EQIPS Initiative Request Form

What is the quality or safety problem?: * What is the gap between current and ideal practice? What evidence currently exists? What framework or theory is available to guide your work?: * What is the objective? What are the specific aims?: * What is the proposed intervention? What are the needs (people, processes, policies, etc.) to complete this project? What are the important workplace contextual or cultural considerations? : * What are your measures of success? : * How will you analyze your data? How will you determine that change has happened and this was related to your intervention?: * What are the expected outcomes? What are the potential unintended consequences?: * What will be the impact of the practice change locally? How can this intervention/change potentially be scaled to improve practice nationally?: * What lessons were learned that helped with implantation? How can you sustain the change?: *

Please provide lead contact information:

Name and Institution: * Project Title: * Practice: * Email:

Please attach any supporting documents including tables, graphs, charts, images, or infographics.

File Upload: File Upload: File Upload:

EQIPS Initiative Request Form

American Urological Association

About AUA

Quick Links