If you are ready to submit you project for approval, please complete the form below (REDCAP). Formal QI training and/or early consultation with the QIIRC to determine appropriateness of the proposed project is strongly recommended! (Children's of Alabama QI coaches)
Once you submit your project, it will undergo preliminary review within 2 week. If the project meets minimum criteria, we will review it at our monthly meeting and give any feedback via email. If it needs help, the project leader will be invited to a coaching session with a member or members of the QIIRC, and asked to resubmit with adjustments as needed.
Beginning date of project (01/01/2011):
End date of project (01/01/2011):
Project leader first name:
Project leader last name:
Project leader email:
Project leader phone number (111-111-1111):
What are you trying to change?
What is your improvement goal?
What is the time frame for this to be accomplished?
Please describe your methods:
What metrics will be used?
How many months does the project expect a physician to be actively involved in order to receive MOC Part 4 credit? (minimum 6 months)
Please describe your results:
Additional Information (Please submit any additional tools used in this project, such as Process Maps, Root Cause Analysis, Pareto Charts, Key driver diagram, etc.)
Description of the activity in 300 words or less to be listed on ABP website.
Completion Criteria to be listed on the ABP website.
(e.g., Once you have met the activity completion criteria set by the sponsor organization, the sponsor organization notifies the American Board of Pediatrics of your completion).
Relevant Pediatric Subspecialties (list all that apply):
Primary contact first name:
Primary contact last name:
Primary contact email:
Primary contact phone number (111-111-1111):
Website URL (if applicable):
Other physicians on project: