Morehouse School of Medicine, Atlanta, GA, USA.
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720968456. doi: 10.1177/2150132720968456.
The Morehouse School of Medicine Patient Centered Medical Home and Neighborhood Project was developed to implement a community-based participatory research driven, integrated patient-centered medical home and neighborhood (PCMH) pilot intervention. The purpose of the PCMHN was to develop a care coordination program for underserved, high-risk patients with multiple morbidities served by the Morehouse Healthcare Comprehensive Family Health Clinic.
A community needs assessment, patient surveys and provider interviews were administered.
Among a panel of 367 high-risk patients and potential participants, 93 participated in the intervention and 42 patients completed the intervention. The patients self-reported increased utilization of community support, increased satisfaction with health care options, and increased self-care management ability.
The results were largely attributable to the efforts of community health workers and targeted community engagement. Lessons learned from implementation and integration of a community-based participatory approach will be used to train clinicians and small practices on how to affect change using a care coordination model for underserved, high-risk patients emphasizing CBPR.
莫尔豪斯医学院以患者为中心的医疗之家和邻里项目旨在实施一个基于社区的参与式研究驱动的、综合的以患者为中心的医疗之家和邻里（PCMH）试点干预措施。PCMHN 的目的是为莫尔豪斯医疗保健综合家庭健康诊所服务的多种合并症的服务不足、高风险患者开发一个护理协调计划。
进行了社区需求评估、患者调查和提供者访谈。
在 367 名高危患者和潜在参与者中，有 93 名参与了干预，42 名患者完成了干预。患者自我报告增加了对社区支持的利用，对医疗保健选择的满意度提高，自我护理管理能力增强。
这些结果主要归因于社区卫生工作者的努力和有针对性的社区参与。从实施和整合基于社区的参与式方法中学到的经验教训将用于培训临床医生和小型实践，了解如何使用以关怀为基础的研究为服务不足、高风险患者强调 CBPR 的护理协调模式来影响变革。
