Evaluation Measure for this Project/Goal (use standardized data, easily obtainable if possible examples: PQRS, NQF, CMS, IQR and or – UDS measures): Measure Description Data Source Target Current Current Performance Date Performance Performance Person(s) When to be Where to be Plan Describe the solution you plan to test: Responsible done? done? Person(s) When to be Where to be List of the tasks needed to set up the test of change: Responsible done? done? How will you measure your test? What data do you need before and after the test? Implement your test. What did you do? Whom did you engage? Do What did you learn? Was it what you expected? Show your outcome data. Describe your successes and barriers. Study
Evaluation Measure for this Project/Goal (use standardized data, easily obtainable if possible – examples: PQRS, NQF, CMS, IQR and or UDS measures): Measure Description Data Source Target Performance Current Performance Current Performance Date Plan Describe the solution you plan to test: Person(s) Responsible When to be done? Where to be done? List of the tasks needed to set up the test of change: Person(s) Responsible When to be done? Where to be done? How will you measure your test? What data do you need before and after the test? Do Implement your test. What did you do? Whom did you engage? Study What did you learn? Was it what you expected? Show your outcome data. Describe your successes and barriers.
PDSA-Worksheet-Template-Version-2.docx