Our recipes are primers that will help you explore and implement care strategies to benefit your providers, patients, and practice. You can search for the available recipes by keywords, or browse using the filters below.

Building Community Linkages to Address SDOH via eConsults @ Public Health System Los Angeles County Department of Health

This project utilized analysis of eConsults from a metropolitan county-level public services agency and its affiliated health centers to a community-based health and social services…

Innovators

  • Tony Kuo, MD, MSHS
  • Noel Barragan, MPH, MBA
  • Amelia DeFosset, MPH
  • Janina Morrison, MD, MPH

Improving Diabetes Care via Medical Assistants and Community Health Workers @ Northern California Community Health Centers

This project at a group of community health centers implemented a new medical assistant and community health worker-led diabetes care management program to study differential…

Innovators

  • Hector P. Rodriguez, MD, MPH
  • Mark W. Friedberg, MD
  • Arturo Vargas-Bustamante, PhD, MA, MPP
  • Xiao Chen, PhD
  • Ana E. Martinez, MPH
  • Dylan H. Roby, PhD

Employing Community Health Workers (CHWs) to Improve Population Health via the IMPaCT Model @ Penn Center for Community Health Workers

The IMPaCT (Individualized Management of Patient-Centered Targets) model is a standardized, scalable, evidence-based Community Health Worker (CHW) intervention proven to improve chronic disease control, quality…

Innovators

  • Shreya Kangovi, MD, MS
  • Scott Tornek, MBA
  • Olenga Anabui, MBA, MPH
  • Jill Feldstein, MPA
  • Tamala Carter

Improving Care Coordination via Johns Hopkins Community Health Partnership (J-CHiP) @ Johns Hopkins Medicine

Johns Hopkins Community Health Partnership (J-CHiP) is a three-pronged care coordination program with comprehensive community support for a cohort of high-risk patients, enhanced discharge procedures…

Weight Management for Patients with Serious Mental Illness via “Weight Web” Computerized Peer Coaching @ Greater Los Angeles VA Medical Center

A computerized provision of weight management with peer coaching for VA patients with serious mental illness

Innovators

  • Alexander Young, MD MSHS

Screening, Brief Intervention, & Referral to Treatment for Social Determinants of Health @ Intermountain Health Care

Intermountain Healthcare created a Social Determinants of Health Committee in order to devise a strategic plan with which to address social determinants of health for…

Innovators

  • Elizabeth Joy, MD MPH FACSM

Chronic Disease Management via Health Coaches, Wearables, and SMS Integration @ UCLA Health

This intervention trained pre-medical students to serve as health coaches in an integrated SMS-based and wearable-tracker-based 16-week-long chronic disease prevention program in a primary care…

Innovators

  • Daniel Croymans, MD MBA MS
  • Paul Bixenstine, MD

Wellness Navigators for Social Determinants of Health @ LA+USC Medical Center

Use of clinic-based Community Health Workers to address social determinants of health

Innovators

  • Janina Morrison MD, MPH