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

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.

Hispanic Secondary Stroke Prevention Initiative Design: Study Protocol and Rationale for a Randomized Controlled Trial

“…The theoretical foundation of the HiSSPI study is grounded in the Chronic Care Model, an organizational framework for restructuring chronic disease management to create a partnership between health systems and communities [ 28 ]. The focus of our design emphasizes a community-based approach to successfully linking individuals in underserved populations with effective health care services [ 15 , 16 ]. The study was reviewed and approved by the University of Miami Institutional Review Board and is registered with ClinicalTrials.gov (NCT02251834).…”

“…A promising approach to improving disease outcomes among Hispanic individuals has been the use of community health workers (CHWs) [ 15 ]. CHWs are trusted members of a target community who understand the local health beliefs and recognize the social and historical experiences shaping their communities [ 15 , 16 ]. They serve as links between their communities and the health care system, acting as patient advocates, delivering prevention education and counseling services, and linking people to the appropriate care facilities [ 17 ].…”

“…They serve as links between their communities and the health care system, acting as patient advocates, delivering prevention education and counseling services, and linking people to the appropriate care facilities [ 17 ]. There has been increasing evidence on CHWs for a variety of preventive and chronic conditions [ 16 ], including knowledge and behaviors aimed at vascular risk factors and self- management [ 18 - 20 ]. Although more limited, randomized studies have also shown that CHW interventions can improve physiological outcomes such as glycemic control [ 21 ].…”

Mutual Capacity Building to Reduce the Behavioral Health Treatment Gap Globally

“…With a greater awareness of the relationship between substance use disorders (SUDs), mental health, and HIV outcomes, CHWs are now being trained to provide brief psychological treatments for SUDs and common mental disorders (Myers et al 2019). Inspired by LMIC experiences, CHWs have been employed frequently in high-income countries (HICs) for chronic physical disease management (Jack et al 2017). Although newer to HIC behavioral health services, early studies suggest promising behavioral health outcomes (Barnett et al 2018).…”

Hispanic Secondary Stroke Prevention Initiative Design: Study Protocol and Rationale for a Randomized Controlled Trial (Preprint)

“…CHWs are trusted members of a target community who understand the local health beliefs and recognize the social and historical experiences shaping their communities [15,16]. They serve as links between their communities and the healthcare system, acting as patient advocates, delivering prevention education and counseling services, and linking people to the appropriate care facilities [17].…”