Community-clinical linkages

Domain 4: community-clinical linkages - Ensures individuals with or at high risk of chronic diseases have access to effective community resources to prevent or manage disease and improve quality of life.

Current activities

Community health workers and patient navigators

These activities champion the use of ancillary care team members and support linkages between health systems and community resources.

Community pharmacist integration

These projects promote the inclusion of pharmacists in the care team and highlight the value of the provision of medication therapy management services to support the control of high blood pressure and/or diabetes.

Diabetes Self-Management Education (DSME)

These strategies promote participation in ADA-recognized, AADE-accredited, state-accredited/certified, and/or Stanford licensed DSME programs.

National Diabetes Prevention Program (NDPP)

This program aims to strengthen referral mechanisms and increase the use of and reimbursement for the NDPP statewide.