In the early stages of DSRIP planning, BPHC conducted a Community Needs Assessment: an in-depth analysis of the health challenges and the healthcare and community resources in the Bronx. In this assessment, we identified not only which health issues are most common, but also why they are so pervasive.
Based on our findings, we customized ten projects to our community’s specific healthcare issues, focusing on chronic disease management, hospital and emergency services, and behavioral health. For information on each project’s goals, target population, and interventions, please refer to the Project One Pagers below:
2.a.i – Create an Integrated Delivery System
2.a.iii – Health Home At-Risk Intervention Program
2.b.iii – ED Care Triage for At-Risk Populations
2.b.iv – Care Transitions to Reduce 30-Day Readmissions
3.a.i – Integration of Primary Care and Behavioral Health Services
3.b.i – Evidence-Based Strategies for Disease Management – Cardiovascular Disease (CVD)
3.c.i – Evidence-Based Strategies for Disease Management – Diabetes
3.d.ii – Expansion of Asthma Home-Based Self Management Program
4.a.iii – Strengthen Mental Health and Substance Abuse Infrastructure Across Systems
4.c.ii – Increasing Early Access to and Retention in HIV Care