The Medical Outreach Program enhanced services provided to unstably housed, minority individuals with human immunodeficiency virus by including physicians on the community outreach team who provide general medical consultation, triage, acute care, evaluation, and prescriptions for needed medications.
The Medical Language Interpretive Services program in Grady Health System uses a multipronged approach to increase staffing and the hospital's capacity to provide interpretation services to meet the needs of patients with low English proficiency.
The Bienestar Health Program is a comprehensive and culturally competent school-based behavior modification program intended to prevent or delay the onset of type 2 diabetes among Mexican-American and other at-risk youth.
Childcare centers and elementary schools in the Rochester area have access to a Web-based telemedicine system that allows clinicians to provide remote diagnoses and recommendations for sick children.
A health plan's individualized, in-home, environmental asthma intervention program targets all pediatric members with confirmed allergies to indoor allergens and symptomatic asthma. During multiple in-home visits, trained asthma counselors provide education, perform an environmental assessment, demonstrate intervention equipment, devise a written care plan, and assess and address psychosocial issues.
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.
The Pathways Model employs community health workers who connect at-risk individuals to evidence-based care through the use of individualized care pathways designed to produce healthy outcomes; implementation of this model in Richland County, OH, resulted in increased services to at-risk women and a decline in the rate of low birth weight babies.