Improving Asthma-Related Health Outcomes Among Low-Income, Multiethnic, School-aged Children: Results of a Demonstration Project That Combined Continuous Quality Improvement and Community Health Worker Strategies

Fox, Patrick J.; Porter, Patricia G.; Lob, Sibylle; Boer, Jennifer H.; Rocha, David A.; Adelson, Joel W.

doi:10.1542/peds.2006-1805

Cited by 76 publications

(66 citation statements)

References 33 publications

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“…Two of four RCTs demonstrated a significant decrease relative to control, 40,53 and two showed no significant decrease relative to control. 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: 93%

“…[33][34][35] Five showed no significant difference in ED visits. [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.…”

Section: Emergency Department Visitsmentioning

confidence: 94%

“…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%

“…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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