APPROACH AND METHODOLOGY
This commitment will enact a new model of healthcare delivery in which certain trained laypeople are leveraged to perform medical tasks that do not require a professional. A 'Grand-Aide' is a mature layperson who is an experienced and respected member of the community and who has received basic training in medical care. While being a grandparent is not a requirement, the characteristics of a 'Grand-Aide' are: having wisdom, being nurturing and caring, able to stay calm with a sick person, experience in caring for, generating respect in patient and community. Grand-Aides will be selected and trained by the Houston Community College in conjunction with the University of Virginia. They will each take part in the care of approximately 200-250 people and are employed by a primary care clinic, possibly as part of a 'patient-centered medical home.'
When a member of a family calls, a Grand-Aide will provide initial telephone triage using protocols for simple primary care conditions in children and adults (e.g. cold, vomiting, back pain) that are loaded onto a cell phone, under the supervision of a nurse, nurse practitioner, physician assistant or physician. As directed by the supervisor, the Grand-Aide will give advice via telephone and potentially make a home visit, utilizing the cell phone as a 'portable telemedicine' device to send video to clarify the medical condition or view a physical finding, such as a rash. Based on the Grand-Aides' findings the supervisor may make a visit as well when necessary.
Grand-Aides will also make home visits to local families to teach preventive care, early recognition of illness, and management of primary care conditions.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
In the recent budget bill, the State of Texas appropriated $1.25 million for this pilot
9/1/2011 - 12/31/2011
Training of 12 Grand-Aides at Houston Community College
1/1/2010 - 11/30/2012
Grand-Aides will work in 2 clinics (6 each) in Texas between January and December of 2012. By the end of the year the Grand-Aides will be participating in the care of approximately 2,500 families
22 outcome measures (e.g. number of visits to Grand-Aides, reduction in unneeded primary care clinic and primary care Emergency Department visits, health outcomes at 2 and 7 days) that reflect the effectiveness and cost of the program will be recorded and analyzed
The Texas Health and Human Services Commission is directed to report the results of this pilot program, including cost and quality measures, to the Senate Finance Committee and the House Appropriations Committee
Grand-Aides are examined, certified, and re-certified on an annual basis by the Grand-Aides Foundation.
Over the next 10 years, a shortage of 100,000 physicians and up to 1 million nurses is projected for the United States. The national professional medical societies have called for a 30% increase in the number of graduating physicians and nurses. However, if the projected shortages are even close to true, medical and nursing schools will require a 100% increase in graduates over the next 4 years.
Under new healthcare reform, an estimated 32 million more people will gain access to health insurance coverage in the coming years, without enough physicians and nurses to provide timely access to care. An example of the coming problem was seen in Massachusetts when the state provided universal medical coverage: the uninsured rate decreased from 10% to < 3%, while the waiting time to see a primary care physician ballooned from 33 to 48 days. In such situations emergency departments are flooded with patients in need of basic care and serve as overcrowded clinics, putting patients with true emergencies in jeopardy.
New models of workforce and healthcare delivery are needed.