Survey Tools

Hospital Summary Visit

Author: 
North Dakota Medicare Rural Hospital Flexibility Program and North Dakota CAH Quality Network

Provides a summary document for on-site visits to a critical access hospital. Includes information on the following: technical assistance received from the Medicare Rural Hospital Flexibility Program; quality initiatives; and, awards.

Programs: 

Midwest Retention Toolkit

Author: 
The National Rural Health Resource Center and the National Rural Recruitment and Retention Network

Similar to a provider’s medical bag, the Retention Toolkit has a variety of instruments or tools for use at each stage of a health care organization’s retention plan.

Utah Rural Hospital & Community Healthcare Needs Assessment Survey

Author: 
Utah Hospital Association

Provides a needs assessment for rural hospitals and community health care needs. Includes hospital organization structure; concerns and challenges; community relationships; community health care improvement; and, community health concerns.

Programs: 

Critical Access Hospital Site Visit Prep Form

Author: 
Idaho State Office of Rural Health and Primary Care

Provides information on how to prepare for a critical access hospital (CAH) site visit in order to identify all services and activities the CAH is accessing. This document is used as a basis for discussion time with the CAH team during the site visit.

Programs: 

Flex Program Conducts a Critical Access Hospital Medicare Mock Survey

Author: 
Minnesota Department of Health/Minnesota State Office of Rural Health and Primary Care

Provides information on how the Minnesota Flex Program conducts mock surveys to help critical access hospitals (CAHs) prepare for their Medicare Survey, and more importantly, help CAHs ensure the highest quality of care at their facilities. By conducting mock surveys, CAHs receive survey preparation recommendations, conditions of participation guidance, and additional resources.

For more information contact Judy Bergh.

 

Programs: 

North Dakota Critical Access Hospital and Flex Program Survey - 2011

Author: 
Center for Rural Health, University of North Dakota School of Medicine and Health Sciences

This tool was developed to survey information about a critical access hospital (CAH) including: hospital characteristics, hospital issues, Flex program impact on the CAH, and networks.

Programs: 

Critical Access Hospital (CAH) On-Site Survey Form

Author: 
Alabama Office of Primary Care and Rural Health

These tools can be used during site visits to critical access hospitals (CAHs) to identify and prioritize rural hospital needs. Information collected on the form includes technical assistance needs and status of projects and a tracking spreadsheet.

Programs: 

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