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Katie Dawson has walked around Boston with a homeless patient to help her find a place to live. She has visited other patients in their homes and accompanied them to nearly 100 primary care appointments. She has guided many more in applying for food assistance or obtaining a social security card. She is currently connecting one patient with resources to learn how to read.
The soft-spoken and calm Dawson is the first community health worker at Brigham and Women's Advanced Primary Care Associates, South Huntington, in Jamaica Plain. A member of the patient-centered medical home, Dawson works with the practice's most complex patients, acting as a guide, advocate and care facilitator.
"It is a unique approach to supporting patients who are high utilizers of inpatient and emergency services," said South Huntington practice manager Linda Jo Stern, MPH. "Katie supports and accompanies patients on medical appointments and out in the community, helps them navigate the complex medical and health care environment and works with them on health literacy issues."
Despite the South Huntington medical home's successes, the practice was finding that a cohort of roughly 100 medically and psychosocially complex patients were failing the model-as defined by unnecessary health care utilization and avoidable progression of disease. So last year, when the Brigham and Women's Physicians Organization established the Care Redesign and Incubator Startup Program (BCRISP), allowing teams of frontline clinicians to submit project ideas that would improve quality of care and reduce health care costs, South Huntington submitted a proposal.
Under the leadership of Medical Director Stuart Pollack, MD, the practice sought to integrate a community health worker into its team to work with these high-risk patients. The practice was one of six finalists to receive funding and be piloted, and Dawson joined the team shortly after in September 2013.
In the first five months of the pilot, the number of emergency department visits by these patients decreased by 5 percent, hospitalizations by 16 percent and 30-day readmissions by 39 percent. The practice predicts a projected annual savings of $200,000 to $250,000.
"Katie's success-whether measured in increased patient satisfaction, better clinical outcomes or decreased unnecessary and costly utilization of health care resources-is another, striking example of the impact that fully functional teams can have in improving health care," said Joseph Frolkis, MD, PhD, vice chair for Primary Care in BWHC's Department of Medicine. "We remain committed to building such teams in all 14 of our primary care practices so that all our patients can experience these benefits."
With a caseload of 12 patients, Dawson is thrilled to be part of the team and serving the patients who most need her help-patients who have difficulties navigating the health system because their "lives are chaotic" and "chronically disorganized," she says. Her academic background in criminal justice and psychology combined with her past experience as a case worker for children experiencing abuse have guided her passion for helping people and working in the community.
"I go home every day feeling very rewarded," she said. "I'm touched by the accomplishments of the pilot and the team." She hopes funding will be extended for another year and that community health workers will be integrated into other BWH primary care practices as well.
Says one of her patients: "[Before working with Katie,] I really didn't want to do anything for myself. I didn't want to leave the house sometimes. She helped me open up and . . . started coming to appointments and asked questions I didn't think of. She advocates for me. She calls my doctors and they listen to her. She became part of my family."