2013 Learning Collaboratives

Twenty-five practices from throughout Oregon were selected to participate in the 2013 Learning Collaboratives, which took place from January – October 2013.


The 25 practices were divided into four groups, each led by a technical assistance (TA) provider with the skills and knowledge to meet the needs of the practices:



Our work in the learning collaborative encouraged us to think about more proactive care for our patients through the use of varied patient registries and reports through our practice management system.  Achievement of our practice goals and measures were met through these methods and CareSync’s support provided another aspect for ensuring these methods continued and were improved upon. 

-Brianne Jenkins, Santa Clara Medical Clinic



Practice Goals

Each of the participating practices was expected to demonstrate their success in the Collaborative by setting and working towards two self-selected goals. Examples of goals set by these practices included:

  • Increase screening test and vaccination rates among targeted populations
  • Enhance care for patients with certain conditions, including building registries, proactively managing patients, and activating reminders for patients who are due for check-ups
  • Improve patient access to care by offering same or next day appointments, and decreasing deferred acute care and emergency visits
  • Decrease nurse triage time to increase nurse availability to provide proactive care management
  • Ensure 75% of patients discharged from the hospital have a care coordination phone call, medication reconciliation, and allergy reconciliation; ensure those patients are offered an appointment with their physician within seven days 
  • Begin receiving real-time reports and discharge summaries from local hospitals when clinic patients go to the emergency department or are admitted



PCPCH Recognition

Participating practices were also expected to apply for and achieve Patient-Centered Primary Care Home (PCPCH) recognition, or maintain or advance their current PCPCH tier within one year after completing the Collaborative. At the close of the 2013 Collaboratives, of the twenty-five participating practices, eight achieved PCPCH recognition for the first time (four at Tier 2; four at Tier 3), one improved from Tier 2 recognition to Tier 3, and four plan to apply for recognition for the first time in early 2014.  Almost all of the remaining clinics were already recognized as a Tier 2 or 3 before starting the Collaborative, and believe they will maintain or advance their tier when they re-attest in the coming year.  


It was a great experience and helped us reach our goal of attesting for Tier II!

-Shannon Waddle, Santiam Medical Clinic



Learning Sessions & Coaching

Through the Collaborative, practices participated in face-to-face learning sessions and individualized practice coaching to meet their goals. Each of the participating practices was asked to complete a survey following the conclusion of the Collaborative. The nineteen practices who responded to the survey reported a variety of improvements in important areas like organizational goal setting, use of clinical quality measures, quality improvement, care coordination and transitions of care - practice improvements were made in a variety of areas, but all practices reported an improvement in at least one area.  Additionally, participants plan to rely on the other practices in their Collaborative for ongoing support; less than a month after the Collaborative had ended, 75% of respondents were already or had plans to be in touch with a participant from another practice. 


The extensive education and reinforcement provided by ORPRN from goal setting, employee and provider engagement and quality improvements - all of the training they did made us set attaining a PCMH status as a priority for our clinic.

-Stacie Rothwell, HDH Family Care


One of the most important changes that CareSync helped with was the development of our new Care Management team. From the learning sessions and one-on-one coaching, we were better able to define each team member's role, improve workflows, and increase efficiency.

-Stephanie Bryant, Willamette Family Medical Center


Often this was improved (practice's approach to quality improvement) by hearing from others on what had worked for them, getting ideas on how to move forward on our challenges and just overall support in knowing that we were not alone in our challenges.

-Lisa Weida, Westside Pediatric Clinic


We learned so much from the in person learning sessions and would have loved more of them. Talking as a group was incredibly helpful and encouraging.

-Megan Harris, Sanford Children’s Clinic