved until completed. Please write the agency's name as the agency would like it to appear on the award in the event that the agency is a recipient.

Note: Please do not send protected health information (PHI) with your report. Please de-identify your reports of any patient identifiers.

HealthInsight 2017 Nursing Home Quality Award Application Deadlines:

New Mexico: Friday, July 21, 2017

Nevada: Monday, August 14, 2017

Utah: Monday, August 14, 2017

Facility Information

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Last Name, First Name

Invalid Input

Invalid Input

 

Please select and measure below:

*
Invalid Input

Please provide a description of improvement efforts related to how your facility organized around this measure/initiative and what your results were. Positive trending is required to meet this portion of the award criteria, but all positive trends are welcome (no minimum improvement is required). Data shared must represent a minimum of two full quarters and must occur within the previous twelve months.
Invalid Input

How was the need for improvement identified?

Invalid Input

How has your facility organized itself around the effort? Was a team formed? Who were the members? What role did leadership play in the project?

Invalid Input

What were the interventions? What did you do and how did you do it? What is different today as a result of this project that was not occurring before it began?

Invalid Input

How was performance measured? How did your facility know that the interventions were appropriate? How did your facility know if the interventions were working or not working?

Invalid Input

What were the results? What percentage of improvement did your facility experience? What was your rate before the initiative (baseline) and what were your results after the initiative (remeasurement)?

Invalid Input

Did you partner with any local hospitals or other community health care providers? If so, please share your experience.

Invalid Input

 

Feedback

Feedback is welcome on the application process or suggestions for measures or technologies to incorporate in the future. Please provide your feedback here:

Invalid Input

New Mexico: Please complete this application by 5:00 p.m. (PT) Friday, July 21, 2017. If you have any questions, please contact Anne Timmins at atimmins@healthinsight.org. We will publish names of award recipients on our website and disseminate press releases for their use to promote the award.

Nevada: Please complete this application by 5:00 p.m. (PT) Monday, August 14, 2017. If you have any questions, please contact Donna Thorson at dthorson@healthinsight.org. We will publish names of award recipients on our website and disseminate press releases for their use to promote the award.

Utah: Please complete this application by 5:00 p.m. (MT) Monday, August 14, 2017. If you have any questions, please contact Michelle Carlson at mcarlson@healthinsight.org. We will publish names of award recipients on our website and disseminate press releases for their use to promote the award.

HealthInsight will cover the cost of the plaque for the recipient buildings. If additional plaques are requested, the requestor must incur those costs.

If my practice is selected as a recipient of the HealthInsight Quality Award:

Invalid Input

I authorize HealthInsight to release my organization’s name for publication via press releases, articles, and website announcements.

Invalid Input

I authorize HealthInsight to photograph our staff representatives with the award and display the photograph(s) in newsletters and on healthinsight.org.

Please complete:*
Invalid Input

After you click "Submit Form," your form will be checked for errors and you will be returned to the pages that have information that needs to be fixed. After you fix these errors, please continue through to the end of the form to resubmit.