Community-based clinical prevention : Health as human capital

Background: The presentation describes a unique community-based clinical prevention model and the results of a two phase evaluation of that model.

Methods: The Clinical Prevention Model (CPM) is based upon the Health as Human Capital Model that assumes every person is capable of pursuing goals and objectives that contribute to their perceived quality of life. CPM is an intervention aimed at increasing consumer knowledge and choice in use of health and social services in order to promote growth in human capital. High level Master's prepared community nurses and clinical pharmacists help families take ownership of their health and capacity to be productive. The model has been implemented with a sample of high risk Medicaid recipients in two phases. The first phase was a controlled, random assigned study over a year. The second phase is a longitudinal evaluation focused on job assistance and implementation of a new insurance model.

Results: In both the controlled study and the longitudinal evaluation participants completed the CDC Health Related Quality of Life-4 (HRQOL). In the longitudinal study participants also provided work history information and completed an empowerment scale. In the controlled study, nine months following initiation of the intervention the CPM service group showed statistically significant increases in self-rating of health (t(53)=4.2, p<.0001), in the number of days when physical health was not good (t(51)=2.5, p<.05) and in number of days in the past 30 when poor physical and mental health kept them from doing usual activities (t(53)=3.5, p<.001). Independent t-tests indicated significant differences between groups in rating of health (t(90.5)=2.2, p<.05), days physical health was not good (t(94)=2.6, p<.05), and days out of 30 when poor physical and mental health kept them for doing usual activities (t(95)=2.8, p<.01).Data show a 14% decrease in public assistance costs while the control group had a 8% increase. Findings from the longitudinal study and the implications for health policy will be presented.

Conclusions: Given the complexity of the families, the findings are considered very promising. They suggest a new, exciting model for advanced community nursing practice in clinical prevention that improves health and human capital.