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Basnet S, Wroblewski K, Hansen E, Perez E, Lyu R, Abid Z, Roach A, Latham C, Salibi N, Battle B, Giles L. Collaborative Integration of Community Health Workers in Hospitals and Health Centers to Reduce Pediatric Asthma Disparities: A Quality Improvement Program Evaluation. J Community Health 2024; 49:682-692. [PMID: 38388809 PMCID: PMC11306379 DOI: 10.1007/s10900-024-01331-y] [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] [Accepted: 01/25/2024] [Indexed: 02/24/2024]
Abstract
To address pediatric asthma disparities on the South Side of Chicago, a community health worker (CHW) home visiting intervention was implemented collaboratively by academic institutions and community based health centers. This evaluation assessed the effectiveness of this longitudinal quality improvement CHW intervention in reducing asthma morbidity and healthcare utilization. All patients aged 2-18 who met the high-risk clinical criteria in outpatient settings or those who visited the ED due to asthma were offered the program. A within-subject study design analyzed asthma morbidity and healthcare utilization at baseline and follow-up. Multivariable mixed-effects regression models, adjusted for baseline demographic and asthma characteristics, were used to assess changes over time. Among 123 patients, the average age was 8.8 (4.4) years, and 89.3% were non-Hispanic black. Significant reductions were observed in the average daytime symptoms days (baseline 4.1 days and follow-up 1.6 days), night-time symptoms days (3.0 days and 1.2 days), and days requiring rescue medication (4.1 days and 1.6 days) in the past two weeks (all p < 0.001). The average number of emergency department visits decreased from 0.92 one year before to 0.44 one year after program participation, a 52% reduction (p < 0.001). No significant difference was found in hospital admissions. These results support the use of a collaborative approach to implement the CHW home visiting program as part of standard care for pediatric asthma patients in urban settings. This approach has the potential to reduce asthma disparities and underscores the valuable role of CHWs within the clinical care team.
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Affiliation(s)
- Sweta Basnet
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Elizabeth Hansen
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ernestina Perez
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Ruobing Lyu
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Zain Abid
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Alexis Roach
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Catina Latham
- Harris School of Public Policy, The University of Chicago, Chicago, IL, USA
| | - Nadia Salibi
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Brenda Battle
- Urban Health Initiative, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| | - Louise Giles
- Department of Pediatric Medicine, The University of Chicago, Chicago, IL, USA
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Yao N, Kowalczyk M, Gregory L, Cheatham J, DeClemente T, Fox K, Ignoffo S, Volerman A. Community health workers' perspectives on integrating into school settings to support student health. Front Public Health 2023; 11:1187855. [PMID: 37415701 PMCID: PMC10320159 DOI: 10.3389/fpubh.2023.1187855] [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] [Received: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction While schools represent key venues for supporting health, they continue to experience gaps in health resources. The integration of community health workers (CHWs) into schools has the potential to supplement these resources but has been underexplored. This study is the first to examine perspectives of experienced CHWs about how CHWs can be applied in school settings to support student health. Methods This qualitative study involved conducting semi-structured interviews focused on implementation of CHWs in schools with individuals who held positions aligned with the CHW scope of work. De-identified transcripts were analyzed, and codes were organized into domains and themes. Results Among 14 participants, seven domains emerged about the implementation of CHWs in schools: roles and responsibilities, collaborations, steps for integration, characteristics of successful CHWs, training, assessment, and potential challenges. Participants shared various potential responsibilities of school-based CHWs, including educating on health topics, addressing social determinants of health, and supporting chronic disease management. Participants emphasized the importance of CHWs building trusting relationships with the school community and identified internal and external collaborations integral to the success of CHWs. Specifically, participants indicated CHWs and schools should together determine CHWs' responsibilities, familiarize CHWs with the school population, introduce CHWs to the school community, and establish support systems for CHWs. Participants identified key characteristics of school-based CHWs, including having familiarity with the broader community, relevant work experience, essential professional skills, and specific personal qualities. Participants highlighted trainings relevant to school-based CHWs, including CHW core skills and health topics. To assess CHWs' impact, participants proposed utilizing evaluation tools, documenting interactions with students, and observing indicators of success within schools. Participants also identified challenges for school-based CHWs to overcome, including pushback from the school community and difficulties related to the scope of work. Discussion This study identified how CHWs can have a valuable role in supporting student health and the findings can help inform models to integrate CHWs to ensure healthy school environments.
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Affiliation(s)
- Nicole Yao
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Monica Kowalczyk
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - LaToya Gregory
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jeannine Cheatham
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tarrah DeClemente
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Kenneth Fox
- Office of Student Health and Wellness, Chicago Public Schools, Chicago, IL, United States
| | - Stacy Ignoffo
- Sinai Urban Health Institute, Chicago, IL, United States
| | - Anna Volerman
- Department of Medicine, University of Chicago, Chicago, IL, United States
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Overmann KM, Vukovic AA, Britto MT. A Content Analysis of Emergency Department Discharge Instructions for Acute Pediatric Febrile Illnesses: The Current State and Opportunities for Improvement. J Patient Exp 2021; 8:23743735211060773. [PMID: 34869843 PMCID: PMC8640326 DOI: 10.1177/23743735211060773] [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: 11/17/2022] Open
Abstract
Quality emergency department (ED) discharge communication is critical to understanding of disease progression, home management, and return instructions. Addressing social aspects of disease burden are important to improving satisfaction and healthcare utilization. The objective of this study was to understand the extent to which written ED discharge instructions address multifaceted aspects of disease to meet the comprehensive needs of families with common childhood illnesses. We analyzed a national sample of 28 written discharge instructions from pediatric EDs using thematic and inductive content analysis. Seven themes were identified. Nearly all discharge instructions devoted a majority of content to themes related to disease physiology. Other themes common to instructions were related to parental instructions for caring for the child and when to return for further care. Content on caregiver reassurance, returning to daily activities, improving well-being, and promoting community health were not a focus of discharge instructions. Inclusion of multifaceted discharge materials which address both medical and social aspects of disease may help improve family-centered emergency care and the quality of care transitions for common childhood illnesses.
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Affiliation(s)
- Kevin M Overmann
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Adam A Vukovic
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Maria T Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Orozco K, Pappalardo AA, Martin MA. Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma. J Pediatr Psychol 2021; 46:673-687. [PMID: 33616185 PMCID: PMC8291673 DOI: 10.1093/jpepsy/jsab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. METHODS Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. RESULTS For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CONCLUSIONS CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.
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Affiliation(s)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Giselle S Mosnaim
- Department of Allergy, Immunology & Asthma, NorthShore University Health System
| | - Kimberly Orozco
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago
- Department of Medicine, University of Illinois at Chicago
| | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Pediatrics, University of Illinois at Chicago
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Sabo S, Wexler N, O'Meara L, Dreifuss H, Soto Y, Redondo F, Carter H, Guernsey de Zapien J, Ingram M. Organizational Readiness for Community Health Worker Workforce Integration Among Medicaid Contracted Health Plans and Provider Networks: An Arizona Case Study. Front Public Health 2021; 9:601908. [PMID: 34164362 PMCID: PMC8216650 DOI: 10.3389/fpubh.2021.601908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Understanding and building organizational capacity for system change and the integration of the Community Health Worker (CHW) workforce within the health scare sector requires a supportive organizational culture among sector leaders and providers. The aim of this mixed-methods study was to assess organizational readiness for CHW workforce integration into Arizona Medicaid health systems and care teams. This collaborative effort was in direct response to emergent state and national CHW workforce policy opportunities, and the shifting health care landscape in Arizona – which merged behavior and physical health. Specifically, and in collaboration with a broad-based, statewide CHW workforce coalition, led by the CHW professional association, we assessed 245 licensed health care professionals with experience working with CHWs and 16 Medicaid-contracted health plan leadership. Our goal was to generate a baseline understanding of the knowledge, attitudes and beliefs these stakeholders held about the integration of CHWs into systems and teams. Our findings demonstrate a high level of organizational readiness and action toward integration of CHWs within the Arizona health care system and care teams. CHWs have emerged as a health care workforce able to enhance the patient experience of care, improve population health, reduce cost of care, and improve the experience of providing care among clinicians and staff.
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Affiliation(s)
- Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Nancy Wexler
- The John A. Hartford Foundation, New York, NY, United States
| | - Louisa O'Meara
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Heather Dreifuss
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Yanitza Soto
- Arizona Department of Health and Human Services, Phoenix, AZ, United States
| | | | - Heather Carter
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Jill Guernsey de Zapien
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
| | - Maia Ingram
- Department of Health Promotion Sciences, Zuckerman College of Public Health, Tucson, AZ, United States
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Schwei RJ, Hetzel S, Kim K, Mahoney J, DeYoung K, Frumer J, Lanzafame RP, Madlof J, Simpson A, Zambrano-Morales E, Jacobs EA. Peer-to-Peer Support and Changes in Health and Well-being in Older Adults Over Time. JAMA Netw Open 2021; 4:e2112441. [PMID: 34129024 PMCID: PMC8207241 DOI: 10.1001/jamanetworkopen.2021.12441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Literature on peer-to-peer (P2P) programs suggests they improve health and well-being of older adults. Analysis from a previous study showed P2P to be associated with higher rates of hospitalization and no significant differences in rates of emergency department or urgent care visits; however, it is not known whether measures of health and well-being varied by group over time. OBJECTIVE To compare the association between receiving P2P support and secondary outcomes (ie, health status, quality of life, and depressive and anxiety symptoms) with receiving standard community services (SCS) over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among a volunteer sample of older adults (≥65 years) who were new to P2P or were already receiving P2P and a corresponding control group. Participants were matched between groups on age, sex, and race/ethnicity. The study was conducted from March 2015 to December 2017 at 3 community-based organizations that delivered P2P in California, Florida, and New York. Data analysis was performed from October 2018 through May 2020. EXPOSURES P2P support, provided by trained older adult volunteers. MAIN OUTCOMES AND MEASURES Mental and physical components of the health status and quality of life measure and depressive and anxiety symptoms were collected over 12 months. The hypothesis was that older adults receiving P2P support would maintain higher health status and quality of life than the SCS group. RESULTS A total of 503 participants were screened, 456 participants were enrolled and had baseline data, and 8 participants only had baseline information with no follow-up data, leaving 448 participants (231 [52%] in the SCS group; 217 [48%] in the P2P group; 363 [81%] women; mean [SD] age, 80 [9] years). The P2P group had improvements in mental health (change at 12 months, 1.1 points; 95% CI, -0.8 to 3.0 points) and physical health (change at 12 months, 1.0 points; 95% CI, -0.7 to 2.8 points). However, the difference of differences between the 2 groups did not differ significantly from baseline to 12 months (mental health: 0.2 points; 95% CI -2.3 to 2.7 points; physical health: 1.7 points; 95% CI, -0.6 to 3.9 points). The P2P and SCS groups had a statistically significant difference of differences in anxiety symptoms of 0.36 points (95% CI, 0.04 to 0.61 points). There were no significant differences in depressive symptoms or mental and physical components of the health status and quality of life. CONCLUSIONS AND RELEVANCE These findings suggest that receiving P2P support did not slow the decline of health and well-being in older adults compared with those who received SCS. Baseline imbalance in key characteristics, even after adjusting for the imbalance using the propensity score method, may explain the results. Randomized trials are needed.
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Affiliation(s)
- Rebecca J. Schwei
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - Jane Mahoney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Jenni Frumer
- Next Generation of Holocaust Survivors Inc, Boynton Beach, Florida
| | | | - Jenny Madlof
- Alpert Jewish Family Service of West Palm Beach, West Palm Beach, Florida
| | - Alis Simpson
- Brockport Research Institute, Brockport, New York
| | | | - Elizabeth A. Jacobs
- Department of Medicine and Population Health, University of Texas at Austin Dell Medical School, Austin
- now with Maine Medical Center Research Institute, Scarborough
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Shaak S, Brown K, Reichart C, Zimmerman D. Community health workers providing asthma education. J Asthma 2020; 59:572-579. [PMID: 33351650 DOI: 10.1080/02770903.2020.1862184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Children living in urban areas experience disproportionate rates of asthma. Substandard housing conditions in some urban areas contribute to greater exposure to household asthma triggers. This article examines the geographic connection between pediatric asthma and substandard housing in one mid-sized city in Pennsylvania and the effectiveness of a home-based Community Health Worker (CHW) intervention targeted at this high-risk area to improve families' abilities to manage their children's asthma.Methods: The CHWs provided education and resources to families of children diagnosed with mild, moderate or severe persistent asthma. A pre and post-test design was implemented to evaluate if the CHW intervention improved the family's ability to successfully manage their child's asthma. Eighty-one patients completed the program over a six-month period.Results: Results showed significant improvements in the areas of asthma knowledge, fewer missed days of school, fewer days with asthma symptoms, reduction in wheezing and fewer sleep disturbances. There was also a significant decrease in the number of Emergency Department visits and hospital days.Conclusions: By teaching asthma management skills and by addressing in-home triggers, home-based CHW led interventions can be an affordable and effective way for caregivers and children with asthma to improve asthma management.
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Affiliation(s)
- Samantha Shaak
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - Kimberly Brown
- Department of Pediatrics, Lehigh Valley Reilly Children's Hospital, Allentown, PA, USA
| | - Christine Reichart
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
| | - David Zimmerman
- Department of Community Health, Lehigh Valley Health Network, Allentown, PA, USA
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Rusch D, Walden AL, DeCarlo Santiago C. A Community-Based Organization Model to Promote Latinx Immigrant Mental Health Through Advocacy Skills and Universal Parenting Supports. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:337-346. [PMID: 32880968 DOI: 10.1002/ajcp.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The unique mental health context of children in Latinx immigrant families calls for innovative community-based intervention strategies. We use an ecological public health approach to highlight the importance of community-based organization (CBO) settings, the critical role of community-based paraprofessionals (i.e., non-clinicians, near-peers) and capacity-building, and the expansion of mental health promotion strategies to include realistic, day-to-day supports for Latinx immigrant parents and families. This realigns mental health with the goals and mission of trusted spaces, like CBOs, that can offer more equitable and non-stigmatized access for Latinx immigrant families. We draw upon two strength-based and empowerment-focused interventions that utilize community-based workforces to promote positive parenting skills (Partners Achieving Student Success-PASS; Mehta et al., 2019) and self-advocacy skills (Community Advocacy Project-CAP; Sullivan & Bybee, 1999) to provide the conceptual framework for Family Mental Health Advocacy (FMHA). FMHA aligns mental health promotion with the advocacy mission of CBOs, engages CBO staff with feasible mental health "messages," and empowers immigrant parents as critical change agents in the lives of their children. We acknowledge the challenges associated with implementing mental health promotion strategies and providing workforce support, as well as the importance of local and national policy influences.
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Affiliation(s)
- Dana Rusch
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Angela L Walden
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
- Office of the Vice Provost for Diversity, University of Illinois at Chicago, Chicago, IL, USA
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Jonas JA, Leu CS, Reznik M. A randomized controlled trial of a community health worker delivered home-based asthma intervention to improve pediatric asthma outcomes. J Asthma 2020; 59:395-406. [PMID: 33148066 DOI: 10.1080/02770903.2020.1846746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effects of using Community Health Workers (CHWs) to deliver the home-based Wee Wheezers asthma education program on asthma symptoms among children with persistent asthma. METHODS In this randomized controlled trial of 151 children aged 2-9 years with persistent asthma, we assigned 75 to the intervention and 76 to the control. The primary outcome was caregiver-reported asthma symptom days. Secondary outcomes included asthma-related healthcare utilization, caregivers' asthma knowledge, illness perception and management behaviors, MDI-spacer administration technique, and home environmental triggers. Outcomes were collected at baseline, 3, 6, 9 and 12 months. A repeated measurements analytic approach with generalized estimating equations was used. To account for missing data, multiple imputation methods were employed. RESULTS At 3 and 6 months, improvement in symptom days was not significantly different between groups. However, at 9 and 12 months, the reduction in asthma symptom days was 2.15 and 2.31 days more respectively for those in the intervention group compared to the control. Improvements in MDI-spacer technique, knowledge and attitudes were significant throughout follow-up. Improvement in habits regarding MDI use was significant at 3 and 6 months, and asthma routines were improved at 3 months. However, there was no change in asthma-related healthcare utilization or home environmental triggers. CONCLUSION Using CHWs to deliver a home-based asthma education program to caregivers of children with persistent asthma led to improvements in symptom days and several secondary outcomes. Expanding the use of CHWs to provide home-based interventions can help reduce disparities in children's health outcomes.
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Affiliation(s)
| | - Cheng-Shiun Leu
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marina Reznik
- Albert Einstein College of Medicine, Bronx, NY, USA.,Children's Hospital at Montefiore, Bronx, NY, USA
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Effect of Family Empowerment Education on Pulmonary Function and Quality of Life of Children With Asthma and Their Parents in Tunisia: A Randomized Controlled Trial. J Pediatr Nurs 2020; 54:e9-e16. [PMID: 32616452 DOI: 10.1016/j.pedn.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Patient education is fundamental in asthma management, especially at pediatric age. It is increasingly recognized as effective in reducing the burden of the disease, but is less clear in improving the quality of life of children with asthma and their parents. This study assessed the effect of an asthma therapeutic education program on pulmonary function and quality of life in children with asthma and their parents. DESIGN AND METHODS A monocentric randomized controlled trial conducted in Farhat Hached University Hospital of Sousse (Tunisia) from May 2018 to September 2019. Thirty-seven families in the experimental group and 39 families in the control group received allocated intervention at baseline. Thirty-four families in each group completed the study at the 12-month follow-up. RESULTS The intervention significantly improved quality of life scores of children and their parents (all p < 0.05). Children in the experimental group had significantly better forced expiratory maneuver than children in the control group. Nonetheless, the FEV1/FVC ratio did not show any significant difference in the experimental and control group (p = 0.9; p = 0.14, respectively). CONCLUSIONS This study demonstrated that a long-term family-based asthma education program resulted in better pulmonary function and QOL of children and parents enrolled in the intervention group, particularly children with non-allergic asthma. PRACTICE IMPLICATIONS Family-based asthma education can reduce the burden of allergic and non-allergic asthma on children and their parents through improving their quality of life. Also, the pulmonary function of children with non-allergic asthma was improved due to My Asthma Therapeutic Education intervention.
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11
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Parikh K, Richmond M, Lee M, Fu L, McCarter R, Hinds P, Teach SJ. Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma. J Asthma 2020; 58:1384-1394. [PMID: 32664809 DOI: 10.1080/02770903.2020.1795877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. METHODS A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program among children enrolled in K-8th grade on Medicaid hospitalized for an asthma exacerbation. H2H program includes 5 components: medications in-hand at discharge, school-based asthma therapy (SBAT) for controller medications, referral for home trigger assessments, communication with the primary care provider (PCP), and patient navigator support. Primary outcomes included feasibility and acceptability. Secondary outcomes included healthcare utilization, asthma morbidity, and caregiver quality of life. RESULTS A total of 32 children were enrolled and randomized. Feasibility outcomes in the intervention group included: medications in-hand at discharge (100%); SBAT for controller medication initiated (100%); home visit referrals made (100%) and home visits completed within 4 weeks of discharge (44%); PCP communication (100%); patient navigator communication at 3 days (81.3%) and 14 days (46.7%). Acceptability outcomes in the intervention group included: 87.5% of families continued SBAT, and 87.5% of families reported it was extremely helpful to have the home visit referral. Adjusting for baseline differences in age, asthma severity and control, there was no significant difference in healthcare utilization outcomes. CONCLUSION These pilot data suggest that comprehensive care coordination initiated during the inpatient stay is feasible and acceptable. A larger trial is justified to determine if the intervention may reduce healthcare utilization for urban, minority children with asthma.
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Affiliation(s)
- Kavita Parikh
- Division of Hospital Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Miller Richmond
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Michael Lee
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Linda Fu
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Robert McCarter
- Center for Translational Research, Department of Biostatistics and Research Methodology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Pamela Hinds
- Department of Nursing Science, Professional Practice & Quality, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Coutinho MT, Subzwari SS, McQuaid EL, Koinis-Mitchell D. Community Health Workers' Role in Supporting Pediatric Asthma Management: A Review. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2020; 8:195-210. [PMID: 35498877 PMCID: PMC9053383 DOI: 10.1037/cpp0000319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Objective Community Health Workers (CHWs) have been effective in improving health outcomes in vulnerable communities by providing health education and management services. We review CHW-led asthma education and management interventions for children and their families. Next, we describe the selection and training of CHWs in pediatric asthma management in the Rhode Island Integrated Response Asthma Care Implementation Program (RI-AIR). Methods We queried the MEDLine, Cochrane, PubMed, and EMBASE databases with keywords ("community health worker", "asthma", "health worker", "lay worker", "pediatric", "child", and "childhood") from inception until September 2019. Criteria for study inclusion included: published in English, conducted in the United States, approved with an ethics notification, published in peer-reviewed journal, and involved CHWs as the interventionists. The initial search identified 216 manuscripts. Fifteen studies met criteria for inclusion. Results CHWs provide asthma management and education services, including home environmental trigger assessments, strategies to reduce environmental trigger exposure, resource linkage, and community referrals. We describe RI-AIR, and its CHW-led asthma education and management interventions. Conclusions CHWs are effective and vital supports for positive asthma outcomes. More research is needed to guide models of intervention using CHWs, specifically addressing integration in interdisciplinary teams, training, and reimbursement for CHW services. Implications for Impact Statement CHWs are effective in helping children with asthma and their families learn to manage asthma. It is important to develop programs that prepare CHWs to work with other medical professionals and health care models to pay for their services.
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Affiliation(s)
- Maria Teresa Coutinho
- Bradley/Hasbro Children’s Research Center, Warren Alpert Medical School of Brown University
| | | | - Elizabeth L. McQuaid
- Bradley/Hasbro Children’s Research Center, Warren Alpert Medical School of Brown University
| | - Daphne Koinis-Mitchell
- Bradley/Hasbro Children’s Research Center, Warren Alpert Medical School of Brown University
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Ebbs D, Hirschbaum JH, Mika A, Matsushita SC, Lewis JH. Expanding Medical Education for Local Health Promoters Among Remote Communities of the Peruvian Amazon: An Exploratory Study of an Innovative Program Model. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:215-223. [PMID: 32256139 PMCID: PMC7090155 DOI: 10.2147/amep.s245491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/02/2020] [Indexed: 05/29/2023]
Abstract
PURPOSE Community health workers (CHWs) play integral roles in primary health care provision in low- and middle-income countries (LMICs). This is particularly true in underdeveloped areas where there are acute shortages of health workers. In this study, we evaluated the development and community utilization of a CHW training program in the Loreto province of Peru. Additionally, a community-oriented training model was designed to augment access to basic health information in underserved and isolated areas of the Amazon. METHODS Health resource utilization was compared in each community by surveying community members before and after implementation of the CHW training program, which utilized a community participatory program development (CPPD) model. RESULTS All communities demonstrated significantly increased CHW utilization (p = 0.026) as their initial point of contact for immediate health concerns following CHW training implementation. This increase in CHW utilization was accompanied by trends toward decreased preferences for local shamans or traveling to the closest health post as the initial health resource. CONCLUSION The community-focused, technology-oriented model utilized in this study proved an effective way to promote the use of CHWs in the Amazon region of Loreto, and could prove valuable to CHW capacitation efforts within other Peruvian provinces and in other LMICs around the world.
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Affiliation(s)
- Daniel Ebbs
- Resident Physician Valley Children’s Hospital, Madera, CA, USA
| | - Julian H Hirschbaum
- Resident Physician Los Angeles County USC Medical Center, Los Angeles, CA, USA
| | - Amanda Mika
- Resident Physician Saint Joseph Hospital, Denver, CO, USA
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Ellis DA, Carcone AI, Naar-King S, Rajkumar D, Palmisano G, Moltz K. Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial. J Pediatr Psychol 2020; 44:110-125. [PMID: 29186562 DOI: 10.1093/jpepsy/jsx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.
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Affiliation(s)
- Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | - Sylvie Naar-King
- Center for Translational Behavioral Research, Florida State University
| | - Dixy Rajkumar
- Department of Family Medicine and Public Health Sciences, Wayne State University
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Trout KE, Chaidez V, Palmer-Wackerly AL. Rural-Urban Differences in Roles and Support for Community Health Workers in the Midwest. FAMILY & COMMUNITY HEALTH 2020; 43:141-149. [PMID: 32079970 DOI: 10.1097/fch.0000000000000255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Patient Protection and Affordable Care Act supports the integration of community health workers (CHWs) into the health care workforce, but little is known about integration and current roles of CHWs among employers in community settings. This analysis of 97 employers described the roles of CHWs in Nebraska and found significant differences between CHWs practicing in rural and urban areas in organization types employing CHWs, funding sources, and minority populations served. The findings suggest that the utility of CHWs is widely recognized among employers, but deliberate support will be needed to better define the roles of CHWs to meet the needs of the increasingly diverse demographic.
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Affiliation(s)
- Kate E Trout
- Department of Natural Sciences, Peru State College, Peru, Nebraska (Dr Trout); and Nutrition and Health Sciences (Dr Chaidez) and Communication Studies (Dr Palmer-Wackerly), University of Nebraska-Lincoln
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Stempel H, Federico MJ, Szefler SJ. Applying a biopsychosocial model to inner city asthma: Recent approaches to address pediatric asthma health disparities. Paediatr Respir Rev 2019; 32:10-15. [PMID: 31678039 DOI: 10.1016/j.prrv.2019.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022]
Abstract
Pediatric asthma in inner cities is often severe and children living in these urban locations with socioeconomic disadvantage experience greater asthma morbidity. There are many interconnected risk factors that individually, and in combination, enhance asthma morbidity. These include biologic factors innate to the child, such as genetics and allergen susceptibility, as well as factors related to the family and neighborhood context. The biopsychosocial model can be used to frame these risk factors and develop interventions specific to the inner city. Successful inner city asthma interventions exist and key characteristics include multi-tiered components that operate within the community to coordinate disease management resources between patients, families and health care systems.
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Affiliation(s)
- Hilary Stempel
- Department of General Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Monica J Federico
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and Anschutz Medical Campus, Aurora, CO, USA.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and Anschutz Medical Campus, Aurora, CO, USA.
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Costich MA, Peretz PJ, Davis JA, Stockwell MS, Matiz LA. Impact of a Community Health Worker Program to Support Caregivers of Children With Special Health Care Needs and Address Social Determinants of Health. Clin Pediatr (Phila) 2019; 58:1315-1320. [PMID: 31130003 DOI: 10.1177/0009922819851263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few studies have evaluated the effects of a community health worker (CHW) intervention on social determinants and caregiver distress. This study assesses the impact of a CHW program for caregivers of children with special health care needs (CSHCN) on these factors in addition to confidence in self-management. A retrospective, pre-post analysis was conducted for those who completed a CHW program. Caregivers reported high levels of distress, low educational attainment, linguistic isolation, positive depression screens, and food and housing issues at baseline. On completion of the program, there was significant improvement in caregiver distress scores (P < .001) and in understanding of their children's diagnoses (P < .001). Furthermore, the number of caregivers reporting food or housing issues was significantly reduced (P < .01 and P < .01, respectively). This study demonstrates the feasibility and potential effects of a CHW intervention for CSHCN and highlights the need for a large-scale controlled trial to further evaluate impact.
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Affiliation(s)
| | | | | | - Melissa S Stockwell
- Columbia University Irving Medical Center, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Luz A Matiz
- Columbia University Irving Medical Center, New York, NY, USA
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Brooks DR, Burtner JL, Borrelli B, Heeren TC, Evans T, Davine JA, Greenbaum J, Scarpaci M, Kane J, Rees VW, Geller AC. Twelve-Month Outcomes of a Group-Randomized Community Health Advocate-Led Smoking Cessation Intervention in Public Housing. Nicotine Tob Res 2019; 20:1434-1441. [PMID: 29145626 DOI: 10.1093/ntr/ntx193] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 09/08/2017] [Indexed: 12/31/2022]
Abstract
Background Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence. Methods We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified. Results Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect. Conclusions An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success. Implications In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.
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Affiliation(s)
- Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Joanna L Burtner
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Belinda Borrelli
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Tegan Evans
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jonathan Greenbaum
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Matthew Scarpaci
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | | | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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Parekh TM, Copeland CR, Dransfield MT, Cherrington A. Application of the community health worker model in adult asthma and COPD in the U.S.: a systematic review. BMC Pulm Med 2019; 19:116. [PMID: 31242944 PMCID: PMC6593583 DOI: 10.1186/s12890-019-0878-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With rising medical costs, stakeholders and healthcare professionals are exploring community-based solutions to relieve the burden of chronic diseases and reduce health care spending. The community health worker (CHW) model is one example that has proven effective in improving patient outcomes globally. We sought to systematically describe the effectiveness of community health worker interventions in improving patient reported outcomes and reducing healthcare utilization in the adult asthma and chronic obstructive pulmonary disease (COPD) populations in the U.S. METHODS Studies were included if they were a randomized control trial or involved a pre-post intervention comparison with clearly stated disease specific outcomes, targeted adult patients with asthma or COPD, and were performed in the United States. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria and was registered with PROSPERO. RESULT The search yielded 4013 potential articles, of which 47 were chosen for full-text review and 4 were chosen for inclusion; all focused on asthma and three had a comparison group. CHW interventions demonstrated improvement in asthma-related quality of life, asthma control, home trigger scores, and asthma symptom free days. There were no studies that reported COPD specific outcomes as a result of CHW interventions. CONCLUSION Emerging evidence suggests CHW interventions may improve some aspects of asthma related disease burden in adults, however additional studies with consistent outcome measures are needed to confirm their effectiveness. Further research is also warranted to evaluate the use of community health workers in the COPD population.
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Rusch D, Walden AL, Gustafson E, Lakind D, Atkins MS. A qualitative study to explore paraprofessionals' role in school-based prevention and early intervention mental health services. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:272-290. [PMID: 30161268 PMCID: PMC6431079 DOI: 10.1002/jcop.22120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/11/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
This study explored the role of paraprofessionals within a school-based prevention and early intervention program to promote children's engagement in learning and positive parenting practices. Study aims were designed to understand how paraprofessionals perceive their role in high-need communities and how they define their work within schools. Two focus groups were conducted with school family liaisons (SFLs) during the 2015-2016 school year. Transcribed audio recordings were coded using thematic analysis wherein 2 authors coded independently, followed by audited discussion and final consensus codes. SFLs acknowledged the importance of serving high-need communities and relationship building was central to their role. They leveraged contextual knowledge (culture, language, and neighborhood) to engage parents, allowing them to serve as effective advocates for parents/families in the school setting. Findings support the importance of paraprofessionals in prevention-focused services and highlight how leveraging shared experiences and prioritizing relationship building facilitates their work as advocates within schools.
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21
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Chiu RG, Xia Y, Sharp LK, Gerber BS. Do community health workers affect non-urgent, ambulatory healthcare utilization among low-income, minority patients with diabetes? J Clin Transl Endocrinol 2019; 16:100184. [PMID: 30815365 PMCID: PMC6377405 DOI: 10.1016/j.jcte.2019.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 11/15/2022] Open
Abstract
Community health workers (CHWs) can reduce emergent care among low-income, ethnic minority patients with type 2 diabetes. A secondary analysis of a randomized controlled trial evaluated the effect of CHWs on non-urgent, ambulatory healthcare utilization. Within this trial, no effect on ambulatory care was found.
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Affiliation(s)
- Ryan G. Chiu
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Yinglin Xia
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Lisa K. Sharp
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois College of Pharmacy, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Ben S. Gerber
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States,Corresponding author at: Division of Academic Internal Medicine and Geriatrics, Institute for Health Research and Policy M/C 275, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
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Naar S, Ellis D, Cunningham P, Pennar AL, Lam P, Brownstein NC, Bruzzese JM. Comprehensive Community-Based Intervention and Asthma Outcomes in African American Adolescents. Pediatrics 2018; 142:peds.2017-3737. [PMID: 30185428 PMCID: PMC6317763 DOI: 10.1542/peds.2017-3737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804911922001PEDS-VA_2017-3737Video Abstract BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma. METHODS African American adolescents (age 12-16 years) with moderate-to-severe persistent asthma and ≥1 inpatient hospitalization or ≥2 emergency department visits in 12 months were randomly assigned to Multisystemic Therapy-Health Care or an attention control group (N = 167). Multisystemic Therapy-Health Care is a 6-month home- and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions. The attention control condition was weekly family supportive counseling, which was also provided for 6 months in the home. The primary outcome was lung function (forced expiratory volume in 1 second [FEV1]) measured over 12 months of follow-up. RESULTS Linear mixed-effects models revealed that compared with adolescents in the comparison group, adolescents in the treatment group had significantly greater improvements in FEV1 secondary outcomes of adherence to controller medication, and the frequency of asthma symptoms. Adolescents in the treatment group had greater reductions in hospitalizations, but there were no differences in reductions in emergency department visits. CONCLUSIONS A comprehensive family- and community-based treatment significantly improved FEV1, medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma. Further evaluation in effectiveness and implementation trials is warranted.
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Affiliation(s)
- Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, College of Medicine, Florida State University, Tallahassee, Florida;
| | - Deborah Ellis
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phillippe Cunningham
- Department of Psychiatry and Behavioral Sciences,
Medical University of South Carolina, Charleston, South Carolina
| | - Amy L. Pennar
- Department of Family Medicine and Public Health
Services, School of Medicine, Wayne State University, Detroit, Michigan
| | - Phebe Lam
- Faculty of Arts, Humanities, and Social Sciences,
University of Windsor, Windsor, Canada; and
| | - Naomi C. Brownstein
- Department of Behavioral Sciences and Social
Medicine, Center for Translational Behavioral Research, College of Medicine,
Florida State University, Tallahassee, Florida
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Gaskin DJ, Vazin R, McCleary R, Thorpe RJ. The Maryland Health Enterprise Zone Initiative Reduced Hospital Cost And Utilization In Underserved Communities. Health Aff (Millwood) 2018; 37:1546-1554. [DOI: 10.1377/hlthaff.2018.0642] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Darrell J. Gaskin
- Darrell J. Gaskin is the William C. and Nancy F. Richardson Professor in Health Policy in the Department of Health Policy and Management and director of the Hopkins Center for Health Disparities Solutions, both at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Roza Vazin
- Roza Vazin was a graduate student research assistant in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, at the time this research was conducted
| | - Rachael McCleary
- Rachael McCleary is a research data analyst in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Roland J. Thorpe
- Roland J. Thorpe Jr. is an associate professor in the Department of Health, Behavior, and Society and deputy director of the Hopkins Center for Health Disparities Solutions, both at the Johns Hopkins Bloomberg School of Public Health
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Wallace C, Farmer J, McCosker A. Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature. HUMAN RESOURCES FOR HEALTH 2018; 16:46. [PMID: 30200968 PMCID: PMC6131945 DOI: 10.1186/s12960-018-0310-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/26/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Health services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community-those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries. METHODS A scoping review methodology was applied to peer-reviewed articles to answer the question: "How do health services identify, recruit and use boundary spanners and what are the outcomes?" The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services. FINDINGS We identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs. CONCLUSIONS Community boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes. Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.
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Affiliation(s)
- Carolyn Wallace
- Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Jane Farmer
- Swinburne University of Technology, Hawthorn, Victoria Australia
| | - Anthony McCosker
- Swinburne University of Technology, Hawthorn, Victoria Australia
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Benjamin LS, Carney MM. Furthering the Value of the Emergency Department Beyond Its Walls: Transitions to the Medical Home for Pediatric Emergency Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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Pappalardo AA, Karavolos K, Martin MA. What Really Happens in the Home: The Medication Environment of Urban, Minority Youth. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:764-770. [PMID: 27914817 PMCID: PMC5423821 DOI: 10.1016/j.jaip.2016.09.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 09/23/2016] [Accepted: 09/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes. OBJECTIVE The objective of this study was to describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population. METHODS Baseline data from 2 cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children's asthma medications and inhaler technique. RESULTS The sample contained 175 mainly Latino youth (85.6%) ranging from 5 to 18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine, and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. A better medication technique was associated with having a controller (b = 12.2, SE = 3.0, P < .0001), quick reliever (b = 8.05, SE = 3.5, P = .023), and a spacer (b = 9.3, SE = 3.54, P = .009). CONCLUSIONS This rigorous evaluation of the home medication environment of high-risk youth demonstrated that many families lack critical medications, devices, and a technique for proper management of asthma.
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Affiliation(s)
- Andrea A Pappalardo
- Asthma and Allergy Center, Bloomingdale, Ill; Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill.
| | - Kelly Karavolos
- Department of Preventative Medicine, Rush University Medical Center, Chicago, Ill
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill
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Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS. Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review. J Gen Intern Med 2017; 32:325-344. [PMID: 27921257 PMCID: PMC5331010 DOI: 10.1007/s11606-016-3922-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/17/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.
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Affiliation(s)
- Helen E Jack
- Center for Primary Care, Harvard Medical School, Boston, MA, USA.
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | | | - Lucy Sun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erin E Sullivan
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
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Volerman A, Chin MH, Press VG. Solutions for Asthma Disparities. Pediatrics 2017; 139:peds.2016-2546. [PMID: 28228500 PMCID: PMC5330398 DOI: 10.1542/peds.2016-2546] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anna Volerman
- Departments of Medicine, and .,Pediatrics, University of Chicago, Chicago, Illinois
| | | | - Valerie G. Press
- Departments of Medicine, and,Pediatrics, University of Chicago, Chicago, Illinois
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Nkonki L, Tugendhaft A, Hofman K. A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes. HUMAN RESOURCES FOR HEALTH 2017; 15:19. [PMID: 28245839 PMCID: PMC5331680 DOI: 10.1186/s12960-017-0192-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/15/2017] [Indexed: 05/04/2023]
Abstract
Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.There is a growing body of economic evaluation literature on cost-effectiveness of CHW interventions. However, this is largely for small scale and vertical programmes. There is a need for economic evaluations of larger and integrated CHW programmes in order to achieve the post-2015 Sustainable Development Goal agenda so that appropriate resources can be allocated to this subset of human resources for health. This is the first systematic review to assess the cost-effectiveness of community health workers in delivering child health interventions.
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Affiliation(s)
- L. Nkonki
- Centre for Health Systems and Services Revision, Division of Community Health, Faculty of Medicine and Health Sciences, Francie van Zijl Rylaan/Drive, Tygerberg, 7505 South Africa
| | - A. Tugendhaft
- PRICELESS SA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K. Hofman
- PRICELESS SA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Something new in the air: Paying for community-based environmental approaches to asthma prevention and control. J Allergy Clin Immunol 2017; 140:1244-1249. [PMID: 28192148 DOI: 10.1016/j.jaci.2016.12.975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/10/2016] [Accepted: 12/06/2016] [Indexed: 10/20/2022]
Abstract
Despite the recommendation in national asthma guidelines to target indoor environmental exposures, most insurers generally have not covered the outreach, education, environmental assessments, or durable goods integral to home environmental interventions. However, emerging payment approaches offer new potential for coverage of home-based environmental intervention costs. These opportunities are becoming available as public and private insurers shift reimbursement to reward better health outcomes, and their key characteristic is a focus on the value rather than the volume of services. These new payment models for environmental interventions can be divided into 2 categories: enhanced fee-for-service reimbursement and set payments per patient that cover asthma-related costs. Several pilot programs across the United States are underway, and as they prove their value and as payment increasingly becomes aligned with better outcomes at lower cost, these efforts should have a bright future. Physicians should be aware that these new possibilities are emerging for payment of the goods and services needed for indoor environmental interventions for their patients with asthma.
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Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care. Med Care 2017; 55:140-147. [DOI: 10.1097/mlr.0000000000000618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krupp NL, Fiscus C, Webb R, Webber EC, Stanley T, Pettit R, Davis A, Hollingsworth J, Bagley D, McCaskey M, Stevens JC, Weist A, Cristea AI, Warhurst H, Bauer B, Saysana M, Montgomery GS, Howenstine MS, Davis SD. Multifaceted quality improvement initiative to decrease pediatric asthma readmissions. J Asthma 2017; 54:911-918. [PMID: 28118056 DOI: 10.1080/02770903.2017.1281294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. METHODS Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. RESULTS From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. CONCLUSION A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.
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Affiliation(s)
- Nadia L Krupp
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Cindy Fiscus
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Russell Webb
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Emily C Webber
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Teresa Stanley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Rebecca Pettit
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Ashley Davis
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Judy Hollingsworth
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Deborah Bagley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Marjorie McCaskey
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - John C Stevens
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Andrea Weist
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - A Ioana Cristea
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Heather Warhurst
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Benjamin Bauer
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Michele Saysana
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Gregory S Montgomery
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Michelle S Howenstine
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Stephanie D Davis
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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Hsu J, Wilhelm N, Lewis L, Herman E. Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:1123-1134.e27. [PMID: 27658535 PMCID: PMC5117439 DOI: 10.1016/j.jaip.2016.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/02/2016] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
Abstract
The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (eg, higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments.
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Affiliation(s)
- Joy Hsu
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga.
| | | | - Lillianne Lewis
- Epidemic Intelligence Service, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Elizabeth Herman
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga
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Uwemedimo OT, Arora G, Russ CM. New views on global child health: global solutions for care of vulnerable children in the United States. Curr Opin Pediatr 2016; 28:667-72. [PMID: 27434718 DOI: 10.1097/mop.0000000000000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This paper provides a brief overview of the current landscape of global child health and the impact of social determinants on the world's children. In the United States (US), global child health (GCH) has increasingly been highlighted as a priority area by national organizations, such as the National Academy of Medicine and American Academy of Pediatrics, as well as individual pediatricians committed to ensuring the health of all children regardless of geographic location. Although GCH is commonly used to refer to the health of children outside of the US, here, we highlight the recent call for GCH to also include care of US vulnerable children. Many of the lessons learned from abroad can be applied to pediatrics domestically by addressing social determinants that contribute to health disparities. RECENT FINDINGS Using the 'three-delay' framework, effective global health interventions target delays in seeking, accessing, and/or receiving adequate care. In resource-limited, international settings, novel health system strengthening approaches, such as peer groups, community health workers, health vouchers, cultural humility training, and provision of family-centered care, can mitigate barriers to healthcare and improve access to medical services. SUMMARY The creative use of limited resources for pediatric care internationally may offer insight into effective strategies to address health challenges that children face here in the US. The growing number of child health providers with clinical experience in resource-limited, low-income countries can serve as an unforeseen yet formidable resource for improving pediatric care in underserved US communities.
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Affiliation(s)
- Omolara T Uwemedimo
- aDivision of General Pediatrics, Hofstra Northwell School of Medicine, Global Pediatrics Program, Cohen Children's Medical Center, New Hyde Park, New York bDepartment of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California cDivision of Medicine Critical Care, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Belice PJ, Becker EA. Effective education parameters for trigger remediation in underserved children with asthma: A systematic review. J Asthma 2016; 54:186-201. [PMID: 27304997 DOI: 10.1080/02770903.2016.1198374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The prevalence of asthma is highest in minority children living in urban areas. Pediatric asthma research has focused on self-management education and trigger remediation using a multi-trigger, multi-component educational intervention approach. The purpose of this systematic review was to identify common educational parameters of these proposed interventions. The review also sought to identify which clinical outcomes improved with multi-trigger, multi-component educational interventions. DATA SOURCES PubMed, SCOPUS and ProQuest Dissertations were searched between 2000 to 2014 using the following terms: asthma; urban population or poverty area; environmental remediation; health education; allergens or dust mites or cockroaches or mold or mice or rats. STUDY SELECTIONS Studies were included if they met the following criteria: 1) participants were minority children identified as underserved; 2) there was a multi-trigger and multi-component intervention; 3) asthma severity was classified as persistent; and 4) asthma control was classified as not well controlled. RESULTS A total of 531 articles were retrieved of which 17 met the inclusion criteria. The interventions lacked consistency in their explanation. Most studies were vague in reporting pedagogical methods and educational content. Few studies reported a theoretical framework to guide their approach. Over half the studies did not report a learning assessment nor health literacy of the caregiver or the child with asthma. Yet all of the findings demonstrated statistically significant results in some or all of their primary outcomes. CONCLUSION Overall, the research lacked clarity in the approach to impact asthma outcomes and reduces the opportunity to substantiate the findings through replication.
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Affiliation(s)
- Paula Jo Belice
- a College of Health Sciences, Rush University Medical Center , Chicago , IL , USA
| | - Ellen A Becker
- b Department of Cardiopulmonary Sciences , Rush University Medical Center , Chicago , IL , USA
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Ellis DA, King P, Naar-King S. Mediators of Treatment Effects in a Randomized Clinical Trial of Multisystemic Therapy-Health Care in Adolescents With Poorly Controlled Asthma: Disease Knowledge and Device Use Skills. J Pediatr Psychol 2016; 41:522-30. [PMID: 26628249 PMCID: PMC4888112 DOI: 10.1093/jpepsy/jsv114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/29/2015] [Accepted: 11/01/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Determine whether Multisystemic Therapy-Health Care (MST-HC) improved asthma knowledge and controller device use skills among African-American youth with poorly controlled asthma and whether any improvements mediated changes in illness management. METHODS A randomized controlled trial was conducted with 170 adolescents with moderate to severe asthma. Families were randomized to MST-HC or attention control. Data were collected at baseline and 6 and 12 months after intervention completion. RESULTS In linear mixed models, adolescents in the MST-HC group had increases in asthma knowledge; asthma knowledge was unchanged for attention control. Controller device use skills increased for adolescents in the MST-HC group, while skills declined for attention control. Both knowledge and skills mediated the relationship between intervention condition and changes in illness management. CONCLUSIONS Tailored, home-based interventions that include knowledge and skills building components are one means by which illness management in African-American youth with poorly controlled asthma can be improved.
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Affiliation(s)
- Deborah A Ellis
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Pamela King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
| | - Sylvie Naar-King
- Carman and Ann Adams Department of Pediatrics, Wayne State University
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Abstract
In restructuring the delivery of primary care to improve the wellness of a community, every community must review its own circumstances for factors such as resources and capacities, health concerns, social and political perspectives, and competing priorities. Strengthening the health care team with community health workers to create a patient-centered medical home can enhance health care access and outcomes. Community health workers can serve as critical connectors between health systems and communities; they facilitate access to and improve quality and culturally sensitive medical care, emphasizing preventive and primary care.
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Affiliation(s)
- Sheri L Johnson
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Veronica L Gunn
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, Population Health Management, Children's Hospital of Wisconsin, PO Box 1997, C525, Milwaukee, WI 53201-1997, USA.
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Ekici B, Cimete G. Effects of an Asthma Training and Monitoring Program on Children's Disease Management and Quality of Life. Turk Thorac J 2015; 16:158-165. [PMID: 29404097 DOI: 10.5152/ttd.2015.4869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/10/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the effects of an asthma training and monitoring program on children's disease management and quality of life. MATERIAL AND METHODS The sample consisted of 120 children and their parents. Data were collected during, at the beginning, and at the end of the 3-month monitoring period using four forms and a quality of life scale. After an initial evaluation, approaches to control symptoms and asthma triggers and measures that might be taken for them were taught to the children and parents. The children recorded the conditions of trigger exposure, experience of disease symptoms, their effects on daily activities, and therapeutic implementations on a daily basis. RESULTS During the 3-month monitoring period, the number of days when the children were exposed to triggers (p=0.000) and experienced disease symptoms decreased to a statistically significant level (p=0.006). Majority of domestic triggers disappeared, but those stemming from the structure of the house and non-domestic triggers indicated no change (p>0.05). Moreover, 30.8% of the children applied to a physician/hospital/emergency service, 4.2% of the children were hospitalized, and 30% of them could not go to school. The number of times when the children applied to a physician/hospital/emergency (p=0.013), the number of times they used medicines (p=0.050), and the number of days they could not go to school (p=0.002) decreased at a statistically significant level, and their quality of life increased (p=0.001). CONCLUSION Asthma training and monitoring program decreased children's rate of experiencing asthma symptoms and implementations of therapeutic purposes and increased their life quality.
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Affiliation(s)
- Behice Ekici
- Department of Children's Health and Diseases Nursing, Maltepe University, School of Nursing, İstanbul, Turkey
| | - Güler Cimete
- Department of Nursing, Cyprus International University, Faculty of Health Science, Nicosia, Turkish Republic of Northern Cyprus
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Fisher EB, Ayala GX, Ibarra L, Cherrington AL, Elder JP, Tang TS, Heisler M, Safford MM, Simmons D. Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress. Ann Fam Med 2015; 13 Suppl 1:S2-8. [PMID: 26304968 PMCID: PMC4648132 DOI: 10.1370/afm.1852] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Simmons
- School of Medicine, University of Western Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
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Rice JL, Matlack KM, Simmons MD, Steinfeld J, Laws MA, Dovey ME, Cohen RT. LEAP: A randomized-controlled trial of a lay-educator inpatient asthma education program. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30006-9. [PMID: 26210342 DOI: 10.1016/j.pec.2015.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/17/2015] [Accepted: 06/23/2015] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To evaluate the impact of LEAP, a volunteer-based, inpatient asthma education program for families of inner-city children with asthma. METHODS 711 children ages 2-17 years admitted with status asthmaticus were randomized to receive usual care or usual care plus a supplemental education intervention. Both groups completed a baseline interview. Trained volunteer lay educators conducted individualized bedside education with the intervention group. Primary outcome was attendance at a post-hospitalization follow-up visit 7-10 days after discharge. Secondary outcomes included parent-reported asthma management behaviors, symptoms, and self-efficacy scores from a one month follow-up interview. RESULTS Post-hospitalization asthma clinic attendance was poor (38%), with no difference between groups. Families randomized to the intervention group were more likely to report use of a controller (OR 2.4, 95% CI 1.3-4.2, p<0.01) and a valved-holding chamber (OR 2.9, 95% CI 1.1-7.4, p=0.03), and were more likely to have an asthma action plan at follow up (OR 2.0, 95% CI 1.3-3.0, p<0.01). Asthma self-efficacy scores were significantly improved among those who received the intervention (p=0.04). CONCLUSIONS Inpatient asthma education by trained lay volunteers was associated with improved asthma management behaviors. PRACTICE IMPLICATIONS This novel volunteer-based program could have widespread implications as a sustainable model for asthma education.
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Affiliation(s)
- Jessica L Rice
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA.
| | - Kristen M Matlack
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Marsha D Simmons
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Jonathan Steinfeld
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Margaret A Laws
- Boston University School of Medicine, Department of Pediatrics, Boston, USA
| | - Mark E Dovey
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
| | - Robyn T Cohen
- St Christopher's Hospital for Children, Department of Pediatric Pulmonology, Philadelphia, USA
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Gutierrez Kapheim M, Ramsay J, Schwindt T, Hunt BR, Margellos-Anast H. Utilizing the Community Health Worker Model to communicate strategies for asthma self-management and self-advocacy among public housing residents. ACTA ACUST UNITED AC 2015. [DOI: 10.1179/1753807615y.0000000011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ekim A, Ocakci AF. Efficacy of a Transition Theory-Based Discharge Planning Program for Childhood Asthma Management. Int J Nurs Knowl 2015; 27:70-8. [PMID: 25644375 DOI: 10.1111/2047-3095.12077] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study tested the efficacy of a nurse-led discharge planning program for childhood asthma management, based on transition theory. METHODS A quasi-experimental design was used. The sample comprised 120 children with asthma and their parents (intervention group n = 60, control group n = 60). FINDINGS The asthma management self-efficacy perception level of parents in the intervention group increased significantly and the number of triggers their children were exposed to at home was reduced by 60.8%. The rates of admission to emergency departments and unscheduled outpatient visits were significantly lower in the intervention group compared with the control group. CONCLUSIONS Transition theory-based nursing interventions can provide successful outcomes on childhood asthma management. PRACTICE IMPLICATIONS Transition theory-based discharge planning program can guide nursing interventions to standardize care of the child with asthma. Combining care at home with hospital care strengthens ongoing qualified asthma management.
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Affiliation(s)
- Ayfer Ekim
- Department of Nursing, School of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Obstructive lung disease (OLD), including asthma and chronic obstructive pulmonary disease, has a more substantial prevalence and morbidity in urban populations. This review highlights recent publications examining the epidemiology, risk factors and interventions concerning OLD in urban populations. RECENT FINDINGS Using a variety of approaches, estimates of asthma prevalence in urban populations range from 5 to 25%. Early life exposures including in-utero cigarette smoke, postnatal bisphenol A, home and school particulates, and environmental air pollution contribute to increased OLD prevalence and symptom manifestations. Individuals with increased exposure to traffic-related pollution demonstrate abnormal inflammatory and lung function profiles. Obesity, more common in urban populations, is likely both a risk factor for asthma as well as contributor to poor control. Interventions targeted at home-based education and assessments are efficacious and cost-effective in improving outcomes of OLD in urban settings. SUMMARY The burden of OLD in urban populations is driven by maternal, environmental and acquired factors. There are few recent data regarding risk factors and interventions for urban cohorts with chronic obstructive pulmonary disease. The complex interplay of race, socioeconomic status, environmental exposures and healthcare access in the urban population requires continued research efforts.
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Wennerstrom A, Bui T, Harden-Barrios J, Price-Haywood EG. Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned. Health Promot Pract 2014; 16:72-83. [PMID: 25139872 DOI: 10.1177/1524839914547760] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams.
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Affiliation(s)
| | - Tap Bui
- Mary Queen of Vietnam Community Development Corporation, New Orleans, LA, USA
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Josiah Willock R, Mayberry RM, Yan F, Daniels P. Peer training of community health workers to improve heart health among African American women. Health Promot Pract 2014; 16:63-71. [PMID: 24891525 DOI: 10.1177/1524839914535775] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Training community health workers (CHWs) builds a workforce that is essential to addressing the chronic disease crisis. This article describes a highly replicable CHW training program that targets heart disease risk among African American women. BACKGROUND African American women suffer disproportionately from heart disease mortality and morbidity. Well-trained CHWs are uniquely positioned to close this disparity gap. Method. We used a Learning Circle approach to train CHWs in heart health education. The curriculum blended web-based, self-directed learning and in-person peer coaching. CHWs learned through (a) peer-to-peer sharing, (b) problem solving and brainstorming, and (c) leadership and experiential activities. Training evaluation measures were CHWs' (a) self-confidence, (b) heart health knowledge, (c) satisfaction with training, (d) training retention, and (e) replication of training within 90 days after training. RESULTS This training resulted in appreciable effects on four of five outcome measures. Heart health knowledge increased significantly among experienced CHWs (p = .011). CHWs were satisfied with training and retention was 100%. CHWs initiated and subsequently delivered 122 person hours of community heart health education and CHW training in their communities. DISCUSSION/CONCLUSION CHW heart health training using Learning Circles is a practical and replicable method of training CHWs and holds significant potential for building capacity in resource-poor community organizations.
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Affiliation(s)
| | | | - Fengxia Yan
- Morehouse School of Medicine, Atlanta, GA, USA
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Wennerstrom A, Johnson L, Gibson K, Batta SE, Springgate BF. Community Health Workers Leading the Charge on Workforce Development: Lessons from New Orleans. J Community Health 2014; 39:1140-9. [DOI: 10.1007/s10900-014-9869-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bittencourt L, Scarinci IC. Is there a role for community health workers in tobacco cessation programs? Perceptions of administrators and health care professionals. Nicotine Tob Res 2014; 16:626-31. [PMID: 24420327 DOI: 10.1093/ntr/ntt217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Studies have shown that with appropriate training, Community Health Workers (CHWs) can be actively involved in health promotion and disease prevention (including tobacco cessation). This study examined the perceptions of administrators and health care professionals regarding the actual and potential role(s) of CHWs in a tobacco cessation program (TCP) within a universal health care system. METHODS This study was part of a larger exploratory, cross-sectional comprehensive assessment of the implementation of the TCP through the primary care public health system in 7 towns in the state of Paraná, Brazil. Questionnaires were administered to 84 administrators at different levels (regional, municipal, and health units) and 80 health care professionals who were directly involved in the TCP. For this study, we assessed the perceptions of administrators and health care professionals on the actual and potential role(s) of CHWs in the TCP. RESULTS The overall response rate was 56.2%. Although 48.4% of respondents indicated that CHWs already participated in the TCP, there was a wide range in the participants' responses regarding their involvement (33.3% among regional administrators and 65% among health care professionals). Identification/referral of patients and promotion of the TCP in the community were the most frequent CHWs' activities reported. Overall, respondents were very receptive about trained CHWs having multiple roles in the TCP, except for delivery of a brief intervention. CONCLUSION With appropriate training, health care administrators and health care professionals are very receptive regarding the involvement of CHWs in a TCP delivered through a public health system.
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Affiliation(s)
- Lorna Bittencourt
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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Fisher EB, Coufal MM, Parada H, Robinette JB, Tang PY, Urlaub DM, Castillo C, Guzman-Corrales LM, Hino S, Hunter J, Katz AW, Symes YR, Worley HP, Xu C. Peer support in health care and prevention: cultural, organizational, and dissemination issues. Annu Rev Public Health 2014; 35:363-83. [PMID: 24387085 DOI: 10.1146/annurev-publhealth-032013-182450] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patient-centered medical homes and chronic health homes; and (f) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts--intended audience, health problems, organizational and cultural settings--and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation
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