Hsu Clarissa, Hertel Erin, Johnson Eric, Cahill Carol, Lozano Paula, Ross Tyler R, Ehrlich Kelly, Coleman Katie, BlueSpruce June, Cheadle Allen, Matthys Juno, Chapdelaine Michelle, Gray Marlaine, Tufte Janice, Robbins Michele
Assistant Investigator at the Center for Community Health and Evaluation at the Group Health Research Institute in Seattle, WA.
Senior Research Associate at the Center for Community Health & Evaluation, Kaiser Permanente Washington Health Research Institute in Seattle.
Perm J. 2018;22. doi: 10.7812/TPP/18-101. Epub 2018 Oct 22.
Health systems increasingly recognize the impact of social determinants of health such as access to housing, transportation, and nutritious food. Lay health workers have been used to address patients' social determinants of health through resource referral and goal setting in targeted populations, such as individuals with diabetes. However, we know of no studies that evaluate this type of role for a general primary care population.
To assess the implementation and impact of the Community Resource Specialist (CRS) role in Kaiser Permanente Washington.
We analyzed data from staff interviews, patient focus groups, clinic site visits, patient surveys, the electronic health record, and administrative sources.
Satisfaction with CRSs was high, with 92% of survey respondents choosing "very satisfied" or "somewhat satisfied." Of patients with a resource referral and follow-up encounter, 45% reported using the resource (n = 229) and 86% who set a goal and had a follow-up encounter (n = 218) progressed toward their goal. Primary care teams reported workload easing. Patients who used CRSs and participated in focus groups reported behavior changes and improved health, although no changes were detected from electronic health records or patient survey data. Key learnings include the need to clearly define the CRS role, ensure high visibility to clinical staff, and facilitate personal introductions of patients (warm handoffs).
Adding an individual to the primary care team with expertise in community resources can increase patient satisfaction, support clinicians, and improve patients' perceptions of their health and well-being.
卫生系统越来越认识到住房、交通和营养食品等健康社会决定因素的影响。非专业卫生工作者已被用于通过在目标人群（如糖尿病患者）中进行资源转诊和设定目标来解决患者的健康社会决定因素。然而，我们尚未发现有研究评估这种角色在普通初级保健人群中的作用。
评估华盛顿凯撒医疗集团中社区资源专员（CRS）角色的实施情况和影响。
我们分析了来自员工访谈、患者焦点小组、诊所实地考察、患者调查、电子健康记录和行政来源的数据。
对CRS的满意度很高，92%的调查受访者选择“非常满意”或“有些满意”。在接受资源转诊并进行后续随访的患者中，45%报告使用了该资源（n = 229），在设定目标并进行后续随访的患者中，86%（n = 218）朝着目标取得了进展。初级保健团队报告工作量有所减轻。使用CRS并参加焦点小组的患者报告了行为改变和健康改善，尽管电子健康记录或患者调查数据未发现变化。主要经验教训包括需要明确界定CRS的角色、确保临床工作人员有较高的可见度以及促进患者的个人介绍（热情交接）。
在初级保健团队中增加一名具有社区资源专业知识的人员可以提高患者满意度、支持临床医生并改善患者对其健康和幸福感的认知。
