Race and ethnicity
As part of the Geriatric Resources for Assessment and Care of Elders (GRACE) program, social worker/nurse practitioner teams collaborate with a larger interdisciplinary team and primary care physicians to develop and implement individualized care plans for low-income seniors, leading to significant improvements in health status.
A community-based primary care clinic uses nurses to provide culturally competent care coordination to Latino patients with chronic illnesses and disabilities, leading to greater provision of recommended care, lower health care costs, and enhanced self-management capabilities.
The El Rio Inner-City Asthma Intervention Program is a comprehensive bilingual, bicultural program that primarily serves low-income, inner-city Latino children with moderate or severe persistent asthma.
Cambridge Health Alliance enhanced its round-the-clock interpreter services by tracking key indicators that gauge the quality of these services; analyses of these data led to significant improvements in the program's telephone-based services and staff efficiency and the decision to implement depression screening in patients with limited English proficiency.
Reformed first-hour operational processes at two clinic sites reduced wait times, increased patient satisfaction, and improved patient–provider interactions.
The Partners in Pregnancy program combines telephone-based case management with periodic home visits from registered nurses and community-based workers to improve pregnancy outcomes for high-risk pregnancies in a Medicaid managed care population.
A pediatric center provides comprehensive, coordinated services within a primary care medical home for low-income and immigrant children with special health care needs.
A randomized clinical trial at San Francisco General Hospital used visual medication schedules and brief teach-back protocols in English, Spanish, and Cantonese to improve anticoagulant control among low-literacy patients in the public hospital's anticoagulation clinic.
The HIV Testing Program provides sexual health education, counseling, and HIV testing to at-risk youth in easy-to-access locations, along with individual counseling for those who test positive, leading to the successful identification and linking to treatment of HIV-positive individuals.
Rural and Urban Access to Health, an integrated network of field-based workers, connects vulnerable populations to health, human, and social services in nine largely rural counties in central Indiana.