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    Community Health Worker- Medicine - Baltimore, United States - University of Maryland Faculty Physicians

    University of Maryland Faculty Physicians
    University of Maryland Faculty Physicians Baltimore, United States

    1 week ago

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    Description


    The Maryland Quality Improvement Program (M-QIP) has been designed to address significant health issues among the West Baltimore Medicaid population.

    The Diabetes and Chronic Disease Management Program strives to manage diabetes in the Medicaid population by creating an inpatient diabetes consult team.

    FPI's analysis of inpatient records demonstrates that as many as 30% of all persons seen in the inpatient setting have recorded elevated blood glucose levels during their stay.

    Taking a proactive approach to controlling blood glucose levels for these patients will lead to shorter lengths of stay, reduced readmissions, and better outcomes from surgeries which will consult on all cases with a blood glucose level above an established threshold.

    This team will also work to engage patients identified through this program who have diabetes or pre-diabetes in follow-up care to manage their chronic conditions on an outpatient basis.

    Under the supervision of the Community Health Worker (CHW) would assist with community engagement and outreach.

    The CHW plays a vital role in recruiting clients from the community who may benefit from the Glucose Management Team's services.

    They proactively identify and screen individuals, helping to ensure that the program reaches its intended target audience effectively.

    The CHW acts as a bridge between patients and healthcare providers by scheduling appointments, providing information, and assisting with transportation and social services arrangements.

    This directly contributes to improved access to ambulatory care for diabetes patients, which is essential for properly managing the condition.

    They would act as a liaison between clients and community resources, including social services agencies; the CHW helps clients access additional support that can enhance their overall well-being.

    This can include services like nutrition assistance, housing support, and more. The CHW's follow-up efforts, including reminders and home visits, increase client retention.

    By maintaining contact and addressing any barriers to participation, the CHW helps ensure that clients remain engaged with the program, ultimately leading to better health outcomes.

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