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Boundary Proof of Concept Patient Medical Home/Primary Care Networks - Case Study

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1395
Health Authority
Interior
Division
Kootenay Boundary Division of Family Practice
Published Date
2019/02
Link to File
/media/divresources/BoundaryPoCCaseStudy.pdf
Description
"This case study is broken into the following main sections: 1) overview of case study approach, 2) Overview of Boundary PoC design and implementation, 3) Key outcomes achieved to date, 4) Key Boundary PoC successes, 5) Key enablers of success in the Boundary PoC process, 6) Key Boundary PoC challenges; and 7) Conclusions and recommendations."
Health Authority
Interior
Division
Kootenay Boundary Division of Family Practice
Corporate Author
General Practice Services Committee
Kootenay Boundary Division of Family Practice
Interior Health Authority
Published Date
2019/02
Topics
Evaluation
Patient Medical Home
Primary Care Network
Team-Based Care
Quality Improvement
Resource Type
Case Study
File Type
Pdf
Link to File
/media/divresources/BoundaryPoCCaseStudy.pdf
Description
This case study is broken into the following main sections: 1) overview of case study approach, 2) Overview of Boundary PoC design and implementation, 3) Key outcomes achieved to date, 4) Key Boundary PoC successes, 5) Key enablers of success in the Boundary PoC process, 6) Key Boundary PoC challenges; and 7) Conclusions and recommendations.
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Patient Service Program Coordinator - Job Description

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1475
Health Authority
Fraser
Division
Ridge Meadows Division of Family Practice
Published Date
2019
Link to File
/media/divresources/Patient_Service_Program_Coordinator_Ad_Draft.pdf
Description
"Sample job description from Ridge Meadows Division of Family Practice detailing the responsibilities, required skills, brief details of the Patient Service Program Coordinator."
Health Authority
Fraser
Division
Ridge Meadows Division of Family Practice
Corporate Author
Ridge Meadows Division of Family Practice
Published Date
2019
Topics
Human Resources
Primary Care
Patient Medical Home
Primary Care Network
Team-Based Care
Resource Type
Job Description
File Type
Pdf
Link to File
/media/divresources/Patient_Service_Program_Coordinator_Ad_Draft.pdf
Description
Sample job description from Ridge Meadows Division of Family Practice detailing the responsibilities, required skills, brief details of the Patient Service Program Coordinator.
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Fraser Northwest Division of Family Practice - Primary Care Network (PCN) - Registered Nurse in Practice Expression of Interest (EOI) Form

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1487
Health Authority
Fraser
Division
Fraser Northwest Division of Family Practice
Published Date
2019
Link to File
/media/divresources/RegisteredNurseinPractice_ExpressionofInterestForm.pdf
Description
"An example of a PCN EOI form from FNW DoFP for the role of RN."
Health Authority
Fraser
Division
Fraser Northwest Division of Family Practice
Corporate Author
Fraser Health Authority
Fraser Northwest Division of Family Practice
Published Date
2019
Topics
Primary Care
Primary Care Network
Nurse
Team-Based Care
Resource Type
Job Description
File Type
Pdf
Link to File
/media/divresources/RegisteredNurseinPractice_ExpressionofInterestForm.pdf
Description
An example of a PCN EOI form from FNW DoFP for the role of RN.
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MSC Story - Accessible Upstream Care Supporting Patient Health

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1509
Published Date
2019
Link to File
/media/divresources/MSCStory_AccessibleUpstreamCareSupportingPatientHealth.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how team-based care improved access for patients"
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Evaluation
Team-Based Care
Most Significant Change
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_AccessibleUpstreamCareSupportingPatientHealth.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how team-based care improved access for patients
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MSC Story - Engaging Polypharmacy Patients through Team-Based Care

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1515
Published Date
2019
Link to File
/media/divresources/MSCStory_EngagingPolypharmacyPatientsthroughTeamBasedCare.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how collaborating with a pharmacist in practice led to greater patient engagement in their care."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Evaluation
Most Significant Change
Team-Based Care
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_EngagingPolypharmacyPatientsthroughTeamBasedCare.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how collaborating with a pharmacist in practice led to greater patient engagement in their care.
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MSC Story - Good Care Gives Hope for Chronic Conditions

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1517
Published Date
2019
Link to File
/media/divresources/MSCStory_GoodCareGivesHopeforChronicConditions.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how team-based care helps improve patient mental health."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Evaluation
Most Significant Change
Team-Based Care
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_GoodCareGivesHopeforChronicConditions.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story looks at how team-based care helps improve patient mental health.
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MSC Story - Improving Patient Care with a Coordinated Team Approach

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1520
Published Date
2019
Link to File
/media/divresources/MSCStory_ImprovingPatientCarewithaCoordinatedTeamApproach.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story tells the reader about how the PMH led to faster, more responsive patient care."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Team-Based Care
Patient-Centred Care
Evaluation
Most Significant Change
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_ImprovingPatientCarewithaCoordinatedTeamApproach.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story tells the reader about how the PMH led to faster, more responsive patient care.
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MSC Story - Marching to a New Drummer - Funding Better Patient Care

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1521
Published Date
2019
Link to File
/media/divresources/MSCStory_MarchingtoaNewDrummerFundingBetterPatientCare.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story is about how a blended compensation model supports full-service family practice and team-based care."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Evaluation
Most Significant Change
Team-Based Care
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_MarchingtoaNewDrummerFundingBetterPatientCare.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story is about how a blended compensation model supports full-service family practice and team-based care.
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Published Date
2019
Link to File
/media/divresources/MSCStory_TimeandaTeamApproach.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This particular story is about how the PMH innovation allows nurses spend extra time with patients to help support the GP."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Team-Based Care
Evaluation
Most Significant Change
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_TimeandaTeamApproach.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This particular story is about how the PMH innovation allows nurses spend extra time with patients to help support the GP.
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Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 - Recording

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1537
Published Date
2020-01-22
Link to File
/media/divresources/PrinciplesApproachestoBestPracticeTBC_ReflectionsfromtheNukaSymposium_recording.mp4
Description
"This is the recording of the Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 webinar held January 22, 2020."
Corporate Author
General Practice Services Committee
Personal Author
Dr Bonnie Bagdan Dr Dan Horvat Dr Alan Ruddiman Dr Tim Troughton
Published Date
2020-01-22
Topics
Team-Based Care
Primary Care
Patient Medical Home
Primary Care Network
First Nations
Engagement
Governance
Event
Divisions Webinar Learning Series
Resource Type
Audio Recording
Video Recording
File Type
MP4
Link to File
/media/divresources/PrinciplesApproachestoBestPracticeTBC_ReflectionsfromtheNukaSymposium_recording.mp4
Recording Length
59mins 13secs
Description
This is the recording of the Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 webinar held January 22, 2020.
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Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 - Presentation

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1538
Published Date
2020-01-22
Link to File
/media/divresources/PresentationReflectionsfromtheNukaSymposiumWebinar.pdf
Description
" Southcentral Foundation has had tremendous success in improving primary care from a quadruple aim perspective. In August 2019 a cohort of 19 attended a symposium created for BC participants to learn about their Nuka Model of Care.The webinar, hosted by Dr Dan Horvat along with a panel of Physicians who also attended, presented on the key learnings and how they can be applied in BC. This is the slide deck used during the Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 webinar held on January 22, 2020."
Corporate Author
General Practice Services Committee
Personal Author
Dr Bonnie Bagdan Dr Dan Horvat Dr Alan Ruddiman Dr Tim Troughton
Published Date
2020-01-22
Topics
Primary Care
Patient Medical Home
Primary Care Network
Engagement
First Nations
Governance
Team-Based Care
Event
Divisions Webinar Learning Series
Resource Type
Presentation
File Type
Pdf
Link to File
/media/divresources/PresentationReflectionsfromtheNukaSymposiumWebinar.pdf
Description
Southcentral Foundation has had tremendous success in improving primary care from a quadruple aim perspective. In August 2019 a cohort of 19 attended a symposium created for BC participants to learn about their Nuka Model of Care.The webinar, hosted by Dr Dan Horvat along with a panel of Physicians who also attended, presented on the key learnings and how they can be applied in BC. This is the slide deck used during the Principles and Approaches to Best Practice Team Based Care and Organizational Excellence – Reflections from the Nuka Symposium, August 2019 webinar held on January 22, 2020.
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MSC Story - A Team Approach Restored My Enjoyment of Family Practice

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1539
Published Date
2019
Link to File
/media/divresources/MSCStory_ATeamApproachRestoredMyEnjoymentofFamilyPractice.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story highlights a physician's transition from solo to group practice, which in turn restored their enjoyment of family practice."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Patient Medical Home
Team-Based Care
Evaluation
Most Significant Change
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_ATeamApproachRestoredMyEnjoymentofFamilyPractice.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story highlights a physician's transition from solo to group practice, which in turn restored their enjoyment of family practice.
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MSC Story - Team Support for GP Helping Young People Access the Care They Need

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1540
Published Date
2019
Link to File
/media/divresources/MSCStory_TeamSupportforGPHelpingYoungPeopleAccesstheCareTheyNeed.pdf
Description
"These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story tells the reader about how working onsite with a team helped a GP feel more supported to provide care for youth."
Corporate Author
General Practice Services Committee
Published Date
2019
Topics
Team-Based Care
Patient Medical Home
Evaluation
Most Significant Change
Resource Type
Story
File Type
Pdf
Link to File
/media/divresources/MSCStory_TeamSupportforGPHelpingYoungPeopleAccesstheCareTheyNeed.pdf
Description
These most significant change (MSC) stories take readers on a journey toward understanding how patient medical homes are removing barriers to care around the province. This story tells the reader about how working onsite with a team helped a GP feel more supported to provide care for youth.
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Integrating Nurses into Practice: Transition Stage (Executive Summary)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1559
Division
Central Okanagan Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/CODFP_NiPCP_ExecutiveSummary.pdf
Description
"Processes and initial outcomes from onboarding and integrating nurses into family practices."
Division
Central Okanagan Division of Family Practice
Corporate Author
General Practice Services Committee
Central Okanagan Division of Family Practice
Published Date
2020-11
Topics
Patient Medical Home
Nurse
Team-Based Care
Resource Type
Summary
File Type
Pdf
Link to File
/media/divresources/CODFP_NiPCP_ExecutiveSummary.pdf
Description
Processes and initial outcomes from onboarding and integrating nurses into family practices.
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Integrating Nurses into Practice: Transition Stage (Case Study)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1560
Division
Central Okanagan Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/CODFP_NiPCP_Case_Study_FinalReport.pdf
Description
"The report provides valuable lessons about the process of onboarding and integrating nurses into family practices (e.g. preparation prior to onboarding, building trust with team members). Initial outcomes related to attachment, access, and patient and provider experience are explored. While the findings in the report are primarily focused on the Nurse in Primary Care Practice program in Central Okanagan, the findings can be applied to any team-based care environment, regardless of funding model."
Division
Central Okanagan Division of Family Practice
Corporate Author
General Practice Services Committee
Central Okanagan Division of Family Practice
Published Date
2020-11
Topics
Patient Medical Home
Team-Based Care
Nurse
Resource Type
Case Study
File Type
Pdf
Link to File
/media/divresources/CODFP_NiPCP_Case_Study_FinalReport.pdf
Description
The report provides valuable lessons about the process of onboarding and integrating nurses into family practices (e.g. preparation prior to onboarding, building trust with team members). Initial outcomes related to attachment, access, and patient and provider experience are explored. While the findings in the report are primarily focused on the Nurse in Primary Care Practice program in Central Okanagan, the findings can be applied to any team-based care environment, regardless of funding model.
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Culturally Safe Team-based Care at the Snuneymuxw Health Centre (Executive Summary)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1561
Division
Nanaimo Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/GPSCPMHCaseStudy_SnuneymuxwHealthCentre_ExecutiveSummary.pdf
Description
"This PMH Case Study explores the integration of physician services in a First Nations interdisciplinary health team and culturally safe and appropriate care. The executive summary describes key impacts and lessons on how to implement culturally safe care."
Division
Nanaimo Division of Family Practice
Corporate Author
General Practice Services Committee
Nanaimo Division of Family Practice
Published Date
2020-11
Topics
Patient Medical Home
Team-Based Care
First Nations
Resource Type
Summary
File Type
Pdf
Link to File
/media/divresources/GPSCPMHCaseStudy_SnuneymuxwHealthCentre_ExecutiveSummary.pdf
Description
This PMH Case Study explores the integration of physician services in a First Nations interdisciplinary health team and culturally safe and appropriate care. The executive summary describes key impacts and lessons on how to implement culturally safe care.
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Culturally Safe Team-based Care at the Snuneymuxw Health Centre (Case Study)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1562
Division
Nanaimo Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/GPSCPMHCaseStudy_SnuneymuxwHealthCentre_FullReport.pdf
Description
"This PMH Case Study explores the integration of physician services in a First Nations interdisciplinary health team and culturally safe and appropriate care. The report highlights the work and time required to develop trust and earn the respect of the Snuneymuxw First Nation patients, so that care is provided in culturally safe and appropriate ways."
Division
Nanaimo Division of Family Practice
Corporate Author
General Practice Services Committee
Nanaimo Division of Family Practice
Published Date
2020-11
Topics
Team-Based Care
First Nations
Patient Medical Home
Resource Type
Case Study
Link to File
/media/divresources/GPSCPMHCaseStudy_SnuneymuxwHealthCentre_FullReport.pdf
Description
This PMH Case Study explores the integration of physician services in a First Nations interdisciplinary health team and culturally safe and appropriate care. The report highlights the work and time required to develop trust and earn the respect of the Snuneymuxw First Nation patients, so that care is provided in culturally safe and appropriate ways.
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What We Value: Stories of Most Significant Change (MSC) from Physicians, Allied Healthcare Providers, and Patients (Executive Summary)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1565
Division
Central Okanagan Division of Family Practice
Kootenay Boundary Division of Family Practice
North Peace Division of Family Practice
North Shore Division of Family Practice
South Island Division of Family Practice
South Okanagan Similkameen Division of Family Practice
Sunshine Coast Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/PMHMostSignificantChangeEvaluation_ExecutiveSummary.pdf
Description
"The PMH Most Significant Change Evaluation describes the changes that resulted from Patient Medical Home (PMH) strategies such as the implementation of team-based care with allied health professionals (i.e., pharmacists and social workers), and clarifies the values held by different stakeholders in primary care transformation. The executive summary contains priority next steps for system actors (GPSC, Divisions, and FPs) to address."
Division
Central Okanagan Division of Family Practice
Kootenay Boundary Division of Family Practice
North Peace Division of Family Practice
North Shore Division of Family Practice
South Island Division of Family Practice
South Okanagan Similkameen Division of Family Practice
Sunshine Coast Division of Family Practice
Corporate Author
General Practice Services Committee
Published Date
2020-11
Topics
Patient Medical Home
Most Significant Change
Team-Based Care
Evaluation
EMR
Resource Type
Summary
File Type
Pdf
Link to File
/media/divresources/PMHMostSignificantChangeEvaluation_ExecutiveSummary.pdf
Description
The PMH Most Significant Change Evaluation describes the changes that resulted from Patient Medical Home (PMH) strategies such as the implementation of team-based care with allied health professionals (i.e., pharmacists and social workers), and clarifies the values held by different stakeholders in primary care transformation. The executive summary contains priority next steps for system actors (GPSC, Divisions, and FPs) to address.
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What We Value: Stories of Most Significant Change (MSC) from Physicians, Allied Healthcare Providers, and Patients (Executive Summary)

https://www.jcc-resourcecatalogue.ca/en/permalink/divisionresource1566
Division
Central Okanagan Division of Family Practice
Kootenay Boundary Division of Family Practice
North Peace Division of Family Practice
North Shore Division of Family Practice
South Island Division of Family Practice
South Okanagan Similkameen Division of Family Practice
Sunshine Coast Division of Family Practice
Published Date
2020-11
Link to File
/media/divresources/PMHMostSignificantChangeEvaluation_FullReport.pdf
Description
"The PMH Most Significant Change Evaluation describes the changes that resulted from Patient Medical Home (PMH) strategies such as the implementation of team-based care with allied health professionals (i.e., pharmacists and social workers). By collecting, sharing, and reflecting on PMH stories from across BC, this project identifies common and different values held by different stakeholder groups in the BC health system."
Division
Central Okanagan Division of Family Practice
Kootenay Boundary Division of Family Practice
North Peace Division of Family Practice
North Shore Division of Family Practice
South Island Division of Family Practice
South Okanagan Similkameen Division of Family Practice
Sunshine Coast Division of Family Practice
Corporate Author
General Practice Services Committee
Published Date
2020-11
Topics
Patient Medical Home
Most Significant Change
Team-Based Care
Evaluation
EMR
Resource Type
Case Study
File Type
Pdf
Link to File
/media/divresources/PMHMostSignificantChangeEvaluation_FullReport.pdf
Description
The PMH Most Significant Change Evaluation describes the changes that resulted from Patient Medical Home (PMH) strategies such as the implementation of team-based care with allied health professionals (i.e., pharmacists and social workers). By collecting, sharing, and reflecting on PMH stories from across BC, this project identifies common and different values held by different stakeholder groups in the BC health system.
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Published Date
2019-07
Link to File
/media/divresources/OscarEMRIntroduction_InstructionSheets_v4.pdf
Description
"These instruction sheets provide an overview of basic OSCAR functions for new users. This is an independent quick reference guide on getting started with OSCAR that has been created by physicians, for physicians."
Corporate Author
Recruitment and Retention Steering Comittee
Practice Support Program
Published Date
2019-07
Topics
EMR
Team-Based Care
Resource Type
Manual
File Type
Pdf
Link to File
/media/divresources/OscarEMRIntroduction_InstructionSheets_v4.pdf
Description
These instruction sheets provide an overview of basic OSCAR functions for new users. This is an independent quick reference guide on getting started with OSCAR that has been created by physicians, for physicians.
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25 public records – page 1 of 2.