Nine Opportunities to Advance Patient-Centered Care with My Health Checklist

The relationships that community health workers (CHWs) build with patients and caregivers are vital to support health care and well-being. CHWs in rural communities across the country have explored ways to use an age-friendly resource, My Health Checklist, as part of this work. Designed specifically for older adults, the checklist helps them reflect on their health, identify what’s going well, and prioritize the questions and concerns that matter most. For CHWs and providers, it becomes a practical tool to make appointments more efficient, effective, and centered on the older adult.

As part of this work, 15 rural CHWs and CHW trainers affiliated with the National Rural Health Association (NRHA) have been using My Health Checklist through a community of practice, hosted by NRHA and IHI with support provided by AARP. They are sharing their learnings about what works for the older adults they serve. Janel Lowman, MHA, Senior Manager of Community Outreach at USA Health Mitchell Cancer Institute, is one of the trainers. She noted that CHWs are already well aware of the importance of putting the patient at the center of care, saying, “A deep sense of care for individuals in their community is part of what drives many CHWs to do the work they do.” Lowman added, “My Health Checklist is a valuable tool to advance this goal. It supports CHWs to guide conversations in a way that helps keep care truly centered on what matters to the patient.”

Following are nine opportunities the CHWs shared to advance patient-centered care with My Health Checklist:

• My Health Checklist can help open conversations between caregivers and patients around an appointment. It can also lead to advance directive discussions. (National Rural Health Association, Connected Care for Older Adults)
• For a CHW helping someone fill out My Health Checklist, being physically in someone's home can help see the broader picture. In an office setting, a patient may come in their best outfit, presenting themselves differently than what may be happening at home. (USA Health Mitchell Cancer Institute, Connected Care for Older Adults)
• As part of a phone line model in Hawaii, CHWs introduce the checklist and go through it verbally with an older adult. This approach can tap into the oral tradition for story and communication — not assuming the written word is what works for everyone. (Our Kūpuna)
• It matters to have the checklist come from a trusted community member (CHW) and have it available for them to fill in on their own time to show what's important to them. (National Rural Health Association) 
• The checklist can open up conversations around fears and limitations with a trusted person. At border sites, the current climate may limit movement or access to care. Leaving the checklist at someone’s home and inviting them to review it on their own could help them say, "I don't feel safe leaving my home right now." This would provide insight into the patient’s mobility, which is an element of the 4Ms Framework of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility). (New Mexico Department of Health Office of Border Health)
• The checklist can help engage older adults actively in their medical care and prioritize key discussion points with their doctors. It serves as a valuable reference tool for older adults, even if not fully completed, and helps them prepare for medical appointments. (AARP, Hudson Hospital and Clinic)
• The checklist supports independence, agency, and feeling heard. It’s very beneficial to kūpuna (older adults) to be self-sufficient. It allows them to have a voice. (Our Kūpuna)
• A team of CHWs said they loved the My Health Checklist booklet — the format, colors, ease, and the prompts it gives to CHWs to discuss with older adults. Some older adults prefer to take the booklet and think about it on their own, while others, especially those with cognitive issues, need support. (Connected Care for Older Adults)
• CHWs are vital in addressing patient needs in resource-limited areas, acting as advocates and ensuring continuity of care. CHWs can use the checklist to enhance communication and care coordination (Connected Care for Older Adults)
• The checklist is key to enhancing patient-centered care, autonomy, and centering what matters by connecting rural patients with clinical teams. It supports listening and understanding What Matters to the person — an opportunity to hear what’s important to the older adult, even when that’s different than what caregivers want. (USA Health Mitchell Cancer Institute) 

CHWs use My Health Checklist to spark conversations, build trust, set priorities, and make connections — all in service of the patient-centered care they work for each day.

Patty Webster, MPH, is an Improvement Advisor and Faculty at the Institute for Healthcare Improvement. Lynn Mertz, PhD, is Senior Strategic Policy Advisor at AARP. Cayla Saret, MPH, is a Senior Managing Editor at IHI.

Photo by Bryanli on UnSplash.

You may also be interested in:

• My Health Checklist, developed by IHI with support from The John A. Hartford Foundation
• Ideas for Sharing My Health Checklist with Older Adults and Those Who Support Them
• Videos and resources from AARP about shared decision making with My Health Checklist