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Assessment of Community Needs and Project Objectives
Lack of coordination of services
Though there are real efforts among providers to cooperate and hence begin to coordinate service, there is much work to be done to add structure to the delivery system. This organization and structure would be designed in such a way that anyone entering the system at any point in the continuum would be:
- suffiently knowledgable and self-empowered to seek and gain acces to the delivery system at the appropriate point
- moved efficiently and compassionately through the delivery system to receive appropriate care of the highest quality and most reasonable cost possible
- cared for in a timely way with emphasis on health and wellness, illness prevention and risk management to promote optimal community public health
Certain specific programs are already working to coordinte care over a continuum. An example at present is the Multidisciplinary Assessment Team for children; but such teams find their efforts challenged by the ever growing number of programs developing in the community and the inadequate communications channels and information flow among present and prospective providers of needed service.
Chemung Valley Health Network Project Objectives
The Health Network maintains a goal of reducing costs while improving access to high quality health-related services through coordination of providers, human service organizations and the community's population at large. Objectives that will support progress toward this goal are:
- Identification of the need for primary care (medical, dental and mental health) providers that builds on the work of the Finger Lakes Health System (FLHSA)'s Southern Tier Primary Care Project; and development of a community recruitment and retention program based on identified needs.
- Assessment and prioritization of community needs to determine needed interventions.
- Development of a community health information network that builds on the existing systems of each provider to coordinate information in a common, and easily accessible format, with the goal of supporting enhanced continuity and quality of care, elimination of duplications and gaps in service, and improved access to the delivery system.
- Development of community clinical pathways that build on existing systems using patient care managers. Initial focus will be on meeting the needs of very high risk individuals whose care creates the greatest economic and healthcare delivery demands on the system.
- Formulation of a community self-help handbook focused on appropriate utilization of resources and coordinated with a community health resource information service (CHRIS), as conceptualized in the Southern Tier Primary Care Project.
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