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Our Work

By combining Direct Patient Support, Interprofessional Education, and Community-Level Interventions, we are able to improve high-need/high-cost patient outcomes, reduce medical expenditures, and help develop our future healthcare leaders.

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Community-Level Interventions

We identified the most common challenges that our patients face and address them at a community level by designing and implementing specific initiatives.

Interprofessional Education

Our students come from 10 academic programs at 4 Atlanta-area institutions. We share interdisciplinary skillsets within diverse teams, host guest lectures, and offer education sessions to partners.

Direct Patient Support

We recruit and get to know individual high-need, high-cost patients to identify the root causes of their frequent hospital readmissions and ED visits. Patients lead the development of their care plans. Together, we navigate the barriers to their goals by building trusting relationships, helping access necessary social resources, and iteratively improving health literacy.

"As a student, I am eager to learn. I’m also eager for hands-on experience that benefits patients.  Yes, learning happens in the classroom and during clinical rotations. That said, there are other valuable lessons to be picked up from students of other professions, and most importantly – patients. I am excited for this program as it is an opportunity to approach a dilemma (high-utilization) with input from the interprofessional team. Law students will assist in parsing out the details of disability paperwork and insurance eligibility. Pharmacy students will aid in establishing a daily routine for medication adherence. Public health students will offer personalized education as it fits within systemic trends. Medical and nursing students will help navigate the healthcare landscape. And social work students will assist in setting tangible goals and accessing community resources to bring them to fruition. From these varied angles, student hotspotters hope to allow Grady’s high-utilizers to engage in lifestyles more conducive to maintaining health, with fewer hospitalizations."

-- Colin McNamara BSN, RN (AISH 2017-18)

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