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Reverse innovation and community engagement to improve quality of care and patient outcomes
Investigator (PI): Wu, Albert
Performing Organization (PO): (Current): Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Center for Health Services and Outcomes Research / (410) 955-6567
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2017
Record Source/Award ID: PCORI/CD-12-11-4948
Funding: Total Award Amount: $2,026,803
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: The residents of urban centers suffer from many health and social problems. In East Baltimore (EB), many barriers frustrate residents' aspirations to achieve health and well-being. Community-based organizations (CBO) can help but reach only a fraction of potential clients. Hospitals, providers, and community members often are unaware of available medical and community-based services. Community engagement can improve understanding and use of health care services, thereby improving patient outcomes. We propose to adapt a World Health Organization community engagement approach to support the Johns Hopkins (JH) Community Health Partnership (J-CHiP), an initiative targeting high-risk adults with chronic conditions who reside in surrounding ZIP codes. The overall goals are to improve the health of EB residents by enhancing communication and "co-developing" a community engagement partnership between JH hospitals and clinics, CBOs, and community. The specific aims are to (1) adapt a community engagement approach to five EB ZIP codes to develop an intervention to strengthen the partnership and bidirectional flow of information about health and human services between JH hospitals and clinics, ten selected CBOs, and residents of surrounding neighborhoods; (2) apply the co-developed intervention to the ten CBOs and J-CHiP staff; and (3) evaluate the effectiveness of the intervention on patient, CBO, and J-CHiP outcomes. In aim 1, selected CBOs will co-develop resource materials, systems, and procedures to function in the enhanced referral network, including an atlas of community assets, and a system to track the services CBOs deliver. Aim 2 will deliver the intervention to selected CBOs and J-CHiP staff. For each of 1,260 J-CHiP patients, we will designate a "closest" CBO, based on prior use and geographic distance. Aim 3 will evaluate the program using a randomized design. Patients whose closest CBO is an intervention CBO (iCBO) will be compared to controls with non-iCBOs. The primary outcome for each patient is change in number of ED visits + hospital days. Additional patient outcomes will include self-reported access to care, self-efficacy, and satisfaction with care. Additional pre- and post-analyses will compare the number of services delivered by intervention CBOs and outcomes for J-CHiP workers. We will also use case study methods to examine how iCBOs work in their new role with patient and J-CHiP stakeholders. Stakeholder input, especially from community members, has been incorporated at every step of the project, including proposal development and community-selected lead and co-investigators. The project will create a locally designed and evaluated referral and follow-up system that will extend care networks from hospitals and clinics to community partners, thereby improving community-wide care coordination that meets the medical and social needs of people with chronic conditions. If successful, it could be sustained and replicated in other communities.
MeSH Terms:
  • Baltimore
  • Chronic Disease /therapy
  • Community Health Services /*organization & administration
  • * Community-Institutional Relations
  • Continuity of Patient Care
  • Geography
  • Health Promotion
  • Humans
  • * Outcome Assessment, Health Care
  • Program Development
  • * Quality of Health Care
  • Randomized Controlled Trials as Topic
  • Referral and Consultation
  • Residence Characteristics
  • World Health Organization
Country: United States
State: Maryland
Zip Code: 20105
UI: 20143183
CTgovId: NCT02222909
Project Status: Completed
Record History: ('2017: Project extended to 2017.',)