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Temple University’s Grand-Aides program is a collaborative venture with the Grand-Aides Foundation based in Houston, which has developed and implemented a model to improve health care delivery by using trained community members, or “Grand-Aides.” These individuals visit patients and families in their homes to address medical issues, improve health care quality, and help to prevent unnecessary use of health services.

The “Grand-Aides” follow algorithms of care and report to nurse supervisors for oversight and management. They are in contact with the nurses through electronic media, using tablet computers and telecommunications applications such as Skype. We have implemented this model during the hospital discharge period to reduce readmission of patients with congestive heart failure (CHF).

Our primary research question at Temple is: do patients in the Grand-Aides program after hospitalization for CHF have lower rates of re-hospitalization and emergency room care during the first 30, 90, and 180 days after discharge than similar patients who do not participate?

This model is distinct because it involves: (1) direct and frequent in-home, personal contact between the Grand-Aide and patients, and (2) the use of treatment algorithms that allow relatively low-cost Grand-Aides to collect and share pertinent data through telemedicine with the nurses. We are testing this model for reduction in health costs as well as improvement in patient adherence, post-discharge monitoring, patient satisfaction, and quality of care. All of our manualized procedures, protocols, training, and outcomes assessments conform to the Grand-Aides Foundation protocols and we are in continual contact with the program’s developers about protocol implementation and data collection.

The Grand-Aides program has four goals at Temple. These are to provide access to appropriate health care for primary and chronic care while freeing professionals to do what only they can do; to reduce congestion in emergency departments, clinics, and hospitals by caring for people at home, resulting in improved access for those who need to be seen elsewhere; to educate patients in preventing secondary complications and in self-care; and to “bend the cost curve” with more affordable care.

For further information, please contact Dr. Kathleen Reeves.