White River Family Practice in Collaboration with the Geisel School of Medicine at Dartmouth College:
The purpose of this sub-grant is to measure and reduce emergency room use and hospital readmission by intervening to increase patients’ level of self-confidence with respect to their health. The project follows patients’ reported measure of health confidence over time. Using the self-confidence measure, the project stratifies patients with chronic disease and targets appropriate interventions. The care coordination team is performing ongoing intensive management of a group of clients with high utilization of the emergency room and hospital readmission. By training staff in motivational interviewing and deploying team-based care protocols to identify patients at risk, White River Family Practice (WRFP) has been able to discern a measureable increase in health confidence among the individuals in their intervention group.