The CVP recognizes policy as a critically important vehicle to address the burden of chronic disease for vulnerable populations. Below are some examples of ways in which the CVP has advanced the public policy agenda for vulnerable populations faced with chronic disease, and in support of the practitioners and systems that disproportionately serve these populations.
ATSM Adapted Across Diverse Clinical SettingsDr. Dean Schillinger worked with the Central Coast Alliance for Health to adapt an automated telephone symptom management (ATSM) program for nearly 300 members with diabetes in the Monterrey and Merced area. Half of CCAH members are mono-lingual Spanish speakers. Additionally, Asian Health Services in Oakland is adapting the ATSM program for about 150 Cantonese speaking patients.
Computerized, Multilingual Visual Medication Schedule and Teach-Back Protocols Improve Anticoagulation Control for Low-Literacy PatientsThe Agency for Health Research and Quality (AHRQ) recognized Dr. Schillinger’s work developing and implementing a visual medical schedule (VMS) and teach-back protocol to address anticoagulation control for underserved patients at SFGH. The VMS is a single piece of paper that includes digitized images of the patient’s warfarin regimen on a weekly calendar. The words are printed in English and, if appropriate for the patient, in Spanish or Cantonese as well. After describing the updated warfarin dose illustrated on the VMS, a clinical staff member asks the patient to repeat the dosing schedule (teach-back method), and, if necessary, corrected his or her understanding one time only. The teach-back method was designed to reinforce the VMS in a manner that approximates how a typical clinician would interact with the patient, serving as a “double check” to make sure that the patient does not misinterpret the VMS, leading to potential harm. The New York University/Bellevue Medical Center adopted this innovation.
Link: Innovations AHRQ
Automated, Telephone-Based Interactive, Language-Appropriate Monitoring Engages and Improves Health Behaviors of Low-Income Diabetes PatientsThe Automated Telephone Diabetes Management (ATDM) program, a part of the Improving Diabetes Efforts Across Language and Literacy (IDEALL) project, provided automated telephone monitoring of individuals with poorly controlled type II diabetes who receive their care at four safety net clinics in San Francisco. An adjunct to regular clinic care, the system made weekly automated, interactive calls to participants in their native language (English, Spanish, or Cantonese), with follow up calls made as needed by a nurse care manager with appropriate language skills. Preliminary results suggest the intervention engaged patients in the self-management of their condition, improved health behaviors, increased detection of adverse and potentially adverse situations, and significantly enhanced the capacity of nurse managers to serve patients. Kaiser Medical Center in Southern California is implementing this innovation in their clinics.
Link: Innovations AHRQ