TCPi Care Coordination Across the Medical Neighborhood
Care Coordination Across the Medical Neighborhood
Welcome to the Care Coordination Across the Medical Neighborhood module, an ABFM-approved Performance Improvement (PI) activity eligible for PI credits toward Family Medicine Certification Requirements. This module will assist you in identifying and implementing key TCPi concepts related to coordinating patient care with other providers.
As you complete this module, you will receive hands-on practice in evaluating care measure outcomes; identifying measures for improvement; and devising a method, or intervention, to improve care through better coordination with your patients’ other healthcare providers. The “10 Building Blocks of High Performing Care” are described and integrated into the work required to complete this module.
As change and success are more readily accomplished as a team, you are encouraged to involve your staff in determining what kind of intervention would best benefit your patients and practice and in developing the plan for implementing the intervention.
PLEASE NOTE: If you wish to receive credit from ABFM, you will need to fill out a pre-intervention plan, implement your plan for 7 days, submit data at least 7 days later, and then complete a post-intervention plan. Unless you fulfill this obligation, you will only receive a certificate of completion at the end of this module.
This module complements our Knowledge Self-Assessment (KSA) Practice Transformation modules (formerly MOC Part II). Although not required, we recommend you complete the following modules prior to starting this module:
Upon completion of this module, the learner should be able to:
- Perform a pre-intervention and post-intervention audit of clinical data and recognize data as a tool for monitoring for successful change.
- Identify at least one evidence-based quality indicator related to care coordination across the medical neighborhood.
- Develop and implement a quality improvement initiative utilizing SMART (specific, measurable, attainable, realistic, timely) goals and a workflow map.
- Apply knowledge gained from a post-intervention data audit to improve the intervention via a second Plan, Do, Study, Act (PDSA) cycle.
Who should Complete this Module?
The information in this module is valuable for clinicians.