Evaluating a patient-centered care management program for Mississippi Delta residents with diabetes or hypertension

The Foundation's initiative, Finding Answers: Disparities Research for Change, was designed to use research and evaluation to test hypothetical solutions for reducing racial and ethnic disparities in health care settings and actual disparity reduction outcomes in ongoing programs.The purpose of this project is twofold: (1)to evaluate and quantify the impact of a comprehensive care management program focused on patient education and self-management on specific health indicators and overall health costs among individuals suffering from Diabetes or Hypertension; and (2) to evaluate and quantify the impact of a financial incentives and rewards program on encouraging healthy behaviors and improved outcomes, among a subset of uninsured patients, over and above the impact of general care management interventions. Aaron E. Henry Community Health Centers (AEH) are implementing a patient-centric care management program for Mississippi Delta residents with Diabetes or Hypertension. Mississippi has some of the worst outcomes and mortality rates in the U.S. for these conditions, and the problem is particularly severe for the uninsured. AEH's care management program seeks to empower patients with education and self-management tools (health report card, medication tracking card and personalized care plan) designed to improve health status. Expected program outcomes include improved health indicator scores and reduction in overall health costs measured by lower hospital stays and ER visits. A deliverable will be a public use data set for inclusion in the Foundation's Health and Medical Care Archive.

Grant Details

Amount Awarded $174,314.00

Awarded on: 8/3/2009

Time frame: 9/1/2009 - 4/30/2012

Grant Number: 66711


Aaron E. Henry Community Health Services Center, Inc.

510 Highway 322
P.O. Box 1216
Clarksdale, 38614-4717


William L. Booker
Project Director