Date of Award


Document Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Judy Tupper


care coordination, patient outcomes, Mercy Health System, Mercy Gap in Care Coordinators, Muskie School of Public Service


The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial contact, the number of patients seen for a primary care visit and CRC screening can be used to measure the population health impact. Furthermore, patients contacted by the GCC may have changed primary care providers, have been screened by another facility, or need assistance obtaining insurance coverage these outcomes were also documented.