Proactive outreach, screening efforts support patient well-being

Our Health Information Coordinators (HICs) and Patient Care Coordinators (PCCs) work together to conduct proactive screening and outreach initiatives as part of our Patient Screening and Chronic Disease Management Program.

This process has three steps:

1. First, the HIC will use EMR data and Alberta Screening and Prevention (ASaP) guidelines to identify patient groups that may benefit from a proactive screening project. Physician members with PMH teams can also select projects of interest to them.
2. Once a quality improvement project is identified and agreed upon, the PCC will coordinate with patients to assist with appointment scheduling, update charts, and gather transfer information where necessary.
3. PMH teams will use Monday.com to track the progress of these projects, while also updating members on project progress in PMH meetings.

These proactive screening projects, informed by demographic data, help keep patient populations healthy.

You can get more details about all our programs and services on cwcpcndocs.com.

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