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Expanding the Safety Net of Specialty Care for the Uninsured: A Case Study


Address correspondence to Erica S. Spatz, M.D., M.H.S., Robert Wood Johnson Foundation Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 330 Cedar Street, FMP 310, New Haven, CT 06520-8017; e-mail:



To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured.

Study Setting

Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation.

Study Design

Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations.

Principal Findings

Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings.


Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.