The Community
Health Access Project (CHAP) implemented the Pathways Model, which
employs community health workers who connect at-risk individuals to
evidence-based care through the use of individualized care pathways
designed to produce healthy outcomes. This model promotes timely,
efficient care coordination through incentives and prevents service
duplication through use of a Community Hub, a regional point of patient
registration and quality assurance supporting a network of agencies
involved in providing care to the target population. The first
implementation of the model in Richland County, OH, resulted in
increased services to at-risk women and a decline in the rate of low
birth weight babies.
See the Description of the Innovative Activity section for new
information on identifying individuals at risk, the references section
for new resources, the Resources Used and Skills Needed for more
information on program costs, the Adoption Considerations for advice on
developing appropriate reporting and evaluation strategies and
developing pathways that function as quality assessment tools, and the
Use By Other Organizations section for new information on the Care
Coordination Learning Network (updated June 2010, AHRQ Innovations Exchange).
