Patient perceptions of a community-based care coordination system.

Community health workers (CHWs) work with health professionals to improve health outcomes by facilitating community-based health education and increase access and continuity to health services within a community. Uninsured, low-income participants of a community-based program, Project Access Dallas, participated in focus group sessions for determining participants' perceptions of CHW effectiveness and participants' abilities to independently manage their health needs. Of the 95 adults invited, 24 (25.3%) attended. Participants reported that CHWs are an invaluable asset in learning how to navigate the health care system, obtaining appointments and being better able to care for themselves with CHW emotional/psychological support. Results suggest that CHWs in a case management model improved patient comprehension of health issues, patient navigation through a health care system, and patients' abilities to independently manage health issues. Implementation of CHWs within a case management model appears to be an effective mechanism for providing health services to underserved populations.

Insights from practice-based researchers to develop family medicine faculty as scholars.

BACKGROUND AND OBJECTIVES: National mandates call for accelerating scholarly development of family medicine faculty. One strategy to address these mandates is training more faculty to participate in practice-based research (PBR). We need to determine competencies that enable faculty to conduct PBR, methods for training faculty in PBR, and strategies to streamline PBR operations in clinics. METHODS: Through a qualitative literature review process, we identified faculty knowledge, attitudes, and skills thought to promote PBR. We then conducted structured interviews with a sample of PBR experts to explore their experience with and opinions about PBR: What knowledge, attitudes, and skills support PBR? What types of training will prepare family physicians to participate in and conduct PBR? What factors in the ambulatory clinical setting facilitate the success of PBR? What are the most important barriers to conducting PBR? RESULTS: Recommendations for PBR teaching and learning fell within the topic areas of scope of training, teaching methods, essential knowledge, and organizational environment. The most frequent expert recommendation was that all clinical practice and teaching settings should offer participatory research training for faculty, learners, and staff on an ongoing basis. Lack of funding and scarcity of time are the greatest impediments to conducting PBR. Additional barriers include lack of interest, lack of motivation, and lack of PBR knowledge and skills. Success in PBR often begins with an enthusiastic PBR champion whose characteristics include passion, initiative, and reflectiveness. Through organizational development, PBR champions can foster enthusiasm and commitment on the part of colleagues, administrators, and staff. It is important to continue to enhance PBR skill development opportunities at national meetings and to foster dissemination of PBR findings through presentations and publications. CONCLUSIONS: To foster growth and success of practice-based researchers, we should implement and sustain comprehensive multi-level training in PBR and nurture a culture of ongoing inquiry in family medicine. A culture conducive to PBR offers opportunities for continual development of enthusiastic, informed, and skilled faculty whose interdisciplinary teams conduct PBR and develop physicians in training as future practice-based researchers.