Community Health Worker Impact on Chronic Disease Outcomes Within Primary Care Examined Using Electronic Health Records

Ingram, Maia; Doubleday, Kevin; Bell, Melanie L.; Lohr, Abby M.; Murrieta, Lucy; Velasco, Maria; Blackburn, John G.; Sabo, Samantha; Zapien, Jill Guernsey de; Carvajal, Scott C.

doi:10.2105/ajph.2017.303934

Cited by 24 publications

(27 citation statements)

References 29 publications

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“…While there was a large range in the ages of the patients in the included articles, age acts as a confounder in the perception of technology, with older generations often being averse to technology [60]. Lastly, while it would have been ideal to include views of all stakeholders involved, we were unable to find opinions from patients' caregivers, family members, community health workers and their families, hospital administrators, funders and legislators, even though they play an integral role in the education and care of a person with diabetes [67,68].…”

Section: Limitationsmentioning

confidence: 99%

Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review

Jain

Yuan

et al. 2020

PLoS ONE

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Introduction Diabetes self-management education is a key aspect in the long-term management of type 2 diabetes. The patient and healthcare professional (HCP) perspective on the use of technology-assisted DSME has yet to be studied. Hence, the objective of this study was to better understand the factors that facilitate or hinder the adoptions of such education by adults with type 2 diabetes and their HCPs. Methods We systematically searched five databases (Medline, Embase, CINAHL, Web of Science Core Collection, and PsycINFO) until August 2019. The search included qualitative and mixed-method studies that reported the views of patients and HCPs regarding features, uses, and implementations of technology-assisted DSME. Data were synthesized through an inductive thematic analysis. Results A total of 13 articles were included, involving 242 patients, ranging from 18 to 81 years and included web-based, mobile application, digital versatile disc (DVD), virtual reality or telehealth interventions. Patients and HCPs had mixed views towards features of the technology-assisted interventions, with patients' personal qualities and HCPs' concerns affecting uses of the interventions. Patients generally preferred technologies that were easy to access, use, and apply and that had reliable information. Patients' ambitions motivated them, and personal attributes such as poor competence with technology, poor literacy, and language barriers acted as barriers. Patients especially liked the peer support that they

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Section: Limitationsmentioning

confidence: 99%

Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review

Jain

Yuan

et al. 2020

PLoS ONE

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“…By assuming a broad range of responsibilities, CHWs bridge the gap between primary care provision and well-being outside the clinical setting, particularly among patients most in need. Several studies have demonstrated reductions in care utilization and more equitable access to curative services for vulnerable patients managing chronic health conditions when CHWs were included in the patient's care team ( [10][11][12][13]; Moffett M, Kaufman A, & Bazemore, 2019 [14];). One randomized control trial of CHWs supporting low-income patients with multiple chronic conditions demonstrated improvements in health outcomes, mental health, and reductions in hospitalizations [7].…”

Section: Introductionmentioning

confidence: 99%

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Damian

Robinson²,

Manzoor³

et al. 2020

Pilot Feasibility Stud

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Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

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“…As clinics are increasingly integrating the CHW workforce into primary care, it is crucial to ensure that effective and evidence-based CHW community interventions are available to complement clinic efforts. Researchers have sought to delineate the most important and effective roles of CHWs within the clinical setting [31, 32]. Clinic-based CHWs work with patients to support them in disease self-management, navigation of health and social systems, and in health education.…”

Section: Introductionmentioning

confidence: 99%

Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border

et al. 2019

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Background Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. Methods The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. Discussion The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. Trial registration This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6725-1) contains supplementary material, which is available to authorized users.

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Community Health Worker Impact on Chronic Disease Outcomes Within Primary Care Examined Using Electronic Health Records

Abstract: Although patients' chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs' evolution may elucidate CHW contributions moving forward.

Cited by 24 publications

References 29 publications

Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review

Patients’ and healthcare professionals’ perspectives towards technology-assisted diabetes self-management education. A qualitative systematic review

A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border

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