If stand-alone quality improvement trainings aren’t helping you improve your patient outcome goals or if you're looking for ways to engage a leadership team within your organization in support of sustainable change, 
it's time to ECQIP yourself.

ECQIP stands for ECHO/Collaborative Quality Improvement Project. ECHO (Extension for 
Community Healthcare Outcomes) is a proven model for interactive distance learning.  The ECQIP model 
will bring together two proven models for distance learning and process improvement – ECHO and the 
Collaborative Model for Improvement. The aim of this project is to assist participating health centers in 
reaching their self-determined quality improvement goals.


ECQIP contains several elements that are critical for reaching your quality improvement goals:

     • Sustained effort to improve a specific measure over time 
     • Regular monitoring of that measure to assess the impact of practice changes 
     • Change model that is consistently applied and widely understood 
     • Team-based approach where everyone knows their role 
     • Process-oriented approach that analyzes all elements of a patient visit and other patient contacts 
     • Learning and improving together across health centers


According to the Institute for Healthcare Improvement, “People with multiple health and social needs are high consumers of health care services, and thus drivers of high health care costs. The elevated cost of care in this population offers a tremendous opportunity to understand the individuals and their priorities and needs, and to craft a service delivery plan that meets their needs more effectively at a significantly lower cost.”

Analyzing data helps to quantify health care processes, outcomes, patient satisfaction, and organizational structure and systems that are associated with producing high quality health care. The focus for the 2020 ECQIP Care Coordination program is a two-part measure that aligns with the Patient Centered Medical Home model of care.

Care Plan Measure

Numerator: Total number of high risk patients that have an active care plan

Denominator: Total number of high risk patients


High Risk Patients - Total number of high risk patients that have been identified for your organization using three of the Patient Care Medical Home categories and have an active care plan in the medical record that is updated at least once a year.

Active Care Plan - A written care plan that includes a care team, an agreement of plan by participant, an emergency plan of care, and a reviewed/creation date during the measurement period.

Transitions of Care Measure

Numerator: Total number of patients that have been in the emergency room or admitted to the hospital within the last quarter that had a follow-up via phone or visit within 72 hours after discharge

Denominator: Total number of patients that have been in the emergency room or hospitalized within the last quarter

Definitions: Quarters will follow a traditional calendar quarter

• Quarter 1: January-March 
• Quarter 2: April-June 
• Quarter 3: July-September 
• Quarter 4: October-December

Practice coaching can improve many aspects of primary care. CHAD's Director of Clinical & Quality Services, Lori Thomas, MSN, RN, will serve as the practice coach for the participating health centers during the ECQIP year. The coach will meet with teams individually on a monthly basis throughout the duration of the project.

For more information about practice coaching, contact [email protected].

The ECQIP Advisory Committee brings partners together for collaborative planning and use of resources with the shared goal of improving care coordination. Click here for a list of the 2020 Care Coordination ECQIP Advisory Committee members.

Click here for the interactive 2020 Care Coordination ECQIP calendar. In addition to tracking future events, you can find recordings and slides from previous events and trainings.

ECQIP Archive
2019 Care Coordination
2018 Diabetes
2017 Cervical Cancer

Lori Thomas
Director of Clinical & Quality Services
605-275-2423 ext. 11
[email protected]