Small Health Care Provider Quality Improvement - Central Oklahoma Family Medical Center (COFMC) is a Federally Qualified Health Center that is proud to serve the people of rural Oklahoma, regardless of ability to pay or insurance eligibility. COFMC offers integrated care in family practice, pediatrics, and behavioral healthcare, all in response to community needs. COFMC has a mission to provide quality, comprehensive, and affordable care that improves the health and well-being of communities. The organization has worked to remove barriers to care, including providers shortages, long travel distances, poverty, and lack of insurance. This project aims to address these needs while building a culture of quality improvement within the Health Center. COFMC has identified the need to enhance chronic care management and care coordination services to promote the health and wellbeing of the service area. COFMC will do so by implementing quality improvement measures and training into daily workflows. The Health Center also aims to increase the number of patients screened for chronic diseases (such as High Blood Pressure, High Cholesterol, Coronary Heart Disease, and Diabetes) and provide appropriate follow-up care. To address health care concerns specifically identified within the rural population, COFMC is proposing the enhancement of quality improvement strategies and staff training to create a sustained culture of quality improvement within the organization. By strengthening data collection through its electronic health record, COFMC can support patients in making a care plan. COFMC will address social drivers of health factors, including socioeconomic status and transportation, to limit barriers in seeking and accessing health care services for all patients served through care coordination. To address health care concerns specifically identified within the rural population, COFMC is proposing the enhancement of data tracking and monitoring through the organization’s EHR. COFMC providers and staff will develop and carry out quality improvement approaches aimed at strengthening patient care and overall organizational effectiveness. The project will also improve how the organization collects and reports data, while expanding its use of technology to work more efficiently. In addition, staff will receive training in billing, coding, and reimbursement practices to help grow revenue and support the organization's financial future. Ultimately, the goal is to establish a lasting culture of quality improvement and reinforce COFMC 's capacity to deliver sustainable healthcare services. The project will prioritize value-based care, helping to drive the growth and impact of Quality Improvement across the organization. The project’s Clinical Health Service Focus Area is care coordination and chronic disease management. With a high prevalence diabetes and heart diseases in the service area, the Health Center has identified diabetes and cardiovascular disease management as its primary quality improvement strategies. The project will strengthen clinical health services leveraging the organization’s electronic health record system to support timely interventions and data collection. COFMC plans to serve the rural population of Pontotoc, Seminole, and Garvin counties located in Central Oklahoma through this project.
