title: The use of participatory action research to design a patient-centered community health worker care transitions intervention.
abstract: BACKGROUND
  Policymakers, patients and clinicians are increasingly eager to foster patient involvement in health care innovation. Our objective was to use participatory action research with high-risk hospitalized patients to design a post-hospital transition intervention.
  
  
  METHODS
  We conducted qualitative interviews with sixty-five low-income, recently hospitalized patients exploring their perceptions of barriers to post-hospital recovery and ideas for improvement. We then used a modified grounded theory approach to design an intervention that would address each barrier using patients׳ suggestions.
  
  
  RESULTS
  Five key themes were translated into design elements. First, patients wished to establish a relationship with healthcare personnel to whom they could relate. The intervention was provided by an empathic community health worker (CHW) who established rapport during hospitalization. Second, patients suggested tailoring support to their needs and goals. CHWs and patients designed individualized action plans for achieving their goals for recovery. Third, patient goals were misaligned with those of the inpatient team. CHW facilitated patient-provider discharge communication to align goals. Fourth, patients lacked post-discharge support for predominantly psychosocial or financial issues that undermined recovery. CHWs provided support tailored to patient needs. Finally, patients faced numerous barriers in obtaining post-hospital primary care. CHWs helped patients to obtain timely care with a suitable provider.
  
  
  CONCLUSIONS
  Low-income hospitalized patients voiced needs and suggestions that were directly translated into the design of a scalable patient-centered CHW intervention.
  
  
  CONCLUSIONS
  The approach of using participatory action research to tightly mapping patient input into intervention design is rapid and systematic strategy for operationalizing patient involvement in innovation.
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, United States; Spectrum Health Services, Inc., United States; Penn Center for Community Health Workers, United States. Electronic address: kangovi@mail.med.upenn.edu.
authors.forename: Shreya
authors.initials: S
authors.lastname: Kangovi
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States.
authors.forename: David
authors.initials: D
authors.lastname: Grande
authors.affiliation: Penn Center for Community Health Workers, United States.
authors.forename: Tamala
authors.initials: T
authors.lastname: Carter
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, United States.
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States.
authors.forename: Marisa
authors.initials: M
authors.lastname: Rogers
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Shannon
authors.affiliation: Department of Medicine, University of Pennsylvania Perelman School of Medicine, United States; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States; Philadelphia VA Center for Health Equities Research and Promotion, United States.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
keywords: Community health worker; Participatory action research; Patient-centered research