Six Practices Working to Improve Access and Patient-Centered Care

October 22, 2014   |  Tags: Blog   |  Tags: Learning Session , Access
Marcelle Thurston, MS, RD, CDE, CareOregon







On Friday, October 17, 2014 more than 40 people from six primary care practices across Oregon came together to learn strategies for improving patient access to their practices. One practice, St. Alphonsus Medical Group Ontario, even traveled all the way to Portland from Ontario, OR – now that is dedication to patient-centered care!

Clinic teams reviewed case studies to better understand the Building Blocks of High Performing Primary Care, including the importance of empanelment and team-based care as pre-requisites for improving access. Clinic teams discussed how important transformation concepts applied in their practice and identified next steps towards their goals for the Collaborative.

Each team came to the session with a storyboard about their practice that included a description of the team, their goals, and plans for a Plan-Do-Study-Act (PDSA) cycle.  Read about each practice’s goal and take a peek at their storyboards below: 


Doernbecher Pediatric and Adolescent Health Clinic’s goal is to balance panel sizes by May 2015. As they shared their storyboard with other participants they noted that as they have started this process they have uncovered a great deal about needing to improve in other areas – testament to the building blocks and how many aspects of primary care home transformation are interconnected.


Dr. Erica Meyer shared the storyboard created by Metropolitan Pediatrics – Northwest, which included strategies for working towards their goal of increasing well-child visits by 8% and adolescent well-visits by 9% by March 2015. They shared some of their strategies for achieving their goals: personalized outreach letters to catch the attention of parents and patients, using text and email to reach out to 12 – 21 year-olds, improve timing and availability of appointments, and pre-visit planning to transition visits to well-visits when possible (for helpful tips on enhancing the adolescent well-visits, review this webinar hosted by the Institute in September).


The Metropolitan Pediatrics – Westside storyboard included a beautiful tree visual to describe their work to date. The practice is really struggling with its providing timely care, and has convened a series of focus groups – with parents, physicians, front desk and back office staff – to do a root cause analysis. The analysis found that: patients are being scheduled too far out and forgetting about appointments (no-shows block appointment slots that can be used by other patients), support staff has room to work at the top of their scope of practice and to take some of the workload off the plate of physicians, and they are missing a protocol for how to handle provider schedules when the providers are out of office.


National College of Naturopathic Medicine (NCNM) is using the Collaborative to work towards their goal of assigning 100% of patients to a practice team by May 2015. NCNM is new to primary care transformation work, and a team of champions, including five physicians, are participating to perfect these processes at one clinic and then spread them to others, including a plan for hiring and training front desk staff.


Two OHSU Family Medicine clinics – CHH South Waterfront & Gabriel Park are participating in the Collaborative with Practice Enhancement Coordinator Emily Barclay, who is receiving additional support to improve her skills as a practice coach in order to consult with clinics on their improvement efforts. Both practices are working on right-sizing their panels; they reviewed this article from their CareOregon coach that really resonated with them. The practices have realized that beyond the mechanics, they are going to need to do work to change culture for both providers and patients.


St. Alphonsus Medical Group – Ontario understood their SBIRT process is broken when they received their report from a health plan. Therefore, they are taking action to improve the process as one of their goals for this Collaborative. Their storyboard included step-by-step actions they are taking to fix it, including re-training staff with the great training SBIRT resources available online.


The Wallace Medical Concern is aiming to improve patient engagement with their My Chart portal.  To drive up enrollment they have hosted contests between medical assistants and front desk staff to see who can get more patients signed up, and have formed a partnership with Portland State University to analyze and tackle digital literacy challenges among their patient population, which may be contributing to lower rates of engagement with My Chart.


Improving Access through PCPCH is a Learning Collaborative running through May 2015 that includes learning sessions and individualized coaching for practices working on the patient-centered primary care model. CareOregon is leading the Collaborative, providing technical assistance and context expertise as session facilitators and practice coaches.

The Collaborative is one of four managed by the Patient-Centered Primary Care Institute; visit the website to read more about Institute Learning Collaboratives. There are a variety of Institute webinars (which are available to the public at no cost) that cover topics addressed through this Collaborative like empanelment, team-based care, and scrubbing and huddling.


Marcelle Thurston, MS, RD, CDE is a Primary Care Innovation Specialist at CareOregon. Through her role she serves as the practice coach for the six clinics (with eight sites) participating in the Improving Access through PCPCH Collaborative.

Marcelle comes to CareOregon with a diverse skill set in employer health and wellness, public health, and as a clinical Registered Dietitian and Certified Diabetes Educator. Most recently, Marcelle worked with Kaiser Permanente Colorado, serving as the consulting project manager for clinical integration.

She has over six years experience in public health as the chronic disease coordinator in the Prevention Services Division at the Colorado Department of Public Health and Environment, manager of the CDC-funded Diabetes Prevention and Control Program at the Washington State Department of Health and as the nutrition coordinator for the Physical Activity, Nutrition, and Obesity Prevention Program.

Marcelle's involvement in public health focused on quality improvement and practice transformation specifically in the prevention and management of diabetes, heart disease and stroke, and nutrition-related policy initiatives. Additionally, Marcelle had direct patient care experience in outpatient and trauma centers.