This program will focus on engaging Group Health patients to help create and test a role within primary care that will connect primary care teams with community resources such as the YMCA and support groups. Stronger clinic-community links are expected to help people get the health resources they need to manage their chronic conditions successfully over the long haul. Chronic conditions include diabetes, depression, and asthma. This strategy has the potential to increase patients' ability to get what they need from both their community and their health care. Our goals are to: 1) Create new ways to involve patients in designing their own health care by developing processes and tools to help patients contribute ideas for how care should be designed. and 2) Design and test a new clinic-community liaison role for primary care teams. The liaison will help patients access the healthcare and community resources they need to prevent and treat chronic conditions. The program will seek to determine how the liaison affects the outcomes that patients care about most. Outcome measures will include include patient experience and satisfaction, quality of care, quality of life, and efficient use of both patient and healthcare resources.
