Jocelyn Carter, MD, MPH
07 July 2021
Dr. Jocelyn Carter, a clinical affiliate of HTL, presents to the Scottsdale Institute on the “Effect of Community Health Worker-Patient Pairings on Readmissions in ACOs at Mass General Brigham“.
Dr. Carter is the director of the Community CAre Transitions (C-CAT) initiative (linking inpatients with community health workers (CHWs) who close gaps in care driven by social determinants of health) and her NIH K23 research career development award from the National Heart, Lung, and Blood Institute examines the feasibility, acceptability, and usability of a digitally-enabled community health worker intervention in heart failure populations.
In this webinar, Dr. Carter presents on the C-CAT initiative, which was structured as a randomized controlled trial in 2017-2019, focused on reducing readmissions prior to transitioning to being operationalized by MGH for internal medicine adult patients in 2019. The C-CAT initiative prioritizes best practice by focusing on patient-centered care. After meeting patients in-hospital prior to discharge, CHWs work actively for 30 days post-hospital discharge (via phone calls, home visits, accompaniment to clinic/intake appointments) to foster connections to clinical care teams, connect patients to low/no-cost resources (e.g. food, transportation, housing) and close resource/knowledge gaps contributing to sub-optimal care. CHWs create space for patients to voice barriers to staying well and work to bring greater awareness to all members of the inpatient/outpatient interdisciplinary care teams to improve care. Positive outcomes were generated from the C-CAT for 30-day readmission, emergency department visits and missed post-discharge appointments. Dr. Carter shares all implementation processes and outcomes.
Dr. Jocelyn Carter, MD, MPH is clinically prepared in internal medicine and preventive medicine. After completing her Internal Medicine and Leadership and Preventive Medicine residency training at Dartmouth-Hitchcock Medical Center, Dr. Carter joined the faculty at Massachusetts General Hospital and Harvard Medical School where she provides clinical care, supervises trainees, and conducts outcomes research. As a clinician-scientist at Massachusetts General Hospital (MGH) and a practicing internal medicine hospitalist within the MGH Division of General Internal Medicine, Dr. Carter’s primary research includes studying patient-centered interventions that improve health outcomes for vulnerable patients with serious-illness. Dr. Carter is particularly interested in population health initiatives and care delivery models that leverage technology while promoting prevention, and completed the MGH Healthcare Transformation Lab Applied Research Fellowship in Healthcare Innovation in 2017.