Commitment Form
Stakeholder's Convening Follow-Up Survey
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1.
Name
(Required.)
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2.
Email
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3.
Organization/Company Affiliated With
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4.
Title/Role
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5.
Acknowledgement and Organization Plans
*By filling out this document, you acknowledge you are authorized to make commitments on behalf of your organization.
(Required.)
Yes
No
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6.
Please choose the answer that best represents your organization's participation in the recommendations discussed at the July 24th Stakeholder's Convening
(Required.)
My organization will participate in the recommendations discussed at the July 24th Stakeholder’s Convening
My organization is interested in participating in the recommendations discussed at the convening and want to identify ways we can be most impactful.
My organization cannot participate in there commendations discussed at the July 24th Convening at this time, please reach out to me at a later date to discuss opportunities in the future.
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7.
What recommendations can your organization participate in? Select all that apply.
(Required.)
Expand education on the connection between CKD and other chronic diseases.
Develop and integrate CKD awareness messaging across public health campaigns.
Integrate CKD prevention within risk factor focused initiatives, aligning with HP 2030 objectives, MDH 2035 plan, and health organizations' goals.
Partner with community organizations and culturally tailored programs that conduct social determinant of health screenings to support individuals at risk for or living with CKD.
Build a compendium of organizations working across Black, Indigenous, and People of Color (BIPOC) communities in Minnesota to improve early identification of CKD and access to patient-centered care.
Engage clinicians and healthcare organizations in improving screening and diagnosis of CKD, emphasizing systems change approaches.
Leverage the Project ECHO model, or other novel approaches, to educate and equip clinicians for CKD prevention and management.
Expand utilization of team-based approaches, including connection to community-based resources, to systematically improve CKD care.
Deploy Community Health Workers, pharmacists, and other community champions in the dissemination of culturally tailored CKD awareness materials and connection to community-based resources.
Expand access to CKD testing and education through reimbursement for non-physician care team members.
Disseminate clinical evidence and build the financial justification to support best practices for guideline concordant CKD screening.
Explore inclusion of the Kidney Health Evaluation Measure in the Minnesota Community Measures D5, or other focused measure sets to build the case for ongoing quality measurement.
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8.
I am prepared to help with the above projects as a…
(Required.)
Leader on a project
Work within a designated task force
Committed team member
Connector or convener (set up meetings with partners)
Funder or financial supporter
Able to help minimally, but enthusiastically
9.
Any questions or feedback for the National Kidney Foundation?