For people without insurance, navigating a health system may seem like a hopeless task.

Many uninsured patients avoid seeking medical care until they are faced with an emergency, or they seek help from emergency departments for problems that a primary care physician could easily address.

This problem is especially prevalent within the immigrant population as they struggle to find care in an unfamiliar system where they don’t speak the language. Margarita Aparicio, a Mexican immigrant with a special needs child, explains, “It’s hard because I don’t read or speak English. I can’t understand what’s on papers I get or how to fill out papers to get help for Fredy.”

Recognizing this growing need in its community, Duke’s Division of Community Health partnered with multiple Durham organizations to create the Local Access to Coordinated Healthcare (LATCH) program -- a free service that uses in-home patient education and advocacy to improve the quality of care for uninsured patients in Durham County.

How LATCH Works

Uninsured Durham residents enroll in LATCH by completing a consent form available in many of Durham’s health and social service agencies. They are then contacted by a member of LATCH’s bilingual (Spanish/English) Care Management Team, comprised of community health workers, health educators, social workers, and a nurse care manager.

The LATCH care managers enroll the uninsured patients in the program, identify the severity of their needs, and teach them how to use the health care resources available to them.

LATCH’s free-of-charge services include:

• Health services coordination to increase access to primary and preventive care, dental services, specialty care, and mental health and substance abuse services
• Health services orientation to facilitate the appropriate use of the health care system
• In-home patient education and chronic disease management
• Assistance, education, and advocacy applying for Medicaid, food stamps, and other social services
• Interpretation/translation services
• Transportation coordination

Empowering patients with knowledge of how the system works gives them the tools they need to successfully advocate for their own health.

Program Results

Duke’s investment in the LATCH program has led to significant improvement in the quality of care that uninsured patients in Durham County receive.

In a recent survey of 250 LATCH enrollees, nearly 80 percent of those surveyed now have a primary source of health care. These patients are more likely to seek routine medical check-ups and receive proactive treatment for their chronic diseases.

When uninsured patients use a primary source of care, they no longer go to emergency departments for routine conditions. With fewer people to see in their emergency departments, physicians can work faster to save the lives of patients in need of critical care.

Because of the LATCH program and Duke’s commitment to offering quality care to all patients, Margarita and her family are now receiving the medical help they need.

“They always come when I call and need help,” she says. “It makes me feels so much better that I have someone to lean on. LATCH not only helps me but so many people.”

The graph below illustrates how the average number of emergency department visits for LATCH enrollees decreased over a two year period from .4 visits per person to .3 visits.