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Project Evaluation Form
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Project Evaluation Form
Url
Project Name
*
Project Lead
*
Project Description (150 character minimum)
*
Area of Impact (Check off the best fit from the list below. Multiple selections maybe made)
*
ALL
Acceptability (e.g., decision-making, interpersonal communication)
Access (e.g., timely access, equitable access, accommodation/barriers)
Integration (e.g., care coordination, information sharing, team functioning)
Appropriate/Effectiveness (e.g., best practices, scope of practice, unnecessary care)
Efficiency (e.g., cost avoidance, practice/procedural efficiency)
Safety (e.g., adverse events, infection prevention/control)
Engagement and Collaboration (e.g., physician engagement and leadership, health system collaboration, alignment)
Innovation and Quality Improvement (e.g., learning and Quality Improvement culture, innovation and knowledge generation)
Spread and Sustainability
Not Applicable
Medical Practice Type
*
ALL
Allergy and Immunology
Anesthesiology
Cardiac Surgery
Cardiology
Community and Rural
Critical Care Medicine
Dermatology
Emergency Medicine
Endocrinology and Metabolism
Gastroenterology
General Practice
General Surgery
Geriatric Medicine
Gynecologic Oncology
Hematology and Oncology
Hospital Medicine
Infectious Diseases
Internal Medicine
Laboratory Medicine
Nephrology
Neurology
Neurosurgery
Nuclear Medicine
Obstetrics and Gynecology
Occupational Medicine
Ophthalmology
Oral and Maxillofacial Surgery
Orthopedics
Otolaryngology
Pain Medicine
Palliative Medicine
Pathology
Pediatric Cardiology
Pediatric Cardiothoracic Surgery
Pediatric Gastroenterology
Pediatric Hematology Oncology HSCT
Pediatric Nephrology
Pediatric Respirology
Pediatric Surgery
Pediatrics
Physical Medicine and Rehabilitation
Plastic Surgery
Psychiatry
Public Health and Preventative Medicine
Radiation Oncology
Radiology
Respiratory Medicine
Rheumatology
Sport and Exercise Medicine
Thoracic Surgery
Urology
Vascular Surgery
N/A
Progress to Date
*
Planned Milestones
*
Risk/Challenges
*
Next Steps
*
Health Authority Input
*
Yes, input received
Yes, collaborative activity with the health authority
In Progress, working on receiving input
No, input not received
N/A
Approach/Methodology (List 3-4 bullet points describing implementation of your project)
*
Mitigation Strategies/Lessons Learned
*
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info@msalmh.ca
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