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The Door-to-Door program was designed to address the barriers to social service and medical care faced by recent immigrants to Chicago. Based on specific needs identified by the community-based agencies associated with the Chicago Hispanic Health Coalition and other community-based agencies associated with the Chicago Department of Public Health, a system of community outreach workers was established. Funding for the program was made available by a grant from the Office of Minority Health, the Illinois Department of Commerce and Community Affairs, along with matching funds from the Chicago Department of Public Health and participating community agencies.
The Chicago Hispanic Health Coalition (CHHC), in collaboration with the National Alliance for Hispanic Health, American Heart Association, American Diabetes Association, Telligen, UI Health, and Pilsen Family Health Center Lower West, in partnership with academic, professional and community-based health and human services organizations, will develop a one-year patient navigator (PN) demonstration program, Door to Door. It will focus on: Type 2 diabetes, asthma, cancer, hypertension, and related overweight-obesity, physical activity, and tobacco risk factors. Its goal is to delay the onset of chronic diseases and their complications that result in morbidity, mortality, and associated disabilities by improving the coordination of services and continuity of care. Due to the high prevalence of chronic disease such as diabetes, asthma, cardiovascular, and cancer among Hispanic/Latinos (H/L) in Illinois are a significant challenge for the medical systems and public health. Trained PNs will assess participant needs and link them to health and human services organizations. PNs will provide education on how to navigate the healthcare system; reduce institutional, linguistic, and cultural barriers to accessing and using the healthcare system; and provide support for the prevention and self-management. This project builds upon the experience of a patient navigator program implemented by the Chicago Department of Public Health (CDPH)’s Chicago Hispanic Health Coalition (1992-2007) that served over 12,000 Hispanic clients. The PNs will be recruited from a pool of active community volunteers and will be culturally and linguistically competent, fully trained, and familiar with the community. D2D will target participants who (a) reside in the target area, (b) are of Hispanic/Latino origin of any age; (c) have a chronic condition or are “at risk” due to lifestyle practices. Participants will be recruited through a referral system according to the Federal Qualified Health System. The project will be implemented in two phases: (1) Planning & Development includes infrastructure building; recruitment and training of PNs; development of evaluation instruments, protocols, and tracking systems. (2) The second phasewill have two complementary components: (1) the Person-to-Person Service component (5 PNs) will link individuals and advocacy services, keeping appointments, interpreting, securing transportation, “self-management” support, etc.; and (2) the Remote Support Services will facilitate communication among providers.