The National Association of Community Health Centers (NACHC) is working with 20 health centers in 16 states on a pilot project offering tools for self-care and remote monitoring for better patient health.
With many U.S. adults delaying preventive care and with six in 10 having at least one chronic condition including heart disease, cancer, and diabetes, regular health management is a matter of life and death with added Covid-19 risks. A large population of high-risk patients who are more likely to suffer from a disproportionate array of chronic conditions are cared for by community health centers.
Participants in the “Leading Change: Transforming At-Home Care,” pilot project are testing innovative approaches to manage care and offer preventive services in the safety of patients’ homes.
In the 10-month pilot project (September 2020 – June 2021), participating health centers receive 20 Patient Care Kits to be distributed to patients for virtual care and remote patient monitoring. The pilot is testing the impact of patient self-care tools offered in connection with care team support, monitoring, and follow-up in a virtual care setting. It also is developing health center and patient care models and workflows for the use of Patient Care Kits and remote patient monitoring in a virtual setting.
The kits include home colorectal cancer screening (stool) test, home blood sugar (A1c) test, blood pressure monitor, thermometer, and a scale. They also include educational and instructional materials for health center staff and patients as well as logs and other recording tools for health center staff and patients.
One cohort of 10 health centers is supported through a cancer screening project developed with support from the Centers for Disease Control and Prevention (CDC) cooperative agreement, and another cohort of 10 health centers is supported through a diabetes control project developed with support from the Health Resources and Services Administration (HRSA).
“We’ve seen a huge reduction in the number of patients with chronic conditions that we can regularly see, so this strategy to provide patients with the tools and information they need to care for themselves at home with our help, will make a tremendous difference in their lives,” said Robert Spencer, CEO of Kintegra Health in Gastonia, N.C., in a statement. Kintegra Health is a community sponsored, family-centered provider of healthcare, health education and preventive care services without regard for the ability to pay.
“It’s important we continue to see patients with chronic conditions throughout the pandemic,” said Beth Weitensteiner, M.D., of Seattle-based International Community Health Services (ICHS) in a statement. “This strategy provides them with tools and information they can use to care for themselves at home with our help. Further empowering patients allows us to better identify new symptoms and potential emergencies, which could be lifesaving.”
Since its founding in 1973, ICHS has grown from a single storefront clinic in Seattle’s Chinatown-International District with deep roots in the Asian Pacific Islander community, to a regional health care provider employing more than 600 people and serving over 32,000 patients at 11 clinic locations. Weitensteiner, assistant medical director of the ICHS Holly Park Clinic, is leading ICHS’s participation in the project.
One of the goals of the pilot project is that participants will provide lessons and best practices that will be shared with health centers nationally.
