Sarah Bush Lincoln Health Center

• Project Title: Care Coordination for CHF and COPD Patients at Family Medical Center
• Grant Period: 8/01/2016 – 7/31/2019
• Program Representative Interviewed: Carol Ray, Director of Coordinated Care
• Location: Mattoon, IL
• Program Overview: The care coordination program at the Sarah Bush Lincoln Health Center, aims to enhance care transitions and engage patients in their own COPD management in order to reduce hospital readmissions and emergency department visits. With a strong focus on patient engagement, coordinators use the patient activation measure (PAM) to determine the COPD patient's level of engagement with their care and tailor the care coordination strategies accordingly, in addition to leveraging motivational interviewing techniques to support positive health behavior change among patients.

Models represented by this program:

• Chronic Care/Chronic Disease Management