title: Expanding the safety net of specialty care for the uninsured: a case study.
abstract: OBJECTIVE
  To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured.
  
  
  METHODS
  Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation.
  
  
  METHODS
  Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations.
  
  
  RESULTS
  Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings.
  
  
  CONCLUSIONS
  Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phipps
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Wang
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lagarde
authors.forename: Georgina I
authors.initials: GI
authors.lastname: Lucas
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D002608:Charities / Q000458:organization & administration; D002908:Chronic Disease; D055812:Community-Based Participatory Research / Q000458:organization & administration*; D003237:Connecticut; D003299:Cooperative Behavior; D005260:Female; D005381:Financing, Organized / Q000458:organization & administration; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006761:Hospitals; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D017057:Medically Uninsured; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D012959:Socioeconomic Factors
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