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Unifying a Community Around Simplifying Care Processes

This Improvement Story originally appeared in IHI's 2006 Progress Report

 

Two powerful innovations are helping patients and providers work together effectively and efficiently in Whatcom County, Washington. A community-based participant in the Pursuing Perfection initiative, Whatcom County’s Community Health Improvement Consortium is focused on improving safety and efficiency, reducing costs, and eliminating barriers across the entire system of care.

 

First, patients are offered the option of creating and maintaining a Shared Care Plan (SCP), a user-friendly tool for storing and retrieving important health-related information such as the patient’s personal profile, names of health care team members, chronic and long-term diagnoses, self-management and lifestyle goals and action steps, treatment goals, names of medications, a list of allergies, and advance directives.

 

Patients with Internet access can store their SCP on a secure website and can give permission to others to view it as well. “Approximately 70 percent of the 750 patients with SCPs have used them when they’ve gone to the emergency room,” says Kelly Hawkins, the SCP web coordinator. “They are an efficient way of providing important information quickly.”

 

Second, patients with more complex needs are assigned a Clinical Care Specialist (CCS), a nurse or social worker who serves as the patient’s coach, advocate and guide. One patient says simply, “My CCS has helped me in too many ways to comment.”

 


More Information

Pursuing Perfection: The Synapse Between Silos: Patient-Centered Care in Whatcom County

 

Pursuing Perfection: Report from Whatcom County, Washington on Patient-Centered Care

 

Profiles in Improvement: Dr. Bertha Safford from Whatcom County

 

01/23/2006