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Porterfield L, Yu X, Warren V, Bowen ME, Smith-Morris C, Vaughan EM. A community health worker led diabetes self-management education program: Reducing patient and system burden. J Diabetes Complications 2024; 38:108794. [PMID: 38878424 DOI: 10.1016/j.jdiacomp.2024.108794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 06/09/2024] [Indexed: 07/12/2024]
Abstract
AIMS Conduct a secondary analysis of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, diabetes Education) made simple trial (SIMPLE) to evaluate healthcare utilization and explore variables that may have influenced HbA1c. METHODS Participants (N = 134 [67/group]) were low-income, uninsured Hispanics with or at risk for type 2 diabetes mellitus. We included in-person and telehealth clinician visits, other visits, missed visits, orders placed, and guideline-adherence (e.g., vaccinations, quarterly HbA1c for uncontrolled diabetes). Using multivariable models, we explored for associations between HbA1c changes and these measures. RESULTS The control arm had higher missed visits rates (intervention: 45 %; control: 56 %; p = 0.007) and missed telehealth appointments (intervention: 10 %; control: 27.4 %; p = 0.04). The intervention group received more COVID vaccinations than the control (p = 0.005). Other health measures were non-significant between groups. Intervention individuals' HbA1c improved with more missed visits (-0.60 %; p < 0.01) and worsened with improved guideline-adherent HbA1c measurements (HbA1c: 1.2 %; p = 0.057). The control group had non-significant HbA1c associations. CONCLUSIONS Findings suggest that the SIMPLE trial's improved HbA1c levels stemmed from a CHW-driven intervention and not additional healthcare contact. Exploratory outcomes resulted in seemingly counterintuitive HbA1c associations with missed visits and guideline-adherent measurements; these may suggest that an intervention that enhances communication provides support to reduce the amount of follow-up needed by participants without sacrificing clinical improvements.
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Affiliation(s)
- Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, United States; Sealy Institute for Vaccine Scienes, University of Texas Medical Branch, Galveston, TX, United States
| | - Xiaoying Yu
- Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, United States
| | - Victoria Warren
- Department of Health and Human Services; University of Houston, Houston, TX, United States
| | - Michael E Bowen
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, United States; Peter O'Donnell Jr. School of Public Health, Univeristy of Texas Southwestern, Dallas, TX, United States
| | - Carolyn Smith-Morris
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Elizabeth M Vaughan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States; Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
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2
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Rex J, Fifer N, Johnson-Webb KD, Menich M, Horn A, Salamone C, T Renzhofer Pappada H, Arsene C, Martin C, Cunningham M. "She's a Family Member": How Community Health Workers Impact Perinatal Mothers' Stress Through Social-Emotional Support and Connections to Programs and Resources. Health Equity 2024; 8:469-479. [PMID: 39011078 PMCID: PMC11249134 DOI: 10.1089/heq.2024.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction This study examines whether being a client in the Northwest Ohio Pathways HUB program reduces stress and improves mental wellbeing for perinatal mothers. The HUB works to improve health by connecting mothers to community health workers (CHWs) who assess mothers' risk factors and connect them to evidence-based care pathways to reduce known risks associated with adverse birth outcomes. Methods A one-time survey of 119 mothers in the program and monthly semi-structured interviews with 41 mothers, totaling 220 interviews. Results Almost all mothers reported significantly reduced stress after joining the program. The majority also reported an improved sense of safety, security, and hope. Interviews show additional moderate reductions in stress over time while being a program client. Interviews also indicate that mothers' relationship with their CHW is key to these improvements: CHW provide social-emotional support, access to tangible goods, and help navigating social service bureaucracies. Discussion The results support the broader literature on the health benefits of community health workers and address identified gaps within the literature, which has infrequently studied CHWs in the perinatal context. Conclusion CHWs may be one way to address racial inequity in birth outcomes linked to infant mortality, given research on the links between inequitable exposure to stressors, the impacts of racism-induced stress, and preterm and low birth weight babies. Further, the findings indicate the need to better support CHWs, and the programs that utilize them, with increased funding, insurance reimbursement, and certification.
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Affiliation(s)
- Justin Rex
- Political Science, Bowling Green State University, Bowling Green, Ohio, USA
| | - Nichole Fifer
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | - Karen D Johnson-Webb
- School of Earth, Environment, & Society, Bowling Green State University, Bowling Green, Ohio, USA
| | - Maddi Menich
- Center for Regional Development, Bowling Green State University, Bowling Green, Ohio, USA
| | | | | | | | - Camelia Arsene
- ProMedica Health System, University of Toledo School of Population Health, Toledo, Ohio, USA
| | | | - Malcolm Cunningham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Mayor's Office of Neighborhood Safety and Engagement, City of Toledo, Office of the Mayor, Toledo, Ohio, USA
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3
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Petry SE, Lara L, Boucher NA. Older Caregivers: Who They Are and How to Support Them. J Aging Soc Policy 2024; 36:589-602. [PMID: 35290168 DOI: 10.1080/08959420.2022.2051683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/12/2021] [Indexed: 10/18/2022]
Abstract
Caregivers play a crucial role in providing health and social supports to their family and friends. Older adults who take on caregiving roles are themselves uniquely vulnerable to negative health and financial effects due to their age and underlying health risks. Many caregivers do not receive adequate support - either formally or informally - exacerbating the strains of providing care. Racial and ethnic minority caregivers may be less likely to report receiving support in their role and face additional challenges. We describe these caregivers over 65 and the burdens they face. We recommend community health workers, direct compensation, and normalization of respite care to support these essential care workers in their role and as they age.
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Affiliation(s)
- Sarah E Petry
- Doctoral Student, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Luz Lara
- Director of Senior Services, Union Settlement, New York, New York, USA
| | - Nathan A Boucher
- Doctoral Student, Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
- Health Research Specialist, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina, USA
- Associate Professor, School of Medicine, Duke University, Durham, North Carolina, USA
- Core Faculty, Duke- Duke University, Durham, North Carolina, USA
- Senior Fellow, Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Associate Research Professor, Sanford School of Public Policy, Duke University, Durham, USA
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Petruzzi L, Smithwick J, Lee L, Delva J, Fox L, Wilkinson G, Vohra-Gupta S, Aranda M, Valdez C, Jones B. Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework. J Ambul Care Manage 2024; 47:187-202. [PMID: 38775666 DOI: 10.1097/jac.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.
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Affiliation(s)
- Liana Petruzzi
- Author Affiliations: Dell Medical School at the University of Texas at Austin, Austin, Texas (Drs Petruzzi, Valdez, and Jones); Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Mss Smithwick and Fox); Knowledge Transfer Exchange Strategies, LLC, Corona, California (Dr Lee); Center for Innovation in Social Work Health, Boston University School of Social Work, Boston, Massachusetts (Dr Delva and Mr Wilkinson); Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas (Drs Vohra-Gupta, Valdez, and Jones); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr Aranda)
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5
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Lopez JZ, Lee M, Park SK, Zolezzi ME, Mitchell-Bennett LA, Yeh PG, Perez L, Heredia NI, McPherson DD, McCormick JB, Reininger BM. An expanded chronic care management approach to multiple chronic conditions in Hispanics using community health workers as community extenders in the Rio Grande Valley of Texas. Prev Med 2024; 184:107975. [PMID: 38685533 PMCID: PMC11149641 DOI: 10.1016/j.ypmed.2024.107975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education. METHODS We conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood pressure among 3806 participants enrolled between 2013 and 2019. Participants were compared according to their program participation as either higher (≥ 10 combined educational classes and CHW visits) or lower engagement (<10 encounters). Data was collected between 2013 and 2020. RESULTS Baseline mean systolic and diastolic blood pressure were 138 and 81 mmHg respectively. There were overall improvements in systolic (-6.49; 95% CI = [-7.13, -5.85]; p < 0.001) and diastolic blood pressure (-3.97; 95% CI = [-4.37, -3.56]; p < 0.001). The higher engagement group had greater systolic blood pressure reduction at 3 months (adjusted mean difference = -1.8 mmHg; 95% CI = [-3.2, -0.3]; p = 0.016) and at 15 month follow-up (adjusted mean difference = -2.3 mmHg; 95% CI = [-4.2, -0.39]; p = 0.0225) compared to the lower engagement group. CONCLUSION This intervention, tested and delivered in a real-world setting, provides an example of how CHW integration into an expanded chronic care model can improve blood pressure outcomes for individuals with co-morbidities.
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Affiliation(s)
- Juliana Z Lopez
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - MinJae Lee
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, USA
| | - Soo K Park
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, TX, USA; Management, Policy and Community Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maria E Zolezzi
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Lisa A Mitchell-Bennett
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Paul G Yeh
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA; Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - LuBeth Perez
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Natalia I Heredia
- Department of Health Promotion & Behavioral Science, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David D McPherson
- Internal Medicine Cardiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joseph B McCormick
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Belinda M Reininger
- Brownsville Regional Campus, The University of Texas Health Science Center at Houston, Brownsville, TX, USA; Department of Health Promotion & Behavioral Science, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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GOTTLIEB LAURAM, HESSLER DANIELLE, WING HOLLY, GONZALEZ‐ROCHA ALEJANDRA, CARTIER YURI, FICHTENBERG CAROLINE. Revising the Logic Model Behind Health Care's Social Care Investments. Milbank Q 2024; 102:325-335. [PMID: 38273221 PMCID: PMC11176407 DOI: 10.1111/1468-0009.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Policy Points This article summarizes recent evidence on how increased awareness of patients' social conditions in the health care sector may influence health and health care utilization outcomes. Using this evidence, we propose a more expansive logic model to explain the impacts of social care programs and inform future social care program investments and evaluations.
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Affiliation(s)
- LAURA M. GOTTLIEB
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - DANIELLE HESSLER
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - HOLLY WING
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - ALEJANDRA GONZALEZ‐ROCHA
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - YURI CARTIER
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
| | - CAROLINE FICHTENBERG
- University of CaliforniaSan Francisco
- Social Interventions Research and Evaluation NetworkCenter for Health and CommunityUniversity of CaliforniaSan Francisco
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7
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Jessup RL, Slade S, Roussy V, Whicker S, Pelly J, Rane V, Lewis V, Naccarella L, Lee M, Campbell D, Stockman K, Brooks P. Peer Health Navigators to improve equity and access to health care in Australia: Can we build on successes from the COVID-19 pandemic? Aust N Z J Public Health 2024; 48:100128. [PMID: 38442568 DOI: 10.1016/j.anzjph.2024.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/23/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Rebecca L Jessup
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia; School of Rural Health, Monash University, Warragul, Australia.
| | - Sian Slade
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
| | - Veronique Roussy
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton Australia; EACH Community Health, Ferntree Gully, Australia
| | - Susan Whicker
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Janet Pelly
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Vinita Rane
- Pandemic Wards, Northern Health, Epping Australia; Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Virginia Lewis
- Australian Insititute of Primary Care and Ageing, La Trobe University, Bundoora, Australia
| | - Lucio Naccarella
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Max Lee
- Strategic Alliances and Partnerships, DPV Health, Epping, Australia
| | - Donald Campbell
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Keith Stockman
- Staying Well and Hospital Without Walls Program, Northern Health, Epping, Australia
| | - Peter Brooks
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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8
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Ignoffo S, Gu S, Ellyin A, Benjamins MR. A Review of Community Health Worker Integration in Health Departments. J Community Health 2024; 49:366-376. [PMID: 37828419 PMCID: PMC10924716 DOI: 10.1007/s10900-023-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/14/2023]
Abstract
Community health workers (CHWs) are frontline public health workers who bridge the gap between historically marginalized communities, healthcare, and social services. Increasingly, states are developing the CHW workforce by implementing training and certification policies. Health departments (HDs) are primarily responsible for community health through policy implementation and provision of public health services. The two objectives of this study are to explore: (1) state progress in establishing CHW training and certification policies, and (2) integration of CHWs in HD workforces. In this scoping review, we searched PubMed, CINAHL, and Google Scholar for articles published between 2012 and 2022. We looked for articles that discussed state-level certification and training for CHWs and those covering CHWs working with and for city, county, state, and federal HDs. We excluded studies set outside of the US or published in a language other than English. Twenty-nine studies were included for review, documenting CHWs working at all levels of HDs. Within the included studies, HDs often partner with organizations that employ CHWs. With HD-sponsored programs, CHWs increased preventative care, decreased healthcare costs, and decreased disease risk in their communities. Almost all states have begun developing CHW training and certification policies and are at various points in the implementation. HD-sponsored CHW programs improved the health of marginalized communities, whether CHWs were employed directly by HDs or by a partner organization. The success of HD-sponsored CHW programs and state efforts around CHW training and certification should encourage increased investment in CHW workforce development within public health.
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Affiliation(s)
| | - Shannon Gu
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Alexander Ellyin
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Maureen R Benjamins
- Sinai Urban Health Institute, Chicago, IL, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Acharya H, Sykes KJ, Neira TM, Scott A, Pacheco CM, Sanner M, Ablah E, Oyowe K, Ellerbeck EF, Greiner KA, Corriveau EA, Finocchario-Kessler S. A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study. JMIR Form Res 2024; 8:e52920. [PMID: 38557671 PMCID: PMC11019415 DOI: 10.2196/52920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. OBJECTIVE We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. METHODS The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. RESULTS At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44%) or satisfied (15/32, 48%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act-compliant record system, improved client engagement, enrollment processes, and identification of resources. CONCLUSIONS Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings.
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Affiliation(s)
- Harshdeep Acharya
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, United States
| | - Kevin J Sykes
- Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, United States
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ton Mirás Neira
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Angela Scott
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Christina M Pacheco
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Matthew Sanner
- Sanner Software Solutions, Kansas City, KS, United States
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | | | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin A Corriveau
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah Finocchario-Kessler
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, United States
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10
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Radparvar AA, Vani K, Fiori K, Gupta S, Chavez P, Fisher M, Sharma G, Wolfe D, Bortnick AE. Hypertensive Disorders of Pregnancy: Innovative Management Strategies. JACC. ADVANCES 2024; 3:100864. [PMID: 38938826 PMCID: PMC11198296 DOI: 10.1016/j.jacadv.2024.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Hypertensive disorders of pregnancy (HDP) complicate 13% to 15% of pregnancies in the United States. Historically marginalized communities are at increased risk, with preeclampsia and eclampsia being the leading cause of death in this population. Pregnant individuals with HDP require more frequent and intensive monitoring throughout the antepartum period outside of routine standard of care prenatal visits. Additionally, acute rises in blood pressure often occur 3 to 6 days postpartum and are challenging to identify and treat, as most postpartum individuals are usually scheduled for their first visit 6 weeks after delivery. Thus, a multifaceted approach is necessary to improve recognition and treatment of HDP throughout the peripartum course. There are limited studies investigating interventions for the management of HDP, especially within the United States, where maternal mortality is rising, and in higher-risk groups. We review the state of current management of HDP and innovative strategies such as blood pressure self-monitoring, telemedicine, and community health worker intervention.
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Affiliation(s)
| | - Kavita Vani
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin Fiori
- Division of Academic General Pediatrics and Department of Family and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sonali Gupta
- Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Chavez
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Molly Fisher
- Division of Nephrology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Diana Wolfe
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anna E. Bortnick
- Department of Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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11
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Basu S, Patel SY, Robinson K, Baum A. Financing Thresholds for Sustainability of Community Health Worker Programs for Patients Receiving Medicaid Across the United States. J Community Health 2024:10.1007/s10900-023-01290-w. [PMID: 38311699 DOI: 10.1007/s10900-023-01290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 02/06/2024]
Abstract
States have turned to novel Medicaid financing to pay for community health worker (CHW) programs, often through fee-for-service or capitated payments. We sought to estimate Medicaid payment rates to ensure CHW program sustainability. A microsimulation model was constructed to estimate CHW salaries, equipment, transportation, space, and benefits costs across the U.S. Fee-for-service rates per 30-min CHW visit (code 98960) and capitated rates were calculated for financial sustainability. The mean CHW hourly wage was $23.51, varying from $15.90 in Puerto Rico to $31.61 in Rhode Island. Overhead per work hour averaged $43.65 nationwide, and was highest for transportation among other overhead categories (65.1% of overhead). The minimum fee-for-service rate for a 30-min visit was $53.24 (95% CI $24.80, $91.11), varying from $40.44 in South Dakota to $70.89 in Washington D.C. The minimum capitated rate was $140.18 per member per month (95% CI $105.94, $260.90), varying from $113.55 in South Dakota to $176.58 in Washington D.C. Rates varied minimally by metro status but more by panel size. Higher Medicaid fee-for-service and capitated rates than currently used may be needed to support financial viability of CHW programs. A revised payment estimation approach may help state officials, health systems and plans discussing CHW program sustainability.
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Affiliation(s)
- Sanjay Basu
- Clinical Product Development, Waymark Care, San Francisco, USA.
| | - Sadiq Y Patel
- Department of Health Care Policy, Harvard Medical School, Boston, USA
| | - Kiiera Robinson
- Clinical Product Development, Waymark Care, San Francisco, USA
| | - Aaron Baum
- Icahn School of Medicine, Mount Sinai, New York, USA
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Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M. Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 2024; 14:e077877. [PMID: 38309760 PMCID: PMC10840031 DOI: 10.1136/bmjopen-2023-077877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wright
- Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - F Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Cullen
- Aged Health, Rehabilitation and Chronic Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Haigh
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Zaidi M, Fantasia HC, Penders R, Koren A, Enah C. Increasing U.S. Maternal Health Equity Among Immigrant Populations Through Community Engagement. Nurs Womens Health 2024; 28:11-22. [PMID: 38072010 DOI: 10.1016/j.nwh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024]
Abstract
Immigrant women in the United States are at an elevated risk of poor maternal health outcomes due to cultural, linguistic, or socioeconomic barriers that may lead to critical delays in obtaining adequate health care. Ensuring access to high-quality, culturally appropriate perinatal health care is crucial to improve the health and well-being of immigrant mothers and their children. Various aspects of perinatal health care for immigrant women can be improved through community engagement strategies. Barriers can be addressed by involving community members in designing and delivering culturally appropriate maternal health services. Some strategies discussed in this commentary include working with community health workers, encouraging telehealth through community health workers, providing breastfeeding and mental health support within cultural norms, and involving community-based doulas and midwives.
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Wippold GM, Garcia KA, Frary SG, Griffith DM. Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework. HEALTH EDUCATION & BEHAVIOR 2024; 51:128-143. [PMID: 37350223 DOI: 10.1177/10901981231179498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts. METHODS The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria. RESULTS Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised. DISCUSSION CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.
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Harris ST, Joynt Maddox KE. Increasing cardiovascular hospitalization rates among young and middle-aged adults in the USA suggest a need for multi-faceted solutions. Eur Heart J 2024:ehae027. [PMID: 38270197 DOI: 10.1093/eurheartj/ehae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Affiliation(s)
- Samantha T Harris
- Cardiovascular Division, Department of Medicine, and Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, and Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St. Louis, MO 63110, USA
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Yoon HS, Teshome BF, Eisenbeis A, Micek ST. Pharmacy technicians trained as community health workers: A prospective multicenter cohort study. J Am Pharm Assoc (2003) 2024; 64:47-54.e1. [PMID: 37673283 DOI: 10.1016/j.japh.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Community health workers (CHWs) are health professionals who are experts in linking patients to health resources. Although CHWs are employed in a variety of health institutions, access to their services may be challenging for patients in underserved locations. Community pharmacies are uniquely positioned to mitigate this barrier as they provide readily accessible care for patients residing in these areas. OBJECTIVES To 1) quantify and report the CHW services provided by certified pharmacy technicians (CPhTs) in an underserved population and 2) provide an initial framework for the implementation of CHW services in community pharmacies or similar health care settings. METHODS This prospective cohort study reports the findings of training CPhTs as CHWs in 3 independent community pharmacies from January 1, 2021 to July 1, 2021. CPhT-CHWs conducted monthly visits by phone, patient home, or pharmacy and documented services using a standardized assessment form. Descriptive statistics were used to summarize the baseline characteristics of the patient population, service codes, types of services and referrals made, and time spent per visit by CPhT-CHWs. RESULTS A total of 198 patient visits by phone, patient home, or at the pharmacy were completed in a 6-month timespan. During these visits, the CPhT-CHW provided 351 services (203 primary services and 149 secondary services) and completed 51 referrals. The average time spent per visit (standard deviation) was 15.5 (11.5) 68.9 (35.4), and 30.6 (16.8) minutes for phone, home, and pharmacy visits, respectively. Patient home visits resulted in the highest average primary services per visit, longest time spent with the patient, and accounted for a majority of social services. CONCLUSION CPhT-CHWs were able to use various methods to contact these patients to further develop patient-to-provider and patient-to-pharmacy relationships. Training CPhTs as CHWs can be an effective way to increase patient contact and provide additional health services.
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Kitzman H, Dodgen L, Vargas C, Khan M, Montgomery A, Patel M, Ajoku B, Allison P, Strauss AM, Bowen M. Community health worker navigation to improve allostatic load: The Integrated Population Health (IPOP) study. Contemp Clin Trials Commun 2023; 36:101235. [PMID: 38156244 PMCID: PMC10753173 DOI: 10.1016/j.conctc.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background Social determinants of health (SDOH) and cumulative stress contribute to chronic disease development. The physiological response to repeated stressors typical of lower-income environments can be measured through allostatic load - a composite measure of cardiovascular, metabolic, and immune variables. Healthcare systems have employed patient navigation for social and medical needs to improve SDOH that has demonstrated limited impact on chronic disease outcomes. This study evaluates a novel community health worker navigation intervention developed using behavioral theories to improve access to social and medical services and provide social support for poverty stressed adults. Methods The Integrated Population Health Study (IPOP) study is a randomized, parallel two arm study evaluating community health worker navigation in addition to an existing integrated population health program (IPOP CHW) as compared to Usual Care (population health program only, IPOP) on allostatic load and chronic disease risk factors. IPOP CHW participants receive a 10-month navigation intervention. Results From 381 screened individuals, a total of 202 participants (age 58.15 ± 12.03 years, 74.75 % female, 79.21 % Black/African American, 17.33 % Hispanic) were enrolled and randomized to IPOP CHW (n = 100) or IPOP Only (n = 102). Conclusion This study will evaluate whether CHW navigation, using a structured intervention based on health behavior theories, can effectively guide poverty stressed individuals to address social and medical needs to improve allostatic load-a composite of cumulative stress and physiological responses. Healthcare systems, nonprofit organizations, and governmental entities are interested in addressing SDOH to improve health, thus developing evidence-based interventions could have broad clinical and policy implications.
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Affiliation(s)
- Heather Kitzman
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Leilani Dodgen
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Cristian Vargas
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Mahbuba Khan
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Aisha Montgomery
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Meera Patel
- Peter J. O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Brittany Ajoku
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | - Patricia Allison
- Baylor Scott and White Health, 4500 Spring Ave, Dallas, TX, 75210, USA
| | | | - Michael Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Rogers HE, Hershey JA, Morone J, Lipman TH, Wilson-Hall L, Anderson K, Hawkes CP. Perspectives of Pediatric Community Health Workers: Roles, Successes, and Challenges. Health Promot Pract 2023; 24:1206-1214. [PMID: 35876335 DOI: 10.1177/15248399221112866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This multicenter qualitative study described the roles of 10 pediatric community health workers (CHWs) in their own words through exploration of the role features, successes, and challenges in pediatric health care settings across three urban U.S. cities (Philadelphia, New York City, and Cincinnati). Individual, semi-structured telephone interviews were conducted. Interviews described prominent features of the pediatric CHW role, which included taking a family-centered approach to goal setting and determining support needed, ensuring family goals stayed at the center of the work, and acting as a trusted figure for families to talk openly with. CHWs described their role as rewarding, believing in the work, and feeling a sense of fulfillment, and felt successful when families had positive outcomes, including when barriers were eliminated, resources were obtained, or independence was demonstrated by families. Challenges CHWs faced in their roles included establishing trust with families, managing the ever-changing family circumstances many families experience due to socioeconomic barriers, and managing limitations of protocol and restrictions within their roles. This study demonstrated numerous considerations for CHW practice in pediatric health care settings, in addition to considerations for pediatric-specific CHW program development and management. The primary policy implication of this study included a basis for increased funding for CHW programs in pediatric health care settings. This study also demonstrated a need for further research on the change CHWs effect within child and family systems outside of health care, such as schools and child welfare agencies.
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Affiliation(s)
- Hanna E Rogers
- Evaluation Strategies, Ypsilanti, MI, USA
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jennifer Morone
- Yale University School of Medicine, New Haven, CT, USA
- Veterans Administration Health Services Research & Development, Washington, DC, USA
| | - Terri H Lipman
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Colin P Hawkes
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University College Cork, Cork, Ireland
- University of Pennsylvania, Philadelphia, PA, USA
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Klein S, Eaton KP, Bodnar BE, Keller SC, Helgerson P, Parsons AS. Transforming Health Care from Volume to Value: Leveraging Care Coordination Across the Continuum. Am J Med 2023; 136:985-990. [PMID: 37481020 DOI: 10.1016/j.amjmed.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Sharon Klein
- Department of Medicine, New York University Langone Health, New York
| | - Kevin P Eaton
- Department of Medicine, New York University Langone Health, Brooklyn
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sara C Keller
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Paul Helgerson
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Andrew S Parsons
- Department of Medicine, University of Virginia School of Medicine, Charlottesville.
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Rafizadeh EB, Rice E, Smith J, Bell J, Harvath TA. Understanding How Community Health Workers Build Trust with Low-Income Women of Color At-Risk for Maternal Child Health Disparities: A Grounded Theory Study. J Community Health Nurs 2023; 40:219-231. [PMID: 36999664 DOI: 10.1080/07370016.2023.2168124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
This article examines how Community Health Workers (CHWs) build trust with low-income women of color who have a historical distrust of the healthcare system, and are at risk for maternal-child health disparities. This qualitative study used a grounded theory methodology guided by Charmaz's inductive social constructivist approach. Data were collected using open-ended semi-structured interviews and focus groups with CHWs who worked in community-based and hospital-based programs in California, Oregon, Illinois, Texas, South Carolina, New York, and Maine. Thirty-two CHWs participated, with 95% of participants being of Latinx and African American ethnicity. They served women from Latinx, African American, and Migrant communities. The CHW communication strategies represent aspects of respect and client-centered care and are applied in the development of a theoretical framework. CHWs were able to build and sustain trust at the initial encounter through these specific strategies: 1) addressing immediate needs related to social determinants of health; 2) embodying mannerisms and dress; 3) speaking appropriately to the client's age, culture, and knowledge; 4) easing client's fears through locus of control, and 5) allowing for time flexibility. These findings have implications for practice through interventions to train healthcare providers to build trust with low-income women of color who have a historical distrust of the healthcare system and who are at risk for maternal-child health disparities. Future research is recommended to explore how the communication trust-building constructs also benefit all other groups at similar risk, including those with mental health disorders and infectious diseases. The findings indicate specific communication strategies through which trust can be built, beginning at the initial encounter with low-income women at risk for maternal-child health disparities and who have a historical distrust of the healthcare system.
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Affiliation(s)
| | - Elizabeth Rice
- School of Nursing, University of California, Davis, Davis, California, USA
| | - James Smith
- Department of Anthropology, University of California, Davis, California, USA
| | - Janice Bell
- School of Nursing, University of California, Davis, Davis, California, USA
| | - Theresa A Harvath
- School of Nursing, University of California, Davis, Davis, California, USA
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Naït Salem R, Rotily M, Apostolidis T, Odena S, Lamouroux A, Chischportich C, Persico N, Auquier P. Health mediation: an intervention mode for improving emergency department care and support for patients living in precarious conditions. BMC Health Serv Res 2023; 23:495. [PMID: 37194100 PMCID: PMC10186303 DOI: 10.1186/s12913-023-09522-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Severe overcrowding of emergency departments (EDs) impacts the quality of healthcare. One factor of this overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. We here present the results of an ancillary qualitative study to explore the prospects regarding a health mediation intervention implemented in EDs for deprived persons who are frequent ED users, from professionals' and patients' perspectives. METHODS Design, data collection, and data analysis were done according to a psychosocial approach, based on thematic content analysis and semi-structured interviews of 16 frequent ED users and deprived patients exposed to HM and of 14 professionals in 4 EDs of South-eastern France. RESULTS All patients reported multifactorial distress. Most of them expressed experiencing isolation and powerlessness, and lacking personal resources to cope with healthcare. They mentioned the use of ED as a way of quickly meeting a professional to respond to their suffering, and recognized the trustworthy alliance with health mediators (HMrs) as a means to put them back in a healthcare pathway. The presence of HMrs in EDs was appreciated by ED professionals because HMrs responded to requests they were not able to access and were perceived as an efficient support for caring for deprived persons in emergency contexts. CONCLUSIONS Our results are in favour of health mediation in EDs as a promising solution, requested by patients and ED professionals, to cope with frequent ED users and deprived patients. Our results could also be used to adapt other strategies for the most vulnerable populations to reduce the frequency of ED readmissions. At the interface of the patients' health experience and the medico-social sector, HM could complete the immediate responses to medical needs given in EDs and contribute in alleviating the social inequalities of health.
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Affiliation(s)
- Riwan Naït Salem
- Laboratoire de Psychologie Sociale (LPS), Aix Marseille Université, Aix-en-Provence, France
| | - Michel Rotily
- Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France.
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France.
| | | | - Sophie Odena
- Aix Marseille Univ, CNRS, LEST, Aix-en-Provence, France
| | - Aurore Lamouroux
- Centre de Santé Universitaire - Espace Santé Aygalades - Assistance Publique Hopitaux de Marseille, Marseille, France
| | | | - Nicolas Persico
- Service d'Accueil des Urgences Adultes, Hopital Nord, Assistance Publique Hopitaux de Marseille, Marseille, France
| | - Pascal Auquier
- Centre d'Etudes et de Recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université, Marseille, France
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Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study. J Gen Intern Med 2023; 38:18-24. [PMID: 36864268 PMCID: PMC9980865 DOI: 10.1007/s11606-022-07921-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. OBJECTIVE This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. DESIGN This is a qualitative study based on in-person, semi-structured interviews. PARTICIPANTS We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). APPROACH Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. KEY RESULTS CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. CONCLUSIONS CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.
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Hodges M, Butler D, Spaulding A, Litzelman DK. The Role of Community Health Workers in the Health and Well-Being of Vulnerable Older Adults during the COVID Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2766. [PMID: 36833462 PMCID: PMC9957090 DOI: 10.3390/ijerph20042766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic disrupted social support networks as well as resource access for participants. The purpose of this study was to: analyze the experiences of older adults enrolled in a geriatric-focused community health worker (CHW) support program, to gain a better understanding of how CHWs might enhance care delivery, and to further understand how COVID-19 affected the social and emotional needs and well-being of older adults during the first 18 months of the pandemic. Qualitative analysis was performed on notes entered by CHWs based on 793 telephone encounters with 358 participants between March 2020 and August 2021. Analysis was performed by two reviewers independently coding the data. Weighing the benefits of seeing family against the risks of COVID exposure was a source of emotional distress for participants. Our qualitative analysis suggests that CHWs were effective in providing emotional support and connecting participants to resources. CHWs are capable of bolstering the support networks of older adults and carrying out some of the responsibilities conventionally fulfilled by family supports. CHWs addressed participant needs that are frequently unmet by healthcare team members and provided emotional support to participants contributing to health and well-being. CHW assistance can fill gaps in support left by the healthcare system and family support structures.
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Affiliation(s)
- Matthew Hodges
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
| | - Dawn Butler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Debra K. Litzelman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
- Indiana University Health Physicians, Indianapolis, IN 46204, USA
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Wildman J, Wildman JM. Impact of a link worker social prescribing intervention on non-elective admitted patient care costs: A quasi-experimental study. Soc Sci Med 2023; 317:115598. [PMID: 36527893 DOI: 10.1016/j.socscimed.2022.115598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/28/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Healthcare systems in many countries are enthusiastically adopting link worker social prescribing interventions that aim to tackle the social determinants of health by linking patients to voluntary and community sector activities and sources of support to address their social needs and improve condition management. Social prescribing interventions aim to improve health and reduce healthcare spending. However, despite the diversion of healthcare budgets to fund social prescribing, we still lack robust evidence for its effectiveness. In this study we evaluate whether participation in a social prescribing intervention reduced non-elective admitted patient care use and costs for 8283 patients aged between 40 and 74 years, with a diagnosis of type 2 diabetes and living in an area of high socioeconomic deprivation in north-east England. Patients were followed for a total of 6 years: 2 years pre-intervention and 4 years post intervention. Exploiting a natural experiment, we used a two-part difference-in-differences regression model to estimate costs conditional on healthcare use. We also estimated intervention effects across several intervention and control groups and sample subgroups. Participation in the intervention resulted in reductions of up to -£77.57 [95% CI: -152.30, -2.84] (for high engagement patients) per patient, per year, in non-elective care costs. Reductions were greater for patients with higher levels of engagement with the intervention. Sub-group analyses showed greater cost reductions for non-White patients, older patients, and patients without additional co-morbidities. Our findings suggest that engagement with a link worker social prescribing intervention may reduce non-elective healthcare spending, perhaps through enabling better condition management that results in fewer avoidable health crises.
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Affiliation(s)
- John Wildman
- Economics, Newcastle University Business School, Newcastle University, UK.
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Li Y. Social care for disabled elderly women in urban China: The roles of the community. Soc Sci Med 2022; 314:115473. [PMID: 36332530 DOI: 10.1016/j.socscimed.2022.115473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
This article analyses the provision of community care for urban disabled elderly women. With the emergence of an aging society in China and the empty nest syndrome in Chinese families, the number of elderly people who cannot take care of themselves is increasing. With the reduction in family size and the weakening of the home care function, traditional family care in China is facing immense challenges. On the one hand, a growing number of disabled elderly women are in urgent need of care; they encounter many difficulties in daily life, including poor health status, the loss of their spouse and living alone, an inability to support themselves economically, the lack of a spiritual life, and a significant reliance on their children to take care of them. On the other hand, the family's function of providing for the elderly has been weakened, and the traditional way of care is affected by the changes in modern society. Based on a qualitative study in Beijing, this article examines the demand for care from disabled elderly women and the current supply of community care. It puts forward a community-centred and targeted assistance model and social work intervention. This study argues that the community care system for disabled elderly women in urban areas should focus on four aspects, namely living care, medical care, spiritual consolation, and emergency assistance; and the protection mechanism should be improved to support disabled elderly women from three aspects: a protection system, a fund guarantee and services from health and social cafe staff and social workers.
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Affiliation(s)
- Yan Li
- School of Government, Nanjing University, Nanjing, Jiangsu, China.
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Lapidos A, Kieffer EC, Guzmán R, Hess K, Flanders T, Heisler M. Barriers and Facilitators to Community Health Worker Outreach and Engagement in Detroit, Michigan: A Qualitative Study. Health Promot Pract 2022; 23:1094-1104. [PMID: 34549635 DOI: 10.1177/15248399211031818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An effective approach to engaging populations who face health care access barriers is support from community health workers (CHWs). There is little research, however, on specific barriers and facilitators related to two key areas of CHW practice: outreach, defined as the ability to make any initial contact with the priority population, and engagement, defined as the ability to continue to work with the priority population after initial contact is made. The current qualitative study is ancillary to a randomized evaluation of a CHW-led program for Medicaid Health Plan enrollees. Implementation experiences with outreach and engagement led the evaluators to develop the current study in which health plan and nonhealth plan CHWs (n = 12) serving low-income, predominantly Black populations in Detroit participated in qualitative semistructured interviews to elucidate barriers and facilitators to outreach and engagement. All audio recordings were transcribed verbatim. The study team used inductive qualitative data analysis techniques. Barriers to outreach included inaccurate contact information and mistrust. Barriers to engagement included lack of ability to provide needed resources, leading to hopelessness and diminished trust, and discontinuity of services due to eligibility changes and terminated programs. Facilitators included adapting outreach schedules and strategies to community needs, availability of resources, and relational strategies that leveraged CHW social proximity. Further research should systematically investigate the relative success of different CHW-led outreach and engagement strategies for specific populations so as to better design and implement CHW programs.
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Affiliation(s)
| | | | | | | | | | - Michele Heisler
- University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Center for Clinical Management Research, Washington, DC, USA
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Herrman D, Papadimitriou C, Green B, LeFlore A, Magasi S. Relationships at Work: Integrating the Perspectives of Disability Partners to Enhance a Peer Navigation Intervention. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:876636. [PMID: 36189057 PMCID: PMC9397959 DOI: 10.3389/fresc.2022.876636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThe Our Peers-Empowerment and Navigational Support (OP-ENS) community-based participatory research study developed, implemented, and evaluated a peer navigator intervention aimed at improving health and healthcare access among Medicaid beneficiaries with disabilities. Peer navigators are community partners with physical disabilities trained to deliver structured peer support interventions that can address barriers to care. The purpose of this paper is two-fold. First, it explicates the relational work the peer navigators do with peers in delivering the intervention. Second, it illustrates how our community-based participatory approach empowered peer navigators to share their knowledge to refine the intervention.MethodsClinical coordinator team meeting notes, critical incident documentation reports, peer navigator reflections (n = 20) were analyzed thematically to understand the peer navigators' relational work and intervention refinements. Following Labov's 6-stage approach to personal narratives and a collaborative writing process academic, clinical, and disability partners co-wrote descriptive exemplars to showcase these processes.FindingsThrough the manualized OP-ENS intervention process, peer navigators helped peers achieve incremental successes. Peer navigators used their training and personal experiences to engage with peers and forge deep connections and relationships of trust. As a result, peers identified a wide-range of social health concerns, including poverty, social isolation, and racial and disability related discrimination that might otherwise go unaddressed. True to the principles of community-based participatory research, by fostering an equity-focused collaboration and listening to peer navigators, the project team implemented subtle but salient refinements to the intervention. Refinements included an explicit focus on social determinants of health affecting peers' health and wellbeing and supplemental trainings to help peer navigators support peers with significant mental health needs.ConclusionThe peer navigators were intentional and skilled at relationship building, thus complex elements which impact peers' health were addressed. Peer navigators were empowered to communicate their perspectives with the study team, who worked together to strengthen the intervention processes and infrastructure. This atmosphere of trust and collaboration amongst diverse stakeholders was instrumental to OP-ENS' successful implementation. Healthcare systems should consider implementing peer support interventions that are responsive to consumer input to address social determinants of health for persons with disabilities.
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Affiliation(s)
- Deana Herrman
- Department of Disability and Human Development, University of Illinois-Chicago, Chicago, IL, United States
| | - Christina Papadimitriou
- Departments of Interdisciplinary Health Sciences and Sociology, Oakland University, Rochester, MI, United States
| | - Bob Green
- Our Peers - Empowerment and Navigational Support, University of Illinois-Chicago, Chicago, IL, United States
| | - Andrea LeFlore
- Department of Occupational Therapy, University of Illinois-Chicago, Chicago, IL, United States
| | - Susan Magasi
- Department of Disability and Human Development, University of Illinois-Chicago, Chicago, IL, United States
- Department of Occupational Therapy, University of Illinois-Chicago, Chicago, IL, United States
- *Correspondence: Susan Magasi
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Heisler M, Lapidos A, Kieffer E, Henderson J, Guzman R, Cunmulaj J, Wolfe J, Meyer T, Ayanian JZ. Impact on Health Care Utilization and Costs of a Medicaid Community Health Worker Program in Detroit, 2018-2020: A Randomized Program Evaluation. Am J Public Health 2022; 112:766-775. [PMID: 35324259 PMCID: PMC9010898 DOI: 10.2105/ajph.2021.306700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare health care utilization and costs between beneficiaries randomly assigned to usual services versus a community health worker (CHW) program implemented by 3 Medicaid health plans. Methods. From February 2018 to June 2019, beneficiaries residing in Detroit, Michigan's Cody Rouge neighborhood with more than 3 emergency department (ED) visits or at least 1 ambulatory care‒sensitive hospitalization in the previous 12 months were randomized. CHWs reached out to eligible beneficiaries to assess their needs and link them to services. We compared ED and ambulatory care visits, hospitalizations, and related costs over 12 months. Results. In intention-to-treat analyses among 2457 beneficiaries, the 1389 randomized to the CHW program had lower adjusted ratios of ED visits (adjusted rate ratio [ARR] = 0.96; P < .01) and ED visit costs (ARR = 0.96; P < .01), but higher adjusted ratios of ambulatory care costs (ARR = 1.15; P < .01) and no differences in inpatient or total costs compared with the usual-care group. Conclusions. Initial increases in ambulatory care use from effective programs for underserved communities may mitigate savings from decreased acute care use. Longer-term outcomes should be followed to assess potential cost savings from improved health. Trial Registration: ClinicalTrials.gov identifier: NCT03924713. (Am J Public Health. 2022;112(5):766-775. https://doi.org/10.2105/AJPH.2021.306700).
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Affiliation(s)
- Michele Heisler
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Adrienne Lapidos
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Edith Kieffer
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - James Henderson
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Rebeca Guzman
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Jasmina Cunmulaj
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Jason Wolfe
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Trish Meyer
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - John Z Ayanian
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
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Longhini J, Canzan F, Mezzalira E, Saiani L, Ambrosi E. Organisational models in primary health care to manage chronic conditions: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e565-e588. [PMID: 34672051 DOI: 10.1111/hsc.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.
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Affiliation(s)
- Jessica Longhini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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"The More We Know, the More We're Able to Help": Participatory Development of an Evaluation Framework for Community Health Worker Programs. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E734-E742. [PMID: 35446815 DOI: 10.1097/phh.0000000000001528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT It is critical to evaluate community health worker (CHW) programs to maximize effectiveness. However, there is little consensus, and structure, for how to evaluate such programs. OBJECTIVE The purpose of this study was to develop a flexible framework for evaluating components of CHW programs in community and clinical settings. DESIGN Semistructured interviews were conducted with CHWs and their supervisors to determine evaluation categories for the framework. A survey was then administered to pilot the framework at federally qualified health centers and community-based organizations with existing CHW programs. SETTING Eighteen federally qualified health centers and community-based organizations in Louisiana, Mississippi, Alabama, and Florida. PARTICIPANTS Participants consisted of 23 CHWs and 19 CHW supervisors. RESULTS Interview participants directly informed the development of an evaluation framework for CHW programs. The framework consists of 7 evaluation categories: client relations, intraorganizational relations, interorganizational relations, capacity development, program effectiveness, cost-efficiency, and sustainability. Survey respondents specified best practices for program implementation for each evaluation category. Recommendations for CHW program evaluation include tailoring evaluation efforts and data collection methods to program context, using mixed-methods approaches for collecting evaluation data, and streamlining evaluation efforts with an organization's existing evaluation systems. CONCLUSIONS The evaluation framework is a flexible and practical model for collecting information needed for monitoring and evaluating CHW programs. By relying on practitioners' perspectives, this study contributes to an evidence base for implementing and evaluating CHW programs.
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Rodrigues SM, Kanduri A, Nyamathi A, Dutt N, Khargonekar P, Rahmani AM. Digital Health-Enabled Community-Centered Care: Scalable Model to Empower Future Community Health Workers Using Human-in-the-Loop Artificial Intelligence. JMIR Form Res 2022; 6:e29535. [PMID: 35384853 PMCID: PMC9021941 DOI: 10.2196/29535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/29/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022] Open
Abstract
Digital health-enabled community-centered care (D-CCC) represents a pioneering vision for the future of community-centered care. D-CCC aims to support and amplify the digital footprint of community health workers through a novel artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers. By focusing digitalization at the level of the community health worker, D-CCC enables more timely, supported, and individualized community health worker-delivered interventions. D-CCC has the potential to move community-centered care into an expanded, digitally interconnected, and collaborative community-centered health and social care ecosystem of the future, grounded within a robust and digitally empowered community health workforce.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Anil Kanduri
- Department of Computing, University of Turku, Turku, Finland
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
| | - Nikil Dutt
- Department of Computer Science, University of California, Irvine, CA, United States
| | - Pramod Khargonekar
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
| | - Amir M Rahmani
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, United States
- Department of Computer Science, University of California, Irvine, CA, United States
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA, United States
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Qualitative Case Study: A Pilot Program to Improve the Integration of Care in a Vulnerable Inner-City Community. Int J Integr Care 2022; 22:15. [PMID: 35634255 PMCID: PMC9122010 DOI: 10.5334/ijic.6184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction: There is a strong correlation between vulnerable populations and poor health outcomes. Growing evidence suggests that person-centred interventions using ‘link workers’ can support communities to navigate and engage with health and community services, leading to improved health service access. We describe the initial phase and qualitative evaluation of a Healthy Living Program, supported by a link worker role. The Program aimed to improve health service access for residents of an Australian inner-city suburb. Methods: To inform future program development, semi-structured interviews were conducted with clients and stakeholders (n = 21). The interviews were analysed thematically to understand program impact, success factors, constraints and potential improvements. Results: Key themes relating to impacts were a new model of working with community, improved access to services, and responsiveness to community need. Key factors for success included being a trusted, consistent presence, having knowledge of the community and health system, and successful engagement with the community and stakeholders. The constraints included difficulty influencing health system change and lack of community input. Suggested improvements were expanding the service, enhancing health system change and increasing community involvement. Conclusion: Knowledge gained from this study will inform future integrated approaches in health districts to address health inequities in areas of need.
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Jiang LG, Zhang Y, Greca E, Bodnar D, Gogia K, Wang Y, Peretz P, Steel PAD. Emergency Department Patient Navigator Program Demonstrates Reduction in Emergency Department Return Visits and Increase in Follow-up Appointment Adherence. Am J Emerg Med 2022; 53:173-179. [PMID: 35065524 DOI: 10.1016/j.ajem.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An estimated 56% of emergency department (ED) visits are avoidable. One motivation for return visits is patients' perception of poor access to timely outpatient care. Efforts to facilitate access may help reduce preventable ED visits. We aimed to analyze whether an ED patient navigator (PN) program improved adherence with outpatient appointments and reduced ED return visits. METHODS We performed a retrospective analysis of patients evaluated and discharged from two EDs from October 2016 to December 2019. Using propensity score matching, an intervention case group was matched against two control groups - patients similar to the case group who presented either (1) pre-PN intervention or (2) post-PN intervention and did not receive intervention. The four outcomes included 72-h return ED visits, 30-day return ED visits, overall ED utilization, as well as the intervention group's adherence rates to PN-scheduled outpatient appointments. From 482,896 charts, propensity matching led to a total of 14,295 patients in each group. RESULTS PN intervention decreased both acute and subacute ED return visits. Compared to both pre-PN and post-PN controls, navigated patients had a decrease in 72-h and 30-day return visits from 2% to 1% and 7% to 4% (p < 0.001) respectively. Navigated patients also had outpatient appointment adherence rates of 74-80% compared to the estimated national average of 25-56%. While there was no difference in mean ED utilization between the intervention group and pre-PN control group, mean ED utilization was found to be higher in the intervention group compared to the post-PN control group with 0.62 visits compared to 0.38 mean visits (p < 0.001). CONCLUSIONS By facilitating access to post-ED care, PNs may reduce avoidable ED utilization and improve outpatient follow-up adherence. While overall ED utilization did not change, this may be due to the overall vulnerability of the navigated group which is the goal PN intervention group.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Yiye Zhang
- Department of Population Health Sciences, Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Erina Greca
- Division of Community and Population Health, NYP Hospital, New York, United States of America
| | - David Bodnar
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Kriti Gogia
- NYC Health and Hospitals, New York, United States of America
| | - Yiwen Wang
- Department of Population Health Sciences, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
| | - Patricia Peretz
- Division of Community and Population Health, NYP Hospital, New York, United States of America.
| | - Peter A D Steel
- Department of Emergency Medicine, NYP Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, United States of America
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Fraze TK, Beidler LB, Gottlieb LM. A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts. Popul Health Manag 2022; 25:509-516. [PMID: 35196116 PMCID: PMC9419929 DOI: 10.1089/pop.2021.0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Health care organizations increasingly recognize the impact of social needs on health outcomes. As organizations develop and scale efforts to address social needs, little is known about the optimal role for clinicians in providing social care. In this study, the authors aimed to understand how health care organizations involve clinicians in formal social care efforts. In 2019, the authors conducted 33 semi-structured interviews with administrators at 29 health care organizations. Interviews focused on the development and implementation of formal social care programs within the health care organization and the role of clinicians within those programs. A few administrators described formal roles for primary care clinicians in organizational efforts to deliver social care. Administrators frequently described programs that were deliberately structured to shield clinicians (eg, clinicians were not expected to review social risk screening results or be involved in addressing social needs). The authors identified 4 ways that administrators felt clinicians could meaningfully engage in social care programs: (1) discuss social risks to strengthen relationships with patients; (2) adjust clinical care follow-up plans based on social risks; (3) modify prescriptions based on social risks; and (4) refer patients to other care team members who can directly assist with social risks. Administrators were hesitant to increase primary care clinicians' responsibilities by tasking them with social care activities. Defining appropriate and scalable roles for clinicians along with adequate support from other care team members may increase the effectiveness of social care programs.
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Affiliation(s)
- Taressa K Fraze
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA.,Healthforce Center, University of California San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA
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Saravia A, Kong KA, Roy R, Barry R, Guidry C, McDaniel LS, Raven MC, Pou AM, Mays AC. Referral Patterns of Outpatient Palliative Care among the Head and Neck Cancer Population. Int Arch Otorhinolaryngol 2022; 26:e538-e547. [DOI: 10.1055/s-0041-1741436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes.
Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions.
Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables.
Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions.
Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.
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Affiliation(s)
- Ari Saravia
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Keonho Albert Kong
- Department of Otolaryngology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina USA
| | - Ryan Roy
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Rachel Barry
- Barry Ear Nose and Throat. 4212 W Congress St, Suite 1500, Lafayette, Louisiana, USA
| | - Christine Guidry
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Lee S. McDaniel
- Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
| | - Mary C. Raven
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Anna M. Pou
- Oschner Health System, New Orleans, Louisiana, USA
| | - Ashley C. Mays
- Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
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Carson SL, Hong C, Behforouz H, Chang E, Dixon LZ, Factor D, George SM, Lewis J, Majeno A, Morales M, Porter C, Shah A, Vassar S, Brown AF. Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting. J Ambul Care Manage 2022; 45:22-35. [PMID: 34812754 PMCID: PMC8622376 DOI: 10.1097/jac.0000000000000405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.
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Affiliation(s)
- Savanna L. Carson
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Clemens Hong
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Heidi Behforouz
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Emily Chang
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Lydia Z. Dixon
- Health Science Program, California State University, Channel Islands, 1 University Dr, Camarillo, CA 93012
| | - Diane Factor
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Sheba M. George
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, College of Science and Health, 1731 E 120th St, Los Angeles, CA 90059
| | - Jenebah Lewis
- USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Angelina Majeno
- Department of Psychological Science, University of California Irvine, 510 E Peltason Dr. Irvine, California 92697
| | - Maria Morales
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
| | - Courtney Porter
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Worker Education & Resource Center, Inc, 1545 Wilshire Blvd #500, Los Angeles, CA 90017
| | - Ami Shah
- Los Angeles County, Department of Health Services, 241 N. Figueroa Street Los Angeles, CA 90012
| | - Stefanie Vassar
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
| | - Arleen F. Brown
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 1820, Los Angeles, CA, 90095
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA 91342
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Rhodes EC, Wilde LaPlant H, Zahid M, Abuwala N, Damio G, Crummett C, Surprenant R, Pérez-Escamilla R. Shifting to virtual breastfeeding counseling for low-income women in the US during COVID-19: A partner-engaged multimethod evaluation of program adaptations. FRONTIERS IN HEALTH SERVICES 2022; 2:1020326. [PMID: 36925793 PMCID: PMC10012814 DOI: 10.3389/frhs.2022.1020326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Background The Breastfeeding Heritage and Pride program (BHP) provides evidence-based breastfeeding peer counseling to low-income women. Due to the COVID-19 pandemic, BHP shifted from delivering in-person and virtual services to providing only virtual services. Program adaptations can impact implementation success, which could influence program effectiveness. We documented program adaptations and explored their impacts on implementation outcomes, guided by the Model for Adaptation Design and Impact. Methods Through a community-clinical-academic partnership, we conducted in-depth interviews with 12 program implementers and peer counselors and conducted a rapid qualitative analysis. To efficiently capture information on adaptations over time, we collected and analyzed information from program meetings and extracted data from a program report. We then triangulated data from these multiple sources. Results Peer counselors received training on virtual service delivery and increased supportive supervision. They recruited women via phone instead of in hospitals, which was viewed as feasible. In-person counseling visits at hospitals and clients' homes were replaced with phone and video calls. Examples of changes to the content delivered included breastfeeding education in the context of the pandemic such as the latest COVID-related infant feeding guidance, provision of face masks, and more assistance with social and economic challenges. Although peer counselors increasingly adopted video calls as a substitute for in-person visits, they emphasized that in-person visits were better for relationship building, helping with breastfeeding problems like latching, and identifying barriers to breastfeeding in the home environment like limited familial support. While adaptations were reactive in that they were made in response to the unanticipated COVID-19 pandemic, most were made with clear goals and reasons such as to ensure the safety of peer counselors and clients while maintaining service delivery. Most adaptations were made through a systematic process based on program implementers' expertise and best practices for peer counseling and were largely but not fully consistent with BHP's core functions. Discussion BHP was able to shift to virtual service delivery for continued provision of breastfeeding counseling during the pandemic. Overall, virtual services worked well but were less optimal for several aspects of counseling. Evaluations of program effectiveness of virtual services are still needed.
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Affiliation(s)
- Elizabeth C Rhodes
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | | | - Mahrukh Zahid
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Nafeesa Abuwala
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Grace Damio
- Hispanic Health Council, Hartford, CT, United States
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Thomas LS, Buch E, Pillay Y, Jordaan J. Effectiveness of a large-scale, sustained and comprehensive community health worker program in improving population health: the experience of an urban health district in South Africa. HUMAN RESOURCES FOR HEALTH 2021; 19:153. [PMID: 34930328 PMCID: PMC8686370 DOI: 10.1186/s12960-021-00696-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION South Africa is an upper middle-income country with wide wealth inequality. It faces a quadruple burden of disease and poor health outcomes, with access to appropriate and adequate health care a challenge for millions of South Africans. The introduction of large-scale, comprehensive community health worker (CHW) programs in the country, within the context of implementing universal health coverage, was anticipated to improve population health outcomes. However, there is inadequate local (or global) evidence on whether such programs are effective, especially in urban settings. METHODS This study is part of a multi-method, quasi-experimental intervention study measuring effectiveness of a large-scale CHW program in a health district in an urban province of South Africa, where CHWs now support approximately one million people in 280,000 households. Using interviewer administered questionnaires, a 2019 cross-sectional survey of 417 vulnerable households with long-term CHW support (intervention households) are compared to 417 households with no CHW support (control households). Households were selected from similar vulnerable areas from all sub-levels of the Ekurhuleni health district. RESULTS The 417 intervention and control households each had good health knowledge. Compared to controls, intervention households with long-term comprehensive CHW support were more likely to access early care, get diagnosed for a chronic condition, be put on treatment and be well controlled on chronic treatment. They were also more likely to receive a social grant, and have a birth certificate or identity document. The differences were statistically significant for social support, health seeking behavior, and health outcomes for maternal, child health and chronic care. CONCLUSION A large-scale and sustained comprehensive CHW program in an urban setting improved access to social support, chronic and minor acute health services at household and population level through better health-seeking behavior and adherence to treatment. Direct evidence from households illustrated that such community health worker programs are therefore effective and should be part of health systems in low- and middle-income countries.
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Affiliation(s)
- L. S. Thomas
- Gauteng Department of Health, School of Public Health, University of Witwatersrand, Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084 Gauteng South Africa
- School of Health Systems and Public Health, University of Pretoria and Colleges of Medicine, Pretoria, South Africa
| | - E. Buch
- School of Health Systems and Public Health, University of Pretoria and Colleges of Medicine, Pretoria, South Africa
| | - Y. Pillay
- Clinton Health Access Initiative, Pretoria, South Africa
| | - J. Jordaan
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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Jones TM, Schulte A, Ramanathan S, Assefa M, Rebala S, Maddox PJ. Evaluating the association of state regulation of community health workers on adoption of standard roles, skills, and qualities by employers in select states: a mixed methods study. HUMAN RESOURCES FOR HEALTH 2021; 19:148. [PMID: 34863193 PMCID: PMC8642755 DOI: 10.1186/s12960-021-00684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The occupation of community health worker (CHW) has evolved to support community member navigation of complex health and social systems. The U.S. Bureau of Labor Statistics formally recognized the occupation of community health worker (CHW) in 2009. Since then, various national and state efforts to professionalize the occupation have been undertaken. The Community Health Workers Core Consensus (C3) project released a set of CHW roles and competency recommendations meant to provide evidence-based standards for CHW roles across work settings. Some states have adopted the recommendations; however, there are a variety of approaches regarding the regulation of the occupation. As of 2020, 19 U.S. states have implemented voluntary statewide CHW certification programs. The purpose of this study was to explore the relationship between state regulation of CHWs and adoption of standard roles, skills, and qualities by employers in select states. METHODS This mixed methods study used purposive sampling of job ads for CHWs posted by employers from 2017 to 2020 in select states. Natural language processing was used to extract content from job ads and preprocess the data for statistical analysis. ANOVA, chi-square analysis, and MANOVA was used to test hypotheses related to the relationship between state regulation of CHWs and differences in skills, roles, and qualities employers seek based on seniority of state regulatory processes and employer types. RESULTS The mean job ads with nationally identified roles, skills, and qualities varies significantly by state policy type (F(2, 4801) = 26.21) and by employer type (F(4, 4799) = 69.08, p = 0.000). CONCLUSIONS Employment of CHWs is increasing to provide culturally competent care, address the social determinants of health, and improve access to health and social services for members of traditionally underserved communities. Employers in states with CHW certification programs were associated with greater adoption of occupational standards set by state and professional organizations. Wide adoption of such standards may improve recognition of the CHW workforce as a valuable resource in addressing the needs of high-need and marginalized groups.
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Affiliation(s)
- Tammie M Jones
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
| | - Alex Schulte
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Suhashini Ramanathan
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Meron Assefa
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Srilatha Rebala
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Peggy J Maddox
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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Williams JAR, Saint Onge JM, Gurley-Calvez T, Anderson R, Mosley J, Brooks JV. Aligning research and practice: The role of academic-community partnerships for improving measurement and process. EVALUATION AND PROGRAM PLANNING 2021; 89:101990. [PMID: 34446311 DOI: 10.1016/j.evalprogplan.2021.101990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Community programs addressing social determinants of health are growing in prominence and are increasingly expected to provide metrics of success. Our objective is to assess the role of an academic-community partnership for a community health worker program targeting social and medical needs, and determine factors impacting its effectiveness. METHODS We draw on a 4.5-year partnership that includes both quantitative and qualitative data collection and analysis. Quantitative data collection mechanisms evolved as a result of the partnership. Qualitative interviews were conducted with community health workers and leadership. RESULTS To align medical and social support services in a sustainable and measurable manner, our academic-community partnership found that creating and maintaining a mutually beneficial space through small wins enabled us to then address larger problems and needs. Ongoing self-study and process evaluation allowed quick adjustments. Unique partnership elements such as having consistent funding and flexible timelines and objectives were essential. CONCLUSIONS When integrating health and social services, academic-community partnerships create pathways for bidirectional learning than can quickly turn research into practice and support sustainability, especially when based on incrementally built trust and a history of small wins.
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Affiliation(s)
- Jessica A R Williams
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States.
| | - Jarron M Saint Onge
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States; Department of Sociology, University of Kansas, 1415 Jayhawk Blvd., 716 Fraser Hall, Lawrence, KS 66045-7540, United States
| | - Tami Gurley-Calvez
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States
| | | | - Jane Mosley
- Health Forward Foundation, 2300 Main, Suite 304, Kansas City, MO 64108, United States
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Mail Stop 3044, Kansas City, KS 66160, United States
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Impact of Community Health Workers on Access to Care for Rural Populations in the United States: A Systematic Review. J Community Health 2021; 47:539-553. [PMID: 34817755 DOI: 10.1007/s10900-021-01052-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Community Health Worker (CHW) interventions have shown potential to reduce inequities for underserved populations. However, there is a lack of support for CHW integration in the delivery of health care. This may be of particular importance in rural areas in the Unites States where access to care remains problematic. This review aims to describe CHW interventions and their outcomes in rural populations in the US. Peer reviewed literature was searched in PubMed and PsycINFO for articles published in English from 2015 to February 2021. Title and abstract screening was performed followed by full text screening. Quality of the included studies was assessed using the Downs and Black score. A total of 26 studies met inclusion criteria. The largest proportion were pre-post program evaluation or cohort studies (46.2%). Many described CHW training (69%). Almost a third (30%) indicated the CHW was integrated within the health care team. Interventions aimed to provide health education (46%), links to community resources (27%), or both (27%). Chronic conditions were the concern for most interventions (38.5%) followed by women's health (34.6%). Nearly all studies reported positive improvement in measured outcomes. In addition, studies examining cost reported positive return on investment. This review offers a broad overview of CHW interventions in rural settings in the United States. It provides evidence that CHW can improve access to care in rural settings and may represent a cost-effective investment for the healthcare system.
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George R, Gunn R, Wiggins N, Rowland R, Davis MM, Maes K, Kuzma A, McConnell KJ. Early Lessons and Strategies from Statewide Efforts to Integrate Community Health Workers into Medicaid. J Health Care Poor Underserved 2021; 31:845-858. [PMID: 33410811 DOI: 10.1353/hpu.2020.0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The 2010 Affordable Care Act provided new impetus and funding opportunities for state Medicaid agencies to integrate community health workers (CHWs) into their health systems. Community health workers are trusted community members who participate in training so they can promote health in their own communities. This qualitative study shares lessons and strategies from Oregon's early efforts to integrate CHWs into Medicaid with concomitant financing, policy, and infrastructure issues. Key informant interviews were conducted with 16 Coordinated care organizations (CCO) and analyzed using an iterative, immersion-crystallization approach. Coordinated care organizations found CHW integration a supportive factor for Medicaid-enrolled members navigating health and social services, educating members about disease conditions, and facilitating member engagement in primary care. Barriers to CHW integration included a lack of understanding about CHW roles and their benefits to health systems, as well as a need for more intensive guidance and support on financing and integrating CHW services.
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Tang PY, Duni J, Peeples MM, Kowitt SD, Bhushan NL, Sokol RL, Fisher EB. Complementarity of Digital Health and Peer Support: “This Is What’s Coming”. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:646963. [PMID: 36994335 PMCID: PMC10012094 DOI: 10.3389/fcdhc.2021.646963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 08/31/2021] [Indexed: 01/07/2023]
Abstract
PurposeThis study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM).MethodsTwo lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants’ medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches’ records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis.ResultsOf the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., “ate at a restaurant” and “stressed”) and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants’ and coaches’ observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge.ConclusionsDMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.
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Affiliation(s)
- Patrick Y. Tang
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Janet Duni
- Population Health Team, Vanguard Medical Group, Verona, NJ, United States
| | - Malinda M. Peeples
- Clinical Services and Research, WellDoc, Inc., Columbia, MD, United States
| | - Sarah D. Kowitt
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nivedita L. Bhushan
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rebeccah L. Sokol
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Edwin B. Fisher
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Edwin B. Fisher,
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Heisler M, Simmons D, Piatt GA. Update on Approaches to Improve Delivery and Quality of Care for People with Diabetes. Endocrinol Metab Clin North Am 2021; 50:e1-e20. [PMID: 34763822 DOI: 10.1016/j.ecl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To translate improvements in diabetes management into improved outcomes, it is essential to improve care delivery. To help guide clinicians and health organizations in their efforts to achieve these improvements, this article briefly describes key components underpinning effective diabetes care and six categories of innovations in approaches to improve diabetes care delivery: (1) team-based clinical care; (2) cross-specialty collaboration/integration; (3) virtual clinical care/telehealth; (4) use of community health workers (CHWs) and trained peers to provide pro-active self-management support; (5) incorporating screening for and addressing social determinants of health into clinical practice; and (6) cross-sectoral clinic/community partnerships.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, Australia; Macarthur Clinical School, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - Gretchen A Piatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan; Department of Learning Health Sciences, University of Michigan Medical School, 1111 E. Catherine Street, Victor Vaughan Building, Room 225, Ann Arbor, MI 48109, USA
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Community outreach for immigrant adults with diabetes and chronic kidney disease. J Am Assoc Nurse Pract 2021; 33:670-672. [PMID: 34491237 DOI: 10.1097/jxx.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is a critical need to discover health-promoting strategies to address a growing Hispanic immigrant adult population with diabetes who are at risk or have chronic kidney disease. Fellows are uniquely positioned to lead research efforts focused on community outreach to recruit this population to a kidney health clinic. Innovative models of care are important to provide care to a population who may not seek medical attention. The author collaborated with a registered renal dietician to develop a kidney health clinic. Funding from the American Nephrology Nurses Association enabled a feasibility study to recruit patients and test the effects of a model of care on patient related and health care system outcomes.
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Studying Executive Directors and Supervisors Views of Organizational and Policy-Level Challenges Faced by Community Health Workers. J Ambul Care Manage 2021; 44:250-263. [PMID: 34120125 DOI: 10.1097/jac.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Within the United States, there is an absence of a national community health worker (CHW) program. There is substantial regional and state-based variability in the population served by CHWs, their disease focus, and availability of training, supervision, and other supports. This article seeks to respond to the call in the literature to work collaboratively with CHW professional associations to identify, reflect, and respond to CHW workforce development and sustainability issues. We partnered with 8 member organizations of the Association of Perinatal Networks of New York and conducted 2 focus groups with 7 executive directors and 6 supervisors. Data were analyzed using thematic analysis. Policy barriers included funding, accessibility of evidence-based practices, and credentialing. Organizational barriers included recruitment and high turnover and interorganizational referral processes and management. This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration.
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Kennedy MA, Hatchell KE, DiMilia PR, Kelly SM, Blunt HB, Bagley PJ, LaMantia MA, Reynolds CF, Crow RS, Maden TN, Kelly SL, Kihwele JM, Batsis JA. Community health worker interventions for older adults with complex health needs: A systematic review. J Am Geriatr Soc 2021; 69:1670-1682. [PMID: 33738803 PMCID: PMC8263299 DOI: 10.1111/jgs.17078] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.
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Affiliation(s)
- Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical
Center, VA Bedford Healthcare System, Bedford, MA
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla E. Hatchell
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter R. DiMilia
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Michael A. LaMantia
- Division of Geriatric Medicine, Department of Medicine,
Larner College of Medicine at The University of Vermont, Burlington, VT
| | | | - Rebecca S. Crow
- Department of Medicine, Geisel School of Medicine at
Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction,
White River Junction, VT
| | - Tara N. Maden
- Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon,
NH
| | | | | | - John A. Batsis
- Division of Geriatric Medicine and Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC
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Kangovi S, Mitra N, Grande D, Long JA, Asch DA. Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment. Health Aff (Millwood) 2021; 39:207-213. [PMID: 32011942 PMCID: PMC8564553 DOI: 10.1377/hlthaff.2019.00981] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Interventions that address socioeconomic determinants of health are receiving considerable attention from policy makers and health care executives. The interest is fueled in part by expected returns on investment. However, many current estimates of returns on investment are likely overestimated, because they are based on pre-post study designs that are susceptible to regression to the mean. We present a return-on-investment analysis that is based on a randomized controlled trial of Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention that addresses unmet social needs for disadvantaged people. We found that every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.
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Affiliation(s)
- Shreya Kangovi
- Shreya Kangovi ( shreya. kangovi@pennmedicine. upenn. edu ) is an associate professor in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Nandita Mitra
- Nandita Mitra is a professor in the Department of Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania
| | - David Grande
- David Grande is an associate professor in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Judith A Long
- Judith A. Long is a professor in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
| | - David A Asch
- David A. Asch is a professor in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania
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Carter J, Hassan S, Walton A, Yu L, Donelan K, Thorndike AN. Effect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2110936. [PMID: 34014324 PMCID: PMC8138690 DOI: 10.1001/jamanetworkopen.2021.10936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. OBJECTIVE To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. INTERVENTION CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. RESULTS A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03085264.
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Affiliation(s)
- Jocelyn Carter
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Susan Hassan
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne Walton
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Boston
- Brandeis University, Waltham, Massachusetts
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Chang W, Oo M, Rojas A, Damian AJ. Patients' Perspectives on the Feasibility, Acceptability, and Impact of a Community Health Worker Program: A Qualitative Study. Health Equity 2021; 5:160-168. [PMID: 33937601 PMCID: PMC8080925 DOI: 10.1089/heq.2020.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: To examine patients' perceptions of the feasibility, acceptability, and impact of a safety net-based community health worker (CHW) program. Methods: Semistructured interviews with patient participants diagnosed with type 2 diabetes (n=13) were analyzed using a traditional text analysis method based on grounded theory. Results: This study highlights that the CHW program can improve satisfaction in accessing health services and community resources, and overall health outcomes of patients in safety net practices. Conclusion: Patients' overall positive perception of the CHW program suggests that the intervention may be a viable solution to address the health and social needs of patients in safety net settings.
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Affiliation(s)
- Wei Chang
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA
| | - May Oo
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA
| | - Adriana Rojas
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA
| | - April Joy Damian
- Weitzman Institute, Community Health Center, Inc., Middletown, Connecticut, USA.,Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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