Expanding the safety net of specialty care for the uninsured: a case study

Health Serv Res. 2012 Feb;47(1 Pt 2):344-62. doi: 10.1111/j.1475-6773.2011.01330.x. Epub 2011 Oct 18.


Objective: To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured.

Study setting: 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.

Study design: Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations.

Principal findings: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Charities / organization & administration
  • Chronic Disease
  • Community-Based Participatory Research / organization & administration*
  • Connecticut
  • Cooperative Behavior
  • Female
  • Financing, Organized / organization & administration
  • Health Services Accessibility / economics
  • Health Services Accessibility / organization & administration*
  • Hospitals*
  • Humans
  • Interinstitutional Relations
  • Male
  • Medically Uninsured*
  • Medicine / organization & administration*
  • Middle Aged
  • Socioeconomic Factors