Outcomes and Costs of Community Health Worker Interventions

Viswanathan, Meera; Kraschnewski, Jennifer L.; Nishikawa, Brett; Morgan, Laura C; Honeycutt, Amanda; Thieda, Patricia; Lohr, Kathleen N; Jonas, Daniel E

doi:10.1097/mlr.0b013e3181e35b51

Cited by 298 publications

(330 citation statements)

References 86 publications

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“…Additionally, while RCTs showed variation in intervention effects, 42% of the RCTs that measured ED visits, hospitalizations, or urgent care visits found that the CHW intervention resulted in a statistically significant decrease in the use of at least one of those services relative to a control. Further, our results suggest that CHWs may be better suited to address the needs of patients who are at high risk of preventable health emergencies, rather than those with more advanced disease, who may require intensive inpatient care: only one RCT found that the CHW-based 8,15 Together, these findings can help payers choose which types of CHW interventions to fund.…”

Section: Discussionmentioning

confidence: 75%

“…In order to capture the breadth of CHW job titles, we drew search terms from: (1) previous systematic reviews on CHWs, 8,[20][21][22] (2) specific job titles used for CHWs in Massachusetts, based on a survey of CHW programs conducted by the Massachusetts Department of Public Health, 23,24 and (3) additional terms on health coaching and doulas, some of which were added after consulting with staff at the Massachusetts Department of Public Health's Office of CHWs. Massachusetts is one of two states 25 with an office of CHWs and has a range of CHW programs, making the list of job titles broad.…”

Section: Search Strategymentioning

confidence: 99%

“…[1][2][3] As value-based payment models expand, providers will have more flexibility to fund CHWs with global budgets, or payers may elect to reimburse for CHW services. [4][5][6] The emerging evidence base on CHW programs 7 for the prevention and management of chronic diseases includes systematic reviews concluding that CHW interventions can improve overall health outcomes 8 and outcomes for patients with heart disease, stroke, 9 type II diabetes, [10][11][12] HIV, 13 and asthma 2,14 and for vulnerable patients with or at risk for a variety of chronic diseases or cancer. 15 Other systematic reviews have also documented the costs and cost-effectiveness of CHW programs, 15 but none, outside of low and middle-income countries, 16 have examined the impact of CHWs on the utilization of health services by patients with chronic conditions.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 75%

Section: Search Strategymentioning

confidence: 99%

Section: Introductionmentioning

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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“…Eng and colleagues (1997) have conceptualized nonspecialist health workers on a spectrum from the “natural helper” (unpaid community members) at one end to the “para‐professional” (paid workers with minimal qualifications, trained, and demonstrating acceptable levels of standardized competencies) at the other. Community health workers have demonstrated effectiveness in increasing access to care (Swider, 2002; Viswanathan et al., 2010), for example, promoting immunization uptake and breastfeeding, improving tuberculosis treatment outcomes, and reducing child morbidity and mortality (Lewin et al., 2010). In the field of mental health, there is robust evidence that lay counselors (a person without professional qualification in mental health care) can be trained to deliver PT effectively for people with depressive and anxiety disorders in low‐ and middle‐income countries (LMIC) (van Ginneken et al., 2013).…”

mentioning

confidence: 99%

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

Nadkarni

Velleman

Dabholkar³

et al. 2015

Alcohol Clin Exp Res

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BackgroundDespite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low‐ and middle‐income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems (CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India.MethodsCAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment.ResultsCAP is a 3‐phase treatment delivered over 1 to 4 sessions based on a motivational interviewing (MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem‐solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol‐dependent patients and the extension of the delivery settings to include home‐based delivery. There was preliminary evidence of the effectiveness of CAP.ConclusionsCAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India.

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“…The evidence of the effectiveness, both in cost and health outcomes, of interventions using CHWs continues to increase [13][14][15][16], but RNs and other licensed health care workers may be hesitant to delegate duties to unlicensed or non-certified health care workers because of their concerns about quality and safety [17].…”

mentioning

confidence: 99%

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

Siemon

2014

J Community Health

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This is an author-produced, peer-reviewed version of this article. The final, definitive version of this document can be found online at Journal of Community Health, published by Springer. The final publication is available at link.springer.com. Copyright restrictions may apply. doi: 10.1007/ s10900-014-9919-6 AbstractA number of states have adopted certification programs for community health workers (CHWs) to improve recognition of CHWs as members of health care teams, increase oversight, and to provide sustainable funding. There has been little research into the impact of state CHW certification on the diffusion and adoption of CHWs into existing health care systems. This study examined the impact of state CHW certification on the perceptions of team climate among registered nurses (RNs) who work with CHWs in states with and without CHW certification programs. The study recruited RNs using a purposeful sampling method and used an online survey, which included the Team Climate Inventory (TCI), and compared the perceptions of team climate between the two groups. The study found no significant differences in the overall mean TCI score or TCI subscale scores between RNs who work in states with CHW certification programs (n = 81) and those who work in states without CHW certification programs (n = 115). There was a statistically significant difference on one survey question regarding whether RNs believe state certification of CHWs improved the ability of their health care team to deliver quality care. More research is needed to assess impact of state certification of CHWs and other factors that influence the diffusion and adoption of CHWs into the current health care system.

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Outcomes and Costs of Community Health Worker Interventions

Abstract: CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.

Cited by 298 publications

References 86 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

The Systematic Development and Pilot Randomized Evaluation of Counselling for Alcohol Problems, a Lay Counselor‐Delivered Psychological Treatment for Harmful Drinking in Primary Care in India: The PREMIUM Study

The Impact of State Certification of Community Health Workers on Team Climate Among Registered Nurses in the United States

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