Page 11 - Cleveland Clinic Akron General

“To really help our neighbors thrive, we must look beyond what we see on their health charts when they are in our exam rooms. We must work with them on daily issues of safe housing, transportation, education and employment.” — Deborah Plate, MD, Chair of the Center for Family Medicine
PHILANTHROPY PRIORITY:
Improving the Health of Patients with
Chronic Diseases
TACKLING SOCIAL DETERMINANTS OF HEALTH
Among adults in America, chronic disease is the leading cause of death and disability. While regularly scheduled visits with a physician are important to manage chronic disease, only 20% of overall health is determined by clinical care. The remaining 80% of health is determined by the physical environment, individual health behaviors, and social and economic factors, all of which are considered social determinants of health. Examples of social determinants of health include safe housing, transportation, education and employment.
The Center for Family Medicine will address chronic diseases and social determinants of health with strategic investments. A full time social worker will soon help patients navigate healthcare and social service provider. The currently embedded Licensed Independent Social Worker will expand from part time to full time to provide behavioral health counseling to patients. And, Akron General’s first Community Health Workers will soon
educate and help our patients with disease management.
In partnership with Akron’s Pathways Community HUB,
our Community Health Workers will provide in-home visits
for health education, care coordination, and advocate for individuals in need of assistance. The pilot phase will focus on assisting diabetic Akron General patients who are not completing regular visits. A cohort has been identified in zip codes 44320, 44306, 44310 and 44307, which are in
the lowest per capita income category, at less than $18,000 annual income, according to census data. The Community Health Workers will also note social determinants of health the patients face and connect the patients with social services and other resources to improve individual quality of life.
Outcomes of the pilot phase will inform an action plan for expanding community care for residents with diabetes and other chronic diseases.
11