Advanced primary care in San Antonio: linking practice and community strategies to improve health.
J Am Board Fam Med
; 26(3): 288-98, 2013.
Article
em En
| MEDLINE
| ID: mdl-23657697
ABSTRACT
Improving health among people living in poverty often transcends narrowly focused illness care. Meaningful success is unlikely without confronting the complex social origins of illness. We describe an emerging community of solution to improve health outcomes for a population of 6000 San Antonio, Texas, residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses. Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores (community health workers) whose mission encompasses change at both the individual and community levels. Centered on patients' functional goals, promotores mobilize family and community resources and consider what community-level action will address the social determinants of health. On the clinical side, care teams implement population-based risk assessment and nurse care management with a focus on care transitions as well as other measures to meet the needs of patients with high morbidity and high use of health care. Population-based outcome metrics include reductions in hospitalizations, emergency department and urgent care visits, and the associated charges. Promotores also assess patients' progress along the trajectory of their selected functional goals.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Serviço Social
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Saúde Pública
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Cuidados de Saúde não Remunerados
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Serviços de Saúde Comunitária
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Medicina de Família e Comunidade
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Parcerias Público-Privadas
/
Internato e Residência
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Sysrev_observational_studies
Aspecto:
Determinantes_sociais_saude
/
Equity_inequality
/
Implementation_research
/
Patient_preference
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Board Fam Med
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Estados Unidos
País de publicação:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA