The researchers conducted interviews with 21 chronically ill, uninsured or Medicaid outpatients from low-income areas, and with 30 primary care practice staff members.
Population Health Management published the study.
Here are five things to know:
1. The CHW model has decreased admissions and produced better outcomes for hospitalized patients.
2. In the Individualized Management for Patient-Centered Targets model, CHWs help patients with chronic conditions navigate the healthcare system and assist them in daily activities.
3. CHWs focus on issues, like hunger and homelessness, which make it difficult for people to maintain their health.
4. The researchers used interview responses to create an outpatient model to administer IMPaCT outside of the hospital setting.
5. The researchers then adapted the hospital IMPaCT model for the outpatient setting:
- Outpatients reported feeling overwhelmed by their multiple conditions and wished to focus on them individually. So, researchers developed a Goal Card, which allows patients to tackle one chronic condition at a time.
- The study also found outpatients possessed more motivation to change their health behavior. So, researchers adapted the model so CHWs help patients track their progress toward goals.
- The outpatient model also includes a weekly clinic-based support group.
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