Table 1

Organizational Factors to Consider When Implementing Peer Support Initiatives in Medical Homes

Uniform guidelines for determining eligibility, recruitment, and selection of peer support candidates.
Clear standards that define responsibilities, scope of work, competencies, performance standards, and reporting relationships that are tied to licensed professionals, such as nurses or social workers, in the medical home.
Operating procedures and back-up plans that allow peer supporters direct access to professional staff in the event of urgent or life threatening circumstances.
Clinical information systems that allow effective communication, at the appropriate level of patient health information, between peer supporters and professional staff.
Orientation and ongoing training for peer support workers in interpersonal and communication skills, documentation and other administrative skills, and content and teaching skills for specific health promotion areas.
Effective dissemination of peer support services to medical home staff, area health care affiliates, and community stakeholders.
Ongoing monitoring of peer support services provided, with appropriate supervision.
Communication and documentation of peer support activities in a database that is accessible to medical home staff and retrievable for reporting and evaluation.
Clear and measurable goals and objectives in the following short-term and intermediate areas: patient-level outcomes, such as health and functional status measures; biometric and other disease state measures; patient-centered and other individual care process measures; organizational-level outcomes, such as access to care, health care utilization, costs of care and savings; and community-level outcomes, such as social capital.