Local Access to Coordinated Healthcare (LATCH)
Providing an Integrated System of Care to Improve the Health of Durham County's Uninsured
Creating a Healthier Community
In 2002, Duke Division of Community Health, in collaboration with multiple Durham organizations, launched Local Access to Coordinated Healthcare (LATCH) to address the increasing numbers of Durham County residents who lacked health insurance, a regular source of care or “medical home,” and for whom accessing the healthcare system was a challenge.
The County's fast-growing immigrant community, most notably newly arrived Latino immigrants, was overwhelmingly uninsured and faced unique language, cultural and financial barriers when accessing the healthcare system. The impact of these obstacles on health was evident in many healthcare realms, especially local hospital emergency departments where uninsured patients sought medical care for conditions that included untreated diabetes, hypertension, asthma, and depression, and pregnant women showed up to deliver a baby with late or no prenatal care. It is against this healthcare backdrop that LATCH found its niche—a culturally and linguistically-competent integrated system of care for Durham County's uninsured.
Building a Consortium of Care
Built on long-term relationships between the Duke Division of Community Health, Durham government agencies, and local community-based organizations, LATCH works to improve enrollees' health, improve their access to care, and increase their appropriate use of health services through a combination of bilingual outreach, care management, health education, service enhancement, and systems change. With its coalition partners, LATCH recognizes health care trends, identifies barriers confronting uninsured patients, and, working as a consortium, addresses and eliminates access barriers.
LATCH in the Community
Community-Based Referral Process
A cornerstone of LATCH is its rootedness in the community. Uninsured Durham residents can enroll in LATCH by completing a short form available throughout Durham's health and social service agencies. Common referral agencies include Duke and Durham Regional hospitals, Duke clinics, Durham County Health Department, Lincoln Community Health Center, Walltown and Lyon Park clinics, and Durham Public Schools, and LATCH patients refer others to the program. El Centro Hispano, Durham's Latino self-help organization, conducts community outreach on behalf of LATCH at health fairs, Laundromats, and tiendas, and goes door-to-door to educate and refer eligible clients to the program. Patients also enroll by calling the LATCH program office. LATCH is supported by funding from Duke University Health System.
Culturally and Linguistically Competent Care Management
LATCH accomplishes its work through a bilingual (Spanish/English) Care Management Team (CMT) comprised of a Program Coordinator, Community Health Workers, Health Educator, and a Social Worker contracted through Durham County Department of Social Services. Once a referral is received, a LATCH Care Manager contacts the patient by phone or through a home visit to ask patients to identify their health and health–related needs. LATCH care coordination services include patient support, health care navigation, health education, and patient advocacy, beginning with asking patients about their need. Patients are risk-stratified and move between levels of care (focused, intermediate, or extensive) as their needs and health conditions change. Patient needs and LATCH program services are maintained in an electronic health information network designed for the program by Duke Division of Clinical Informatics.
LATCH services are offered free-of-charge and address a wide and varied set of needs, including:
Assistance establishing a medical home for enrollees and their family members
Health services orientation to understand the appropriate use of the healthcare system, including the emergency room, urgent care and primary care providers;
Health services coordination and patient referral to primary and preventive care, dental care, specialty services, and mental health and substance abuse services;
In-home patient education on issues that include chronic disease (asthma, diabetes, hypertension), fever management, lead paint poisoning. LATCH helps patients understand provider instructions, medication management, and improvements to the home environment to decrease health risks;
Interpretation/translation services, both medical and non-medical, for patient visits at offices that have no Spanish-speaking capacity;
Assistance, education and advocacy about applying and enrolling in available public benefits programs, including Medicaid, NC HealthChoice (sCHIP), SSI, and Food Stamps.
Program Accomplishments and Highlights
The LATCH coalition is the catalyst that has brought about a number of positive and sustainable changes in the way health care is delivered to uninsured Durham residents. Since its launch in 2002, LATCH's accomplishments include:
LATCH has received more than 14,500 referrals from a variety of health and social service providers and of these referrals, 11,157 new uninsured patients have been enrolled in the program.
Assistance locating and enrolling patients with a primary care provider or clinic, improving understanding of the use of the Emergency Department and urgent care; and healthcare interpretation;
Easier access to prenatal care in Durham County;
Developing bilingual patient financial information at appropriate literacy levels for hospitals and specialty care, increasing the number of bilingual staff at partner organizations, and creating patient education materials including a brochure that teaches patients to read a prescription label.
The annual LATCH patient survey (n=250) taken by telephone, and covering the period of September 2004 to September 2005 show:
80% of LATCH enrollees surveyed reported having a usual source of care;
LATCH enrollees who reported receiving assistance from LATCH were significantly more likely to get routine medical check-ups, an indicator of preventive care utilization, compared to those who did not get any assistance from LATCH;
While approximately 22% of LATCH clients reported having visited the Emergency Department (ED) between 2004 and 2005, there was a 25% decrease in the percentage of clients who used the ED, as well as a decrease in the number of ED visits per person among those clients who reported having used the ED in the past year;
More than 50% of LATCH clients with one or more chronic diseases reported using outpatient care for their conditions;
Patients receiving care management through LATCH are statistically more likely to have a usual source of medical care and to have been seen for their chronic medical condition. LATCH encouraged greater use of primary and preventive care.
Because fever often brings people to the emergency room unnecessarily, close to 100 LATCH enrollees were provided with digital thermometers and/or educated on fever management;
Approximately 400 patients were assisted to negotiate a payment plan for unpaid medical bills, apply for Medicaid (generally Emergency Temporary Medicaid for adults or standard Medicaid for children) or charity care. Ninety of the 400 patients received assistance from LATCH completing a Medicaid application. Many of these patients had been denied upon their original application, and LATCH staff worked with patients, medical records offices and Social Services to obtain coverage;
- El Centro Hispano
- Lincoln Community Health Center
- Army Corps of Engineers
- City of Durham, Department of Parks and Recreation
- Planned Parenthood of Central North Carolina
- Duke Private Diagnostic Clinic
- Durham County Department of Social Services
- Durham County Health Department
- The Durham Center (local mental health authority)
- Duke University Hospital
- Durham Regional Hospital
- Durham Community Health Network
- Center for Child and Family Health
- Duke Division of Clinical Informatics
- Duke Division of Community Health
- Duke University Heath System
For more information:
Local Access to Coordinated Healthcare (LATCH)
Division of Community Health
Department of Community & Family Medicine
Duke University Medical Center
411 W. Chapel Hill St., 3rd Floor
Durham, NC 27710
phone: (919) 613-6509
fax: (919) 613-6899