The Navigating Care Coordination Series provided physicians and their teams an enriched, cross-discipline group learning experience focused on testing new approaches in care coordination. Participants focused on reducing patient care gaps and delays while improving information flow between primary and secondary/tertiary care. Primary care practices worked closely with a referral partner (e.g. regional health authority programs, consultant physicians, community programs, etc.) serving a shared patient population to build a care coordination agreement. The agreement was tested and optimized with existing healthcare team members and implemented within their practices.
Learning Objectives
By the end of this program, participants should be able to:
- Discuss the current state of care coordination in NL;
- List available resources relating to care coordination;
- Create a list of common terms linked to care coordination;
- Describe high-impact changes for care coordination and seamless transitions;
- Synthesize patient stories and experiences of care coordination in the codesign of care coordination agreements;
- Coordinate with a referral partner to test and implement care coordination change ideas within their primary and specialty practices using the model for improvement;
- Develop a care coordination agreement between referral partners;
- Explain how care coordination affects continuity and, subsequently, patient care and safety;
- Share their experiences within the navigating care coordination learning series community about the opportunities and challenges to improve care coordination;
- Describe to other practices and healthcare partners how they have successfully applied QI within their practice to improve care coordination;
- Write a team action plan to sustain and spread care coordination improvements within their practices;
- Demonstrate the value of celebrating improvement successes with the referral partnership team.