Expanding Access Through Community-Based Nursing

Adventist Health Tillamook continues to advance access to healthcare through a community-based nursing model designed to meet patients where they are. This work is now featured in a peer-reviewed publication in CIN: Computers, Informatics, Nursing, a journal focused on advancing evidence-based nursing informatics and clinical practice. The article titled "Strengthening EHR Support for RN-Led Chronic Care Management in Primary Care" highlights how registered nurse-led chronic care management requires new approaches to care coordination and information management, particularly when care is delivered across clinic, home, and community settings.

The model supports patients with chronic conditions by providing care beyond traditional clinic visits, including in-home and community-based services, health coaching, medication support, and care coordination. As described in the published work, registered nurses serve as trusted partners and navigators, helping patients manage their health over time while addressing social needs and improving engagement with care. This approach reflects a broader shift toward more flexible, patient-centered care that responds to the realities of rural communities.

This work has also been recognized at the state level with the 2025 Oregon Rural Health Excellence Award, which honored the program for improving access to care in rural communities by bringing services directly to patients, including those in underserved or hard-to-reach settings. Together, these recognitions reflect a continued focus on innovation, collaboration, and delivering care in ways that support health, wholeness and hope across the communities we serve.