Health Centers Reimagine Preventive Care and Chronic Disease Management with an Exciting Pilot for At-Home Care


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Accordia Health is excited and extremely honored to be chosen for this timely initiative.



The COVID-19 pandemic has forced health systems to reimagine how to effectively manage preventive care and chronic diseases when regular in-person visits are difficult or no longer feasible. With many U.S. adults delaying preventive care, and with 6 in 10 having at least one chronic condition including heart disease, cancer, and diabetes, regular health management is a matter of life and death with added COVID-19 risks. A large population of high-risk patients who are more likely to suffer from a disproportionate array of chronic conditions is cared for by community health centers.

To address this problem, The National Association of Community Health Centers (NACHC) developed a cutting-edge pilot project with 20 select health centers in 16 states around the country that will now offer patients their own self-care tools and remote patient monitoring to prevent unnecessary health problems. NACHC’s project is called “Leading Change: Transforming At-Home Care.”

Accordia Health is excited and extremely honored to be chosen for this timely initiative,” says Beth Edwards, Accordia Health director of Health Center Operations. “The strategy to provide patients with the tools and information they need to care for themselves at home with our help will make a tremendous difference in their lives.”

Twenty high-risk patients from Accordia Health’s Bayou La Batre location will be given a Patient Care Kit that includes a home kit for colorectal cancer screening, a home blood-sugar monitor for diabetes, a blood pressure monitor, a thermometer, and a scale. Patients will also receive educational materials and regular virtual visits from clinic staff. The clinic staff will receive technical assistance from NACHC.

The pilot is funded by the Division of Cancer Control and Prevention at the Centers for Disease Control and Prevention (CDC) and is designed to capture data through June 2021. It officially began on September 24th.

NACHC’s Quality Center is excited to launch this initiative. “This pandemic has shown us how community health center partners can step-up to transform our local healthcare systems and lead us into the future with new blended care delivery models that include at-home self-care integrated with virtual care. These steps have the potential to critically improve the way preventive care and chronic diseases are managed during and beyond this pandemic.”

Accordia Health is the primary care division of AltaPointe Health. AltaPointe Health is Alabama’s most comprehensive health and human services organization that provides more than 1 million services each year through its mental health, substance abuse, intellectual disabilities, and primary care divisions.

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