skip to main content

Discover DSRIP

Discover DSRIP includes a list of 11 DSRIP healthcare providers implementing 27 projects throughout RHP 17’s service area. For each provider, we highlight some of the following: 

  • Provider website link to access services and social media outlets.
  • Lead program coordinator contact information.
  • DSRIP project description included in the RHP 17 Plan.
  • RHP 17 newsletters, spotlighting specific projects and how they have impacted our communities.
  • Baylor Scott & White - Brenham (BSW Brenham)

    Contact

    Visit BSW Brenham’s website for more information, available resources and/or social media outlets.
    Contact BSW Brenham’s DSRIP Program Coordinator for more information. 


    Increasing Primary Care Provider Time at Brenham Free Clinic

    Project Description

    Through this project, additional provider FTEs will be dedicated to service delivery at the Brenham free clinic. We will expand primary care clinic hours by expanding primary care clinic staffing. The project goal is to increase access to and utilization of primary care services at the clinic to reduce ED and hospital utilization.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,422 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 1,710 Encounters


    Improving Primary Care and Supportive Services

    Project Description

    Apply continuous process improvement strategies, guided by the Institute for Healthcare Improvement (IHI) Model for Improvement, to identify causes of avoidable ED/hospital utilization, prioritize potential solutions, and launch Plan, Do, Study, Act (PDSA) cycles on chosen improvements.

    Patients Served by Project


    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 902 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,131 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 632 Individuals

  • Brazos County Health Department (BCHD)

    Contact

    Visit BCHD’s website for more information and available resources.
    Contact BCHD’s DSRIP Program Coordinator for more information. 


    Implementation of Electronic Health Record (EHR) System

    Project Description

    Implement an electronic health record (EHR) system in the Brazos County Health District.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 2,166 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 1,283 Individuals


    Free Rapid HIV Testing

    Project Description

    Provide free HIV testing to targeted clients at high risk for contracting HIV and implement an educational campaign to promote HIV testing awareness/availability.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 819 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 437 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 903 Individuals

  • CHI St. Joseph Regional Health Center

    In partnership with Brazos Valley Prenatal Clinic to implement DSRIP Project

    Contact

    Visit CHI St. Joseph's website for more information, available resources and/or social media outlets.
    Contact CHI St. Joseph's DSRIP Program Coordinator for more information. 


    Prenatal Care Navigation Program

    Project Description

    Establish and implement a prenatal care navigation program to address the needs and provide services to prenatal patient with co-occurring chronic disease conditions that can cause high-risk pregnancies, in an effort to decrease the percentage of high-risk deliveries, provide referral to a primary obstetrician to reduce inappropriate ED use during pregnancy, provide health education, and connect both mother and baby to primary care providers postpartum.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 26 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 57 Individuals 

    Spotlights:

    November 2014 - RHP 17 Newsletter

  • CHI St. Luke's Health - The Woodlands Hospital

    Contact

    Visit CHI St. Luke's The Woodlands Hospital's website for more information, available resources and/or social media outlets.
    Contact CHI St. Luke's The Woodlands Hospital's DSRIP Program Coordinator for more information. 


    Expanding Primary Care Access in Montgomery County

    Project Description

    Improve/expand access to primary care in Montgomery County through increased clinic hours, staffing and/or clinic space. The project seeks to expand the capacity of primary care to better accommodate the needs of the regional, growing patient population and community. Program is specific to OB/GYN & Pediatric care; establishing a Pediatric Bridge Clinic to provide a medical home to neonates utilizing the ED.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 18,431 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 20,760 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 25,574 Encounters

    Spotlights:

    July 2014 - RHP 17 Newsletter

  • Implementing a Chronic Disease Management Registry

    Project Description

    Implement a disease management registry for one or more patient populations diagnosed with selected chronic diseases. A multidisciplinary team will use the registry to continuously identify, track, and evaluate high-risk patients that are non-complaint or in need of of testing, education, and follow-up.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 559 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,246 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 1,437 Individuals

  • College Station Medical Center (CSMC)

    In partnership with Washington County Emergency Medical Service to implement DSRIP Project

    Contact

    Visit Washington County EMS website for more information and available resources.
    Contact CSMC’s DSRIP Program Coordinator for more information.


    Advanced Community Paramedicine (ACP) Navigation Program

    Project Description

    Implement an Advanced Community Paramedicine (ACP) program to identify and provide navigation services to targeted patients at high risk of disconnect from institutionalized healthcare in an effort to reduce inappropriate utilization of emergency departments.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 32 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 60 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 69 Individuals

    Spotlights:

    September 2013 - EMS World, "Texas EMS Department Reforms Operations with ACP Program"

    January 2015 - RHP 17 Newsletter

    August 2015 - Presentation at HHSC Statewide Summit

    February 2015 - RHP 17 Newsletter

  • Conroe Regional Medical Center (CRMC)

    Contact

    Visit CRMC website for more information, available resources and/or social media outlets.
    Contact CRMC’s DSRIP Program Coordinator for more information. 


    Expand Access to Specialized Trauma Services

    Project Description

    Expand access to specialized trauma services through development and implementation of new trauma care processes, expansion & renovation of current trauma care clinical facilities, and improved access to specialty care physicians. CRMC will pursue designation as an American College of Surgeons Level II Trauma Center.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 5,764 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 7,023 Encounters

    Spotlights:

    January 2017 - The Courier of Montgomery County, "Conroe Hospital Trauma Upgrade a Game Changer"

  • Huntsville Memorial Hospital (HMH)

    Contact

    Visit HMH's website for more information, available resources and/or social media outlets.
    Contact HMH's DSRIP Program Coordinator for more information. 


    Cardiac Catheterization Laboratory

    Project Description

    Implement a cardiac catheterization laboratory at HMH in order to improve access to specialty care.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 2,106 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 2,484 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 4,413 Encounters


    Inpatient Dialysis Laboratory

    Project Description

    Implement an inpatient dialysis lab at HMH in order to improve access to specialty care.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 411 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 422 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 491 Encounters


    Nursing Fellowship Program

    Project Description

    Implement a nursing fellowship program to provide improved training in and access to specialty care areas. Program will help HMH recruit, retain and prepare new nurses for successful careers in acute care nursing.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 60 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 763 Encounters


    Mobile Office to Provider Screenings, Vaccinations, Physicals and Health Education

    Project Description

    Implement a mobile office/clinic to improve and expand access to care by providing screenings, vaccinations, physicals and health education. By partnering together, HMH's healthcare services are delivered to the partner facility's location in the community at scheduled times. Mobile clinic is staffed by health professionals who travel into the community to provide screenings, vaccinations, physicals and health education.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,840 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 695 Encounters


    Chronic Care Management Models

    Project Description

    HMH aims to implement chronic disease management models to enable patients to better manage their health. This project will require HMH to expand its role in patient's healthcare and establish protocols and models that help patients maintain healthy behaviors after discharge from the hospital.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 430 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 472 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 525 Individuals


    Primary Care and Non-Emergent Services in Rural Areas

    Project Description

    Implement non-traditional clinics in small rural communities throughout the hospital's primary and secondary service areas in an effort to improve services available in these rural areas and increase the frequency of primary care visits.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 2,611 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 4,354 Encounters

  • MHMR Authority of Brazos Valley (MHMRABV)

    Contact

    Visit MHMRABV website for more information and available resources.
    Contact MHMRABV’s DSRIP Program Coordinator for more information. 


    Crisis Triage Unit

    Project Description

    Develop/implement a crisis triage unit in an effort to provide care in the appropriate setting for persons experiencing a mental health crisis, in lieu of the person being inappropriately transported to an ER.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 693 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 721 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 880 Individuals

    Spotlights:

    August 2014 - RHP 17 Newsletter


    Assertive Community Treatment (ACT) Program

    Project Description

    Development and implementation of an Assertive Community Treatment (ACT) program to provide high-intensity, evidence-based community treatment and support services to individuals with a history of multiple hospitalizations in an effort to prevent avoidable inpatient admissions, provide jail diversion, and to promote wellness, adherence to treatment and recovery in the community.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 357 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 44 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 44 Individuals


  • Montgomery County Public Health District (MCPHD)

    Contact

    Visit MCPHD’s website for more information and available resources.
    Contact MCPHD’s DSRIP Program Coordinator for more information. 


    Montgomery County Community Paramedicine

    Project Description

    Addresses the issue of ever-increasing inappropriate use of emergency medical services and local hospital emergency rooms, as well as provides follow-up and primary care navigation services for targeted patients who are at high risk of disconnect from institutionalized health care.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 26 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 128 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 154 Individuals

    Spotlights:

    September 2014 - RHP 17 Newsletter

    December 2014 - Houston Chronicle, "Paramedics' House Calls Highlights of New Health Care Approach"

    March 2015 - RHP 17 Newsletter

    April 2015 - Journal of Emergency Medical Services, "Montgomery County Hospital District's Community Paramedicine Program Sees Early Success"


  • Texas A&M Physicians (TAMP)

    Contact

    Please see below for each project’s contact and/or website information, available resources and/or social media outlets.


    Health For All - Primary Care Expansion

    Project Description

    Increase the capacity of the Health for All (HFA) clinics in order to expand access to primary care and preventive services, improve transition of care, and improve quality of care for the indigent and low-income population of Brazos and surrounding counties.

    Visit Health For All's website or Contact Health For All's DSRIP Program Coordinator for more information.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 4,608 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 5,483 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 5,452 Encounters


    Expand Telemental Health Services throughout the Brazos Valley

    Project Description

    Expand telehealth services throughout the Brazos Valley with specific emphasis on expansion of telepsychology counseling and services. Services include psychological therapy and assessment to individuals in these counties. The goal of the project is to increase access to and participation in mental health services to indigent and low-income residents throughout the Brazos Valley.

    Visit Telehealth Counseling Clinic's website or Contact Telehealth Counseling Clinic's DSRIP Program Coordinator for more information.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 704 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,469 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 1,662 Encounters

    Spotlights:

    May 2017 - RHP 8 & 17 Newsletter


    Patient-Centered Medical Home

    Project Description

    Transform the TAMP primary care clinic and providers into a certified Patient-Centered Medical Home (PCMH)/Guided Care Model through development and implementation of a redesign process in an effort to assist and support high-risk/high-utilization patients in the area and thereby improve quality and satisfaction of care, while decreasing inappropriate utilization of services.

    Visit TAMP's website or Contact TAMP PCMH's DSRIP Program Coordinator for more information.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 116 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 138 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 181 Individuals


    Evidenced-Based Programs

    Project Description

    Through training, implementation, and evaluation of evidenced-based programs, the "EBP Resource Exchange" will address self-management and wellness needs among chronically ill older adults who have been shown to benefit from such evidence-based programs.

    Visit EBP's website or Contact EBP's DSRIP Program Coordinator for more information.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 354 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 362 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 446 Individuals


    Brazos Valley Post Discharge Care Coordination Program

    Project Description

    Develop/implement a post-discharge care coordination program that provides patient navigation services to targeted frequent ED users at high-risk of disconnect from institutionalized health care. The BVCCP aims to decrease the number of frequent ED users by ensuring appropriate follow-up care upon discharge from the hospital and connecting patients to a regular source of primary care and supportive health services.

    Contact BVCCP's DSRIP Program Coordinator for more information.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 392 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 492 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 507 Individuals

    Spotlights:

    August 2016 - Presentation at HHSC Statewide Summit

  • Tri-County Behavioral Healthcare (TCBH)

    Contact

    Visit TCBH’s website for more information, available resources and/or social media outlets.
    Contact TCBH’s DSRIP Program Coordinator for more information.


    Intensive Evaluation and Diversion Program

    Project Description

    Implement an intensive evaluation and diversion program to provide a community-based alternative for crisis evaluation and diversion screenings, assessments and activities, in an effort to divert individuals in a mental health crisis from emergency rooms and local jails, as well as minimize placement in inpatient psychiatric facilities.

    Patients Served by Project

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 645 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 824 Encounters


    IDD Assertive Community Treatment Program

    Project Description

    Implement an Intellectual & Developmental Disability (IDD) assertive community treatment program to assist patients with co-occurring serious/persistent mental illness and/or severe acting out behavior and to provide crisis evaluation/diversion screenings, assessments and activities.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 24 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 64 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 65 Individuals


    Expanded Psychiatry Delivery Program

    Project Description

    TCBH proposes to provide specialty psychiatric services to persons otherwise unable to receive necessary psychiatric care in Montgomery and Walker counties.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 126 Encounters

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 1,355 Encounters

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 1,585 Encounters

    Spotlights:

    June 2014 - RHP 17 Newsletter


    Integrated Primary & Behavioral Health Services

    Project Description

    Develop/implement a program for integrated primary & behavioral health care services, with included mobile clinic component, to improve care/access to needed primary healthcare for individuals receiving behavioral treatment services from Tri-County in Montgomery & Walker counties.

    Patients Served by Project

    Demonstration Year 3 (Oct. 2013 - Sept. 2014) - 133 Individuals

    Demonstration Year 4 (Oct. 2014 - Sept. 2015) - 496 Individuals

    Demonstration Year 5 (Oct. 2015 - Sept. 2016) - 492 Individuals

    Spotlights:

    November 2016 - RHP 17 Newsletter

Last edited by: ebutton 08/18/2017