Form 1 AIM Biannual Report

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?

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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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