Shreya Kangovi1, David Grande2, Tamala Carter3, Frances K Barg4, Marisa Rogers5, Karen Glanz6, Richard Shannon5, Judith A Long7. 1. Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, United States; Spectrum Health Services, Inc., United States; Penn Center for Community Health Workers, United States. Electronic address: kangovi@mail.med.upenn.edu. 2. Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 3. Penn Center for Community Health Workers, United States. 4. Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, United States. 5. Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States. 6. Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 7. Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Philadelphia VA Center for Health Equities Research and Promotion, United States.
Abstract
BACKGROUND: Policymakers, patients and clinicians are increasingly eager to foster patient involvement in health care innovation. Our objective was to use participatory action research with high-risk hospitalized patients to design a post-hospital transition intervention. METHODS: We conducted qualitative interviews with sixty-five low-income, recently hospitalized patients exploring their perceptions of barriers to post-hospital recovery and ideas for improvement. We then used a modified grounded theory approach to design an intervention that would address each barrier using patients׳ suggestions. RESULTS: Five key themes were translated into design elements. First, patients wished to establish a relationship with healthcare personnel to whom they could relate. The intervention was provided by an empathic community health worker (CHW) who established rapport during hospitalization. Second, patients suggested tailoring support to their needs and goals. CHWs and patients designed individualized action plans for achieving their goals for recovery. Third, patient goals were misaligned with those of the inpatient team. CHW facilitated patient-provider discharge communication to align goals. Fourth, patients lacked post-discharge support for predominantly psychosocial or financial issues that undermined recovery. CHWs provided support tailored to patient needs. Finally, patients faced numerous barriers in obtaining post-hospital primary care. CHWs helped patients to obtain timely care with a suitable provider. CONCLUSIONS: Low-income hospitalized patients voiced needs and suggestions that were directly translated into the design of a scalable patient-centered CHW intervention. IMPLICATIONS: The approach of using participatory action research to tightly mapping patient input into intervention design is rapid and systematic strategy for operationalizing patient involvement in innovation.
BACKGROUND: Policymakers, patients and clinicians are increasingly eager to foster patient involvement in health care innovation. Our objective was to use participatory action research with high-risk hospitalized patients to design a post-hospital transition intervention. METHODS: We conducted qualitative interviews with sixty-five low-income, recently hospitalized patients exploring their perceptions of barriers to post-hospital recovery and ideas for improvement. We then used a modified grounded theory approach to design an intervention that would address each barrier using patients׳ suggestions. RESULTS: Five key themes were translated into design elements. First, patients wished to establish a relationship with healthcare personnel to whom they could relate. The intervention was provided by an empathic community health worker (CHW) who established rapport during hospitalization. Second, patients suggested tailoring support to their needs and goals. CHWs and patients designed individualized action plans for achieving their goals for recovery. Third, patient goals were misaligned with those of the inpatient team. CHW facilitated patient-provider discharge communication to align goals. Fourth, patients lacked post-discharge support for predominantly psychosocial or financial issues that undermined recovery. CHWs provided support tailored to patient needs. Finally, patients faced numerous barriers in obtaining post-hospital primary care. CHWs helped patients to obtain timely care with a suitable provider. CONCLUSIONS: Low-income hospitalized patients voiced needs and suggestions that were directly translated into the design of a scalable patient-centered CHW intervention. IMPLICATIONS: The approach of using participatory action research to tightly mapping patient input into intervention design is rapid and systematic strategy for operationalizing patient involvement in innovation.
Authors: Charlotte M Lewis; Thelma Gamboa-Maldonado; Juan Carlos Belliard; Anna Nelson; Susanne Montgomery Journal: J Ambul Care Manage Date: 2019 Jan/Mar
Authors: Shreya Kangovi; Nandita Mitra; David Grande; Hairong Huo; Robyn A Smith; Judith A Long Journal: Am J Public Health Date: 2017-08-17 Impact factor: 9.308
Authors: Elizabeth Enlow; Laura J Faherty; Sara Wallace-Keeshen; Ashley E Martin; Judy A Shea; Scott A Lorch Journal: Pediatrics Date: 2017-02-21 Impact factor: 7.124