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ForwardWestern PA PCMH Virtual Learning Network Session
The PCMH practices completed a Learning Needs Assessment and they indicated they lacked competence and knowledge around completing a SDOH assessment using a nationally recognized tool and submitting diagnosis codes and also deploying a community based care management team consisting of nurses, social workers, community health workers and medical assistants to engage the patient in developing a personalized care plan and connecting them to community resources and social support.
Target Audience
Nurse
Nurse Practitioner
Physician
Physician Assistant
Social Worker
Learning Objectives
• Describe PCMHs’ Social Determinants of Health (SDOH) screening results and experiences
• Describe how PCMHs are receiving hospital admission, discharge, and transfer (ADT) reports
• Describe the principle and skills of Motivational Interviewing
• Discuss how Motivational Interviewing skills can be used to provide feedback to patients on SDOH screening results
• Describe how social/human service agencies and PCMHs can work together to assist patients with obtaining social/human services and to track the outcomes of those referrals
• Identify next steps to improve referral processes between PCMHs and social/human service agencies
Additional Information
| Attachment | Size |
|---|---|
 4.7.20 PCMH LN Virtual Agenda.docx | 20.94 KB |
The PCMH practices completed a Learning Needs Assessment and they indicated they lacked competence and knowledge around completing a SDOH assessment using a nationally recognized tool and submitting diagnosis codes and also deploying a community based care management team consisting of nurses, social workers, community health workers and medical assistants to engage the patient in developing a personalized care plan and connecting them to community resources and social support.
Pauline Taylor, Program Specialist, PRHI
Mark Valenti, Manager of Training, Education, and Workflow Integration, ECCM, Highmark Health
Bruce Block, MD, Chief Learning and Informatics Officer, PRHI
Shannon Shaffer, MSW, Adult Mobile Counselor, Crisis Center North
Pamela Jeneé Wilbon, Chief Program Officer, Pittsburgh Community Services, Inc.,
In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and The Jewish Healthcare Foundation. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
As a Jointly Accredited Organization, University of Pittsburgh is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. University of Pittsburgh maintains responsibility for this course. Social workers completing this course receive 6.25 continuing education credits.
Available Credit
- 3.00 AMA PRA Category 1 Credit™The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
- 3.00 ANCCUPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
- 3.00 Attendance