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Citizen’s Health Initiative Presentation March 24, 2010

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Presentation on theme: "Citizen’s Health Initiative Presentation March 24, 2010"— Presentation transcript:

1 Elliot Family Medicine at Bedford Commons Patient Centered Medical Home
Citizen’s Health Initiative Presentation March 24, 2010 Amy Dobson Director, EPN

2 Presentation Overview
Care Team Development Addition of services within the Medical Home Patient Engagement

3 Care Team Development Morning Huddle
Changing staff roles required redesign of clinical staff roles Perception of inability to take on expanded role with constant busy practice

4 Clinical Staff Needs Move from task oriented practice to patient oriented practice Staff Engagement Job ownership Professionalism Regular weekly meetings

5 Nurse Role Development
Phone Triage Nurse Visits Patient Centered Nurse team member Assessment of complex patients After visit education

6 Nurse Health Coach Role
Chronic condition support Follow up with hospitalized patients and patients discharged from the ED/UCC Support to our high needs patients

7 Behavioral Health on-site 08/09
Current Data: Rapid referral process Shorter intervention time Improved outcomes

8 Pharmacy on-site 08/09 Current Data: 30+ Coumadin Patients
9 Patients for medication management or Bp management

9 Patient Engagement Targeted Patient Survey Initiated February 2010
Patient Advisory Board Initiated March 24, 2010

10 Questions


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