Adding a New Role at Clinics to Help Patients Access Community Resources [Internet]

Excerpt

Background: The rising prevalence of conditions such as diabetes and hypertension motivate innovations to prevent and manage chronic disease. Health care systems increasingly recognize the influence of social determinants of health (SDOH) such as housing, transportation, and access to healthy food. Lay health workers with community expertise may be a valuable resource for primary care teams to address patients' SDOH.

Concurrently, health care systems increasingly include patients in quality improvement and clinical redesign. Evidence on eliciting useful input from patients in this work is scarce. This project addressed 2 evidence gaps: the lack of guidance on incorporating patients as full partners in clinical design and the need for information on methods for integrating lay health workers into primary care and their effects on care.

Objectives: Aims were to (1) develop, implement, and evaluate new methods to involve patients intensively in care design; (2) design and pilot a new role for primary care teams to connect patients with community resources; and (3) evaluate the design and efficacy of the role. The setting was Kaiser Permanente, a large, integrated care and coverage system in Washington.

Methods: Twelve patients and 11 providers and clinic staff participated in workshops to design the new role, which they called a community resource specialist (CRS). Recruitment and workshops were evaluated using observation, participant surveys, and in-depth interviews with participants and health system leaders.

Implementation and impact of the CRS role was evaluated using electronic health records (EHRs) and administrative data, staff interviews, patient focus groups and surveys, and clinic site visits.

Results: In design workshops, participants developed job specifications and other details about the CRS position. Including patients in the workshops was well received by patients and health system representatives. Having at least half the workshop participants be patients empowered patients to lead and contribute. One challenge to including patients in the clinical design was the use of specialized and technical terms. Based on the model developed at the design workshops, the CRS role was implemented at 3 clinics. Implementation challenges included EHR development issues and integrating a new role into primary care teams and workflow.

CRS evaluations showed high patient satisfaction. Primary care teams reported benefits such as eased workload and perceptions of providing better care. In focus groups, patients who used CRSs reported behavior changes and improved health, although no changes were detected from EHR or patient survey data.

Key learnings from this proof-of-concept implementation of a new clinical role were importance of clearly defining responsibilities; locating the CRS in a place visible to clinical staff; allowing time for training and developing relationships with primary care staff and community resources; personally introducing patients to the new team member; and enlisting a strong clinic champion, preferably a provider, to increase physician uptake.

Conclusions: We demonstrated that patients can be influential codesigners of clinical processes. Lay primary care team members with expertise in community resources, if well integrated into primary care teams can improve patient perceptions of their health and well-being and produce high levels of patient satisfaction.