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CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

ABSTRACT: The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to generate an inventory of 14,914 health-promoting resources; and a health information technology (IT) platform that was integrated with three electronic health record systems at thirty-three clinical sites. By mapping thirty-seven prevalent social and medical conditions to community resources, CommunityRx generated 253,479 personalized HealtheRx prescriptions for more than 113,000 participants. Eighty-three percent of the recipients found the HealtheRx very useful, and 19 percent went to a place they learned about from the HealtheRx. All but one organization continued using the CommunityRx system after the study period ended. This study demonstrates the feasibility of using health IT and workforce innovation to bridge the gap between clinical and other health-promoting sectors.

SUBMITTER: Lindau ST

PROVIDER: S-EPMC5573228 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

Lindau Stacy T ST Makelarski Jennifer J Abramsohn Emily E Beiser David G DG Escamilla Veronica V Jerome Jessica J Johnson Daniel D Kho Abel N AN Lee Karen K KK Long Timothy T Miller Doriane C DC

Health affairs (Project Hope) 20161101 11

The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to gen ...[more]

PMID: 27834242

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Project description:ObjectivesTo examine barriers and facilitators to sustaining a sexual health continuous quality improvement (CQI) programme in clinics serving remote Aboriginal communities in Australia.DesignQualitative study.SettingPrimary health care services serving remote Aboriginal communities in the Northern Territory, Australia.ParticipantsSeven of the 11 regional sexual health coordinators responsible for supporting the Northern Territory Government Remote Sexual Health Program.MethodsSemi-structured in-depth interviews conducted in person or by telephone; data were analysed using an inductive and deductive thematic approach.ResultsDespite uniform availability of CQI tools and activities, sexual health CQI implementation varied across the Northern Territory. Participant narratives identified five factors enhancing the uptake and sustainability of sexual health CQI. At clinic level, these included adaptation of existing CQI tools for use in specific clinic contexts and risk environments (eg, a syphilis outbreak), local ownership of CQI processes and management support for CQI. At a regional level, factors included the positive framing of CQI as a tool to identify and act on areas for improvement, and regional facilitation of clinic level CQI activities. Three barriers were identified, including the significant workload associated with acute and chronic care in Aboriginal primary care services, high staff turnover and lack of Aboriginal staff. Considerations affecting the future sustainability of sexual health CQI included the need to reduce the burden on clinics from multiple CQI programmes, the contribution of regional sexual health coordinators and support structures, and access to and use of high-quality information systems.ConclusionsThis study contributes to the growing evidence on how CQI approaches may improve sexual health in remote Australian Aboriginal communities. Enhancing sustainability of sexual health CQI in this context will require ongoing regional facilitation, efforts to build local ownership of CQI processes and management of competing demands on health service staff.

Project description:The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This study indicates the SM provides a potentially useful approach to measuring teams' views on the likelihood of sustainability and prompting action. Securing engagement of teams with the SM was challenging and redesign of elements may need to be considered. Capacity building and facilitation appears necessary for teams to effectively deploy the SM.

Project description:Biodiversity is sustained by and is essential to the services that ecosystems provide. Different species would use these services in different ways, or adaptive strategies, which are sustained in time by continuous innovations. Using this framework, we postulate a model for a biological species (Homo sapiens) in a finite world where innovations, aimed at increasing the flux of ecosystem services (a measure of habitat quality), increase with population size, and have positive effects on the generation of new innovations (positive feedback) as well as costs in terms of negatively affecting the provision of ecosystem services. We applied this model to human populations, where technological innovations are driven by cumulative cultural evolution. Our model shows that depending on the net impact of a technology on the provision of ecosystem services (θ), and the strength of technological feedback (ξ), different regimes can result. Among them, the human population can fill the entire planet while maximizing their well-being, but not exhaust ecosystem services. However, this outcome requires positive or green technologies that increase the provision of ecosystem services with few negative externalities or environmental costs, and that have a strong positive feedback in generating new technologies of the same kind. If the feedback is small, then the technological stock can collapse together with the human population. Scenarios where technological innovations generate net negative impacts may be associated with a limited technological stock as well as a limited human population at equilibrium and the potential for collapse. The only way to fill the planet with humans under this scenario of negative technologies is by reducing the technological stock to a minimum. Otherwise, the only feasible equilibrium is associated with population collapse. Our model points out that technological innovations per se may not help humans to grow and dominate the planet. Instead, different possibilities unfold for our future depending on their impact on the environment and on further innovation.This article is part of the themed issue 'Process and pattern in innovations from cells to societies'.

Dataset Information

CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

Publications

CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

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