What are Promising Practices?
Promising practices are practices that our health centers have tried and found to be successful, resulting in improvements to clinical quality outcomes, staff and provider satisfaction, and/or patient engagement. These could be new workflows or tools, internal staff education and trainings, EHR improvements, or outreach/in-reach techniques.
We are particularly interested in identifying Promising Practices related to:
- Diabetes
- Social Drivers of Health
- Staff and Provider Satisfaction and/or Retention
- Patient Engagement
- Patient Portal
- Well Child Visits and Childhood Immunizations
Since no two health centers are the same, these practices are not considered “best practices”. A practice may work at one health center, but not at another.
Documented Promising Practices and Presentation Recordings
Breast Cancer Screenings
- Strategies For Improving Breast Cancer Screening Rates – Marin Community Clinics
- One Team, One Goal: A Sustainable Model For Breast Cancer Screening at Alliance Medical Center – Alliance Medical Center
- Mobile Mammography: Community-Centered Breast Cancer Screening – Sonoma County Indian Health Project
Behavioral Health
- Raising the Bar: Improving Depression Screening and Follow-Up Rates at School Sites – West County Health Center
Care Management
- CalAIM ECM Health Center Workflows and Processes CCHC – CommuniCare Health Centers
Cervical Cancer Screening
- Cervical Cancer Screening – OLE Health
- Cervical Cancer Screenings– Marin Community Clinics
- Increasing Cervical Cancer Screenings through Data Clean-up & PSDA Cycles – West County Health Centers
- Outreach and Taking Advantage of the PAP-ortunity – Alexander Valley Healthcare
- Connecting with Patients through Women’s Health Day – Ritter Center
Child Health
- Creating Consistency Through a Master Training Booklet – Sonoma Valley Community Health Center
- Child Vaccine Tracker Updated– CommuniCare Health Centers
- Enhancing ACE Screening through HMG Care Coordination – Contra Costa First 5
- Lower Than Expected Well-Child Visits in the First 15 Months Care Gap – Santa Rosa Community Health
- Well Child Visits in the first 15 months of life – Marin Community Clinics
- Well Child Visits & Child Immunization Workflows – West County Health Centers
- PHC Childhood Immunization Workflow – Petaluma Health Center
- An Integrated Approach to Well-Child Visits – West County Health Centers
- Creating a Culture of Vaccination – Marin Community Clinics
- Newborn Enrollment, Assignment and Continuity of Care -La Clinica
Colorectal Cancer Screening
- Colorectal Cancer Screening #DoThePoo – Community Medical Centers
- Colorectal Cancer Screening – Petaluma Health Center
- Colorectal Cancer Screening – Sonoma Valley Community Health Center
- Utilizing Care Coordinators Increase Colorectal Cancer Screening – OLE Health
- FIT Test Lab Packaging– Santa Rosa Community Health
- Colorectal Cancer Screening: Outreach and Bulk FIT Kit Mailing – Marin Community Clinics
- Exact Sciences Cologuard Bulk Ordering Integration into OHCHIN Epic – Petaluma Health Center
Community Health Workers
Utilizing the CHW Medi-Cal Benefit to Support Perinatal Health – Winters Healthcare, First 5 Yolo, and Communicare+Ole
Community Health Worker Integration into Clinical Care Teams – Santa Rosa Community Health
CHW Sustainability through ACE Screen Reimbursement- Community Medical Centers
Dental
- Dental Assistant Trainee Program – Marin Community Clinics
- Dental Sealants for Children Ages 6-9– Petaluma Health Center
- Integrating Dental with Primary Care to Improve Scheduling & Sealant Rates – Alexander Valley Healthcare
Diabetes
- Nurse Case Management for Blood Pressure Control for Diabetics – Coastal Health Alliance
- Diabetes Management HbA1C – OLE Health
- Diabetes HbA1c Control – Sonoma Valley Community Health Center
- Diabetic Retinal Eye Exam Screenings – Alexander Valley Healthcare
- Prescription of GLP-1’s to Lower Insulin Use and Focus on Lifestyle – Sonoma County Indian Health Project
- Diabetes Case Manager – Alexander Valley Healthcare
- Continuous Glucose Monitoring for Uncontrolled Diabetic Patients – Sonoma Valley Community Health Center
Hypertension
- Hypertension Control – West County Health Centers
- Blood Pressure Measurement Workflow – Alliance Medical Center
- Hypertension Blood Pressure Control – Alexander Valley Healthcare
Infectious Disease
- HIV Testing Program & PrEP Management – Santa Rosa Community Health
Nutrition and Physical Activity
- Expanding Food Access & Improving Nutrition Education Through a Food Pharmacy – Marin City Health and Wellness Center
- Group Classes, Giveaways, and a Garden: Part 1 – OLE Health
- Food is Medicine – CommuniCare Health Centers
- Clinical Team Assistant (CTA) QI Rotations – Santa Rosa Community Health
Pharmacy
An Integrated Clinical Pharmacy Model – Sonoma County Indian Health Project
Improving Wait Times for Immunization Administration – Sebastopol Family Pharmacy
Quality Improvement and Panel Management
- Quality Watch Checklists – West County Health Centers
- Population Health Management– CommuniCare Health Centers
- Pop Health for QI – Marin Community Clinics
- Clinical Team Assistant (CTA) QI Rotations – Santa Rosa Community Health
- Increasing Dental & Behavioral Health Interventions for MAT Participants – Marin City Health & Wellness Center
- QI Chat Room Podcast – Aliados Health
- Promising Practice Documentation – Aliados Health
- Aliados Health Reports on Reports – Aliados Health
- Aliados Health COVID Dashboard – Aliados Health
Team Based Care
- Optimizing Care Team Roles for PHASE – Sonoma County Indian Health Project
- Preventive Care Coordinator Position – CommuniCare Health Centers
- Wiki Site – Petaluma Health Center
- Teamlet Model for Improving HTN and HbA1c Levels – Coastal Health Alliance
Tobacco and BMI Screenings
- CDSS for Tobacco Screening – Santa Rosa Community Health
- BMI Screening and Documentation– Petaluma Health Center
- Adult BMI Screening and Follow-up – Sonoma Valley Community Health Centers
- EHR Integration for BMI Follow-Up Documentation – OLE Health
4Ms
Who We Serve
We serve 23 health centers throughout Northern California.
Funders
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1.5 million. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.
Project Timeline
August 1, 2019 – July 31, 2022
PROJECT CONTACT
For more information, please contact Arlene Peña