1. health and fitness

Stanford Coordinated Care Team Training Center
Transforming Care, Renewing Health
Planning Survey
Please complete one form per team so that Stanford Coordinated Care can assess and ensure we plan a training
program that meets your team’s needs.
Attending Team:
First Name (Team Lead):
Name of your organization:
Last Name:
Name of sponsored organization if different than listed above:
Current program or initiative at your organization (mark all that apply):
Medical home:
□ Current
□ In Progress
Primary care program targeting high risk patients:
□ Current
Care management program targeting high risk patients:
□ In Progress
□ Current
Your funding streams relevant to these programs/initiatives:
□ In Progress
□Managed care □Fee for service □Grant □Other
*Current Electronic Health Record (EHR) in use _______________________________________________________
Additional Information
Pat
In preparing for our phone conversation, please think about your goals of training. What would a successful outcome be
for your team?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Training Topics:
Please rank each topic from 0-5 (5 being the most important to your group). There is no limit on how many you can
select as most important, but please note we cannot fit more than 12 topics in two days. Our aim is to make
presentations short and allow time for problem solving and brainstorming your team regarding your particular issues.
Real meaning of patient centered care: History of ambulatory ICU, patient determining their own outcomes:
0
1
2
3
4
5
Motivational interviewing:
0
1
2
3
4
5
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Selecting patients based on risk/claims:
0
1
2
3
4
5
Getting the patients’ views, patient advisors:
0
1
2
3
4
5
Care transitions:
0
1
2
3
4
5
Assessment of patient to tailor their care:
0
1
2
3
4
5
Measuring success: triple aim, multi-condition dashboard including a panel and a patient’s view:
0
1
2
3
4
5
Team care / Share the care (SCC care coordinator/MA model and enabling protocols):
0
1
2
3
4
5
Team engagement through quality improvement:
0
1
2
3
4
5
Promoting medication adherence:
0
1
2
3
4
5
Chronic pain/integrating physical therapy:
0
1
2
3
4
5
Integrating behavioral health:
0
1
2
3
4
5
Promoting self-management:
0
1
2
3
4
5
Health coaching/care support in primary care:
0
1
2
3
4
5
Health coaching/care support as a stand-alone program:
0
1
2
3
4
5
Marketing to patient and medical community:
0
1
2
3
4
5
Integration with worksite wellness programs:
0
1
2
3
4
5
Please return form to Project Coordinator, Samantha Youre at [email protected] or contact Samantha with any
questions at (650) 736-0745. Once this form has been completed and returned, Samantha will schedule your planning
discussion for the SCC Team Training Center.
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