Evaluation of a Community‐Based Outreach Worker Program for Children With Asthma

Primomo, Janet; Johnston, Sandra; DiBiase, Frank; Nodolf, Jocelyn; Noren, Leanne

doi:10.1111/j.1525-1446.2006.230306.x

Cited by 38 publications

(35 citation statements)

References 19 publications

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“…[36][37][38][39][40] Of the eight pre-post studies, five showed a significant decrease in ED visits relative to a baseline measurement, [41][42][43][44][45] and one had no significant decrease. 46 Two pre-post studies did not indicate statistical significance; of these, one intervention resulted in a decrease in ED visits 47 and one in an increase in ED visits. 48 There were three cohort studies that examined ED use, two of which showed significant decreases in ED use in the intervention group.…”

Section: Emergency Department Visitsmentioning

confidence: 99%

“…34,35,37,39,40,51 One showed a significant decrease relative to the control. 36 Of the seven pre-post studies that assessed hospitalization, all showed a decrease in hospitalizations, 41,[43][44][45][46][47][48] but only five indicated statistical significance. 41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations.…”

Section: Emergency Department Visitsmentioning

confidence: 99%

“…36 Of the seven pre-post studies that assessed hospitalization, all showed a decrease in hospitalizations, 41,[43][44][45][46][47][48] but only five indicated statistical significance. 41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations. One showed a decrease in costs without significance given 52 ; two indicated a significant decrease relative to an observation cohort.…”

Section: Emergency Department Visitsmentioning

confidence: 99%

“…54,55 Of the four pre-post studies measuring this outcome, three demonstrated a statistically significant decrease, 41,44,45 and one showed a non-significant increase. 46 …”

Section: Emergency Department Visitsmentioning

confidence: 99%

“…40,54,59 Three pre-post studies found a decrease in preventable use relative to baseline. 43,45,46 One cohort study found no change in emergency medication use, 49 while another (the only study that measured medication costs) noted a significant decrease in nonnarcotic prescription costs for the control cohort relative to the CHW group. 5 …”

Section: Medication Usementioning

confidence: 99%

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Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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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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Section: Emergency Department Visitsmentioning

confidence: 99%

Section: Emergency Department Visitsmentioning

confidence: 99%

Section: Emergency Department Visitsmentioning

confidence: 99%

“…54,55 Of the four pre-post studies measuring this outcome, three demonstrated a statistically significant decrease, 41,44,45 and one showed a non-significant increase. 46 …”

Section: Emergency Department Visitsmentioning

confidence: 99%

Section: Medication Usementioning

confidence: 99%

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Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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Asthma: Interventions in Community Settings

Krieger

Parker²

2009

Asthma, Health and Society

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Monitoring and Reducing Exposure of Infants to Pollutants in House Dust

Roberts¹,

Wallace

Camann³

et al. 2009

Reviews of Environmental Contamination and Toxicology

113

106

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The health risks to babies from pollutants in house dust may be 100 times greater than for adults. The young ingest more dust and are up to ten times more vulnerable to such exposures. House dust is the main exposure source for infants to allergens, lead, and PBDEs, as well as a major source of exposure to pesticides, PAHs, Gram-negative bacteria, arsenic, cadmium, chromium, phthalates, phenols, and other EDCs, mutagens, and carcinogens. Median or upper percentile concentrations in house dust of lead and several pesticides and PAHs may exceed health-based standards in North America. Early contact with pollutants among the very young is associated with higher rates of chronic illness such as asthma, loss of intelligence, ADHD, and cancer in children and adults. The potential of infants, who live in areas with soil contaminated by automotive and industrial emissions, can be given more protection by improved home cleaning and hand washing. Babies who live in houses built before 1978 have a prospective need for protection against lead exposures; homes built before 1940 have even higher lead exposure risks. The concentration of pollutants in house dust may be 2-32 times higher than that found in the soil near a house. Reducing infant exposures, at this critical time in their development, may reduce lifetime health costs, improve early learning, and increase adult productivity. Some interventions show a very rapid payback. Two large studies provide evidence that home visits to reduce the exposure of children with poorly controlled asthma triggers may return more than 100% on investment in 1 yr in reduced health costs. The tools provided to families during home visits, designed to reduce dust exposures, included vacuum cleaners with dirt finders and HEPA filtration, allergy control bedding covers, high-quality door mats, and HEPA air filters. Infants receive their highest exposure to pollutants in dust at home, where they spend the most time, and where the family has the most mitigation control. Normal vacuum cleaning allows deep dust to build up in carpets where it can be brought to the surface and become airborne as a result of activity on the carpet. Vacuums with dirt finders allow families to use the three-spot test to monitor deep dust, which can reinforce good cleaning habits. Motivated families that receive home visits from trained outreach workers can monitor and reduce dust exposures by 90% or more in 1 wk. The cost of such visits is low considering the reduction of risks achieved. Improved home cleaning is one of the first results observed among families who receive home visits from MHEs and CHWs. We believe that proven intervention methods can reduce the exposure of infants to pollutants in house dust, while recognizing that much remains to be learned about improving the effectiveness of such methods.

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Evaluation of a Community‐Based Outreach Worker Program for Children With Asthma

Abstract: Short-term community-based AOW services for children can be effective in enhancing self-management capabilities, improving the quality of life, increasing the use of asthma management plans, and helping families reduce asthma triggers in the home environment.

Cited by 38 publications

References 19 publications

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Asthma: Interventions in Community Settings

Monitoring and Reducing Exposure of Infants to Pollutants in House Dust

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