Hospital or Health System Name * Check if applying as a system Yes No Hospital CCN (if system, include any CCN in system) * Has your hospital leadership committed to support this initiative? * Yes Has your hospital submitted the 2025 Hospital Survey, and are you committed to submitting the 2026 Hospital Survey? * Yes Please upload the signed template letter. * Upload Follow this link to download the template letter of support to attach to your application: https://www.leapfroggroup.org/sites/default/files/Files/Template%20-%20LC_0.docx More informationFiles must be less than 2 MB. Allowed file types: pdf doc docx. Has your hospital convened a team including, at a minimum 3-5 clinicians including surgery, anesthesia, nursing, pharmacy, QI, and data staff who will regularly participate in the collaborative and have the standing to implement or recommend changes based on findings/learnings? * Yes List at least four team members who have committed to supporting the initiative: * Does your team commit to immediately begin developing a team charter, based on templates Leapfrog will send you, once we have communicated your acceptance into the Learning Collaborative? * Yes Are you confident your hospital has adequate technical infrastructure to support implementation of quality improvement projects, including the ability to stratify quality measures by patient self-identified demographic characteristics? * Yes Briefly (no more than 300 words) describe your data collection and stratification approach, and how you would prepare to report on your hospital's progress in reducing the rates of PE/DVT. Include any disparities identified in similar quality measurement/quality improvement projects or initiatives in the past five years. * Hospital or Health System Contact Name (First and Last) * Contact Email * Submit
