Social determinants of health; Chronic Care Model; productive interactions; vulnerable populations; health care innovation


Health Services Research


Objectives: This paper examines productive interactions—a cornerstone of the Chronic Care Model—between health care providers and vulnerable populations with chronic illnesses and/or disabilities. Methods: We conducted qualitative analysis of 16 focus groups and 29 interviews with patients and/or caregivers and 195 interviews with program leadership and providers across 15 Health Care Innovation Awards that targeted vulnerable populations. We analyzed how awardees addressed health concerns and social determinants of health (SDOH), and identified key components of productive interactions. Results: Providers achieved productive interactions through four primary strategies: establishing trust and showing respect; solving problems; building accuracy in health information exchange; and sharing accountability and responsibility. While providers sought cooperation from patients and caregivers for medical goals, they often addressed SDOH priorities. Discussion: Strategies tailored to vulnerable populations can enable shared decision-making and effective self-care. A nonjudgmental engagement style, accurate information, and consistent communication are important for patient engagement.