Oncology Nursing Society Foundation and The Joint Commission

Development and Testing of Breast Cancer Survivorship (BCS)

Measures Pilot Project

BCS Pilot Test Site Commitment Form

Please verify the following information:

Contact person:Name:

Organization:

Title:

Address:

Phone:

Email:

This form is intended to review the major requirements for successful participation in the pilot testing of the Oncology Nursing Society Foundation’s (ONSF) Breast Cancer Survivorship quality measures. Part of the testing process involves identification of areas in the measure language that need further clarification and refinement – this project is a work in progress, and we consider each pilot site to be a valued partner. ONSF, with its contractor for this work, The Joint Commission, is committed to providing ongoing educational, clinical and technical support necessary to complete participation in this project. Please review the responsibilities of each party listed below:

Pilot sites are responsible to:

  • Sign and return the Business Associates Agreement by XXX.
  • Designate and maintain a specific contact person throughout the duration of the project.
  • Maintain internet access, minimal software requirements (best viewed on Internet Explorer version 8 or higher, any Firefox version or other browser) and email access throughout the duration of the project sufficient to utilize the web-based data collection portal and maintain timely communications.
  • Participate in an initial review of the specification manual and provide feedback on feasibility and clarity of language.
  • Participate fully in the web-based training activities prior to the start of the data collection period.
  • Promptly communicate any concerns or obstacles encountered to ONSF staff.
  • Participate in site visits by ONSF or Joint Commissionstaff, if your site is selected.
  • Submit data from the agreed upon number of cases by the close of the data collection period unless sampling alterations are approved in writing/email by ONSF.
  • Participate in end of project evaluation activities.

ONSF will:

  • Provide training, reference materials and ongoing clinical and technical support prior to and throughout the duration of the project.
  • Respond promptly to concerns or problems encountered by the pilot site.
  • Provide each site with a report including results related to site-specific measure attainment, as well as some comparative data to other de-identified pilot site participant results.

____YES, we will serve as a test site for the project:Development and Testing of BCS Measures.

____NO, we are unable to serve as a test site for the project.

Return to:XXX

No later thanXXX