TCPI Person and Family Engagement - PCPCC  Scholarship Application
The Patient Centered Primary Care Collaborative Support & Alignment Network (SAN)  is offering registration scholarships to our Annual "Primary Care Innovations" Conference in Washington, DC October 11-12, 2017. Registration scholarships are available to clinicians, patient/family advisors, and quality coaches participating in the Transforming Clinical Practice Initiative.

PCPCC's conference features innovators in primary care that exemplify new Shared Principles of Primary Care. PCPCC’s forum charts a new course for primary care that incorporates population health, commits to stewardship of scare resources, relies on team-based care and successfully engages patients in decision-making. In addition, the PCPCC SAN will host a post-conference workshop October 12th from 1-5:00pm ET featuring a discussion of engaging patients and families in decisions about better care and smarter spending as recommended in the Choosing Wisely program.  Participation in the post-conference event is by invitation.

The PCPCC SAN particularly encourages PTN-enrolled clinicians and their patient partners to take advantage of this opportunity while working towards the achievement of TCPI Patient and Family Engagement goals! TCPI scholars will interface and dialogue with subject matter experts on implications of these innovations for person and family engagement. Teams that include patients, clinicians, and QI coaches are given scholarship preference. Physicians earn CME credits upon request.  

Scholarship funds will cover conference registration only.  Limited travel funds may be available for patient or family member advisors collaborating with a TCPI-enrolled practice. Although patient advisors and clinician partners are eligible to apply individually, funding priority will be given to patient advisors and clinicians who attend the training as a pair or part of a care team. Eligible participants must be affiliated with the TCPI and attest to need for funding. Participants may be:

*  Currently a patient and family advisor or patient partner working in a primary care, specialty, or ambulatory setting
*  A TCPI enrolled clinician with a demonstrated interest in improving person and family engagement
*  A practice leader or quality improvement staff in a TCPI participating practice  
*  Teams of patients, clinicians or practice improvement staff

One application can be completed on behalf of an entire team. You can expect a response within a week of your application submission.

Deadline: Wednesday October 4, 2017

Questions? Contact Jacinta Smith at jacinta@pcpcc.net
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Email *
Full Name: *
(First name, Last name)
Phone Number: *
(123-456-7890)
Name & Location of Practice *
(Example: Unity HealthCare; Washington, DC)
Title of Individual & Role in Practice *
(Example: Nurse Practitioner; PFAC Member)
Name, Email, Title, and Role of the patient or clinician partner accompanying you at the training:
(Type "N/A" if you are only applying for yourself.)
I am seeking a scholarship for: *
(Select one option)
Would you like to participate in the post-conference forum on enhancing person and family engagement in Choosing Wisely quality initiatives? The event is October 12, 1-5:00 ET
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Is your practice enrolled in a Practice Transformation Network (PTN)? *
Required
If yes, which PTN?
For Clinicians: Does your practice also partner with community-based organizations to help patients achieve their health goals (i.e. local YMCA, faith-based organizations, health departments, Meals on Wheels, etc.)? *
Required
For Patient and Family Advisors: How long have you been a patient advisor/clinician partner? *
How will you apply the information you learned at the conference training toquality improvement/patient engagement activities at your practice? How will you benefit from the conference and training? *
What are your personal goals for the conference training? *
In 350 words or less, please describe your work or your clinic's work to improve patient and family engagement, and describe any results from this work (cost, quality, or patient experience improvements). *
I hereby acknowledge that the above information is true and accurate to the best of my knowledge and that my request for funds assistance is based on legitimate need and lack of organizational sponsorship and/or funding. I understand that this request for funds is not confirmed until I have received a written approval from PCPCC. If the scholarship is approved, I agree to participate in the entire conference October 11-12, 2017, and the associated PCPCC SAN training opportunities. *
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