Table 1.

ACIG Scoring Template.

Applicants score each item (except 0) from 1-5 (where 5 is the highest).
0. Should this application be considered for an award? Yes/No
If this answer is no, you are not required to provide scores for any of the following questions, but please indicate why in the “Notes” section
1. Alignment with Triple Aim
Project is aligned with one or more of the following:
1. Improve the health of the population
2. Enhance the patient experience and quality of care
3. Optimize the value of care
2. Problem Definition
Application includes a clear statement of the problem
Potential causes of the problem or improvement opportunity have been identified
Magnitude/significance of the project is established
3. Project Benchmarking and Comparison Research
Research conducted on existence and/or effectiveness of intervention in other systems
Bibliography of literature reviewed is provided
4. Project Goals
Goal of the project is clearly defined, reasonable, and feasible in the 12 month timeline
5. Project Intervention(s)
Application includes a clear definition of the intervention(s)
Intervention appears appropriately designed to achieve goal
Intervention addresses identified root causes (if applicable)
6. Data Collection and Analysis
High level data collection plan detailing what measures will be collected and used
Measures are appropriate, objective, and obtainable
Team plans to collect baseline and post intervention data to measure its impact
7. Team Formation and Functioning
Proper team is assembled to complete and meet project objectives
Team has multidisciplinary representation from project stakeholders
Roles for the team members are clearly defined
Basic communication plan has been developed
8. Identification and Communication Plan for Stakeholders
Project stakeholders have been identified
Describes the impact of the intervention on the stakeholders and/or customers
Communication plan is identified to ensure stakeholders are informed
9. Project Timeline
Application includes a timeline with major milestones and tasks
Project timeline is realistic, feasible, and allows timely completion of the project
10. Project Sustainability, Generalizability, and Potential for Dissemination
Project team has plan to maintain changes after ACIG period
Project outcome is generalizable to other locations
Intervention has potential to produce desirable outcomes at the pilot site or beyond
11. Resources and Funding
Requested budget is appropriate for proposed intervention and implementation
12. Grant Total Score
13. Additional Notes/Missing Items