The Care Coordination Model
Reducing Care Fragmentation
To help clinical teams lift the quality of patient transitions and referrals, The Commonwealth Fund supported MacColl via Reducing Care Fragmentation to author a complementary set of materials aimed towards patient-centered medical home transformation.
Reducing Care Fragmentation: A Toolkit for Coordinating Care
Team Up for Health
The 42-month Team Up for Health initiative, funded by The California HealthCare Foundation, brought patients, their families and clinical teams together to define and test processes leading to better self-management of chronic conditions.
Building Teams in Primary Care
Building Teams in Primary Care, by Tom Bodenheimer, is a report to the California Healthcare Foundation with case studies of 15 diverse practice environments. Dr. Bodenheimer is the Chair of LEAP’s National Advisory Committee.
Partnering in Self-Management Support: A Toolkit for Clinicians
MacColl Senior Researcher Judith Schaefer, MPH is co-author of “Partnering in Self-Management Support: A Toolkit for Clinicians”, an introduction to supporting and collaborating with patients and their families in the daily management of chronic conditions.
The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project)
The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project) visited 30 primary care practices that use health professionals and other staff in ways that maximize access to their services, and is cataloging the results. Funding is provided by the Robert Wood Johnson Foundation.
Implementing Chronic Care and Business Strategies in the Safety Net: A Coaching Manual
Containing a coaching framework and tools to support clinical teams as they implement the Chronic Care Model, “Implementing Chronic Care and Business Strategies in the Safety Net: A Coaching Manual” was written for practice facilitators in community health centers.