Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: “A Little Fish in a Big Pond”

Allen, Caitlin G.; Escoffery, Cam; Satsangi, Anamika; Brownstein, J. Nell

doi:10.5888/pcd12.150199

Cited by 39 publications

(42 citation statements)

References 20 publications

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“…Previous studies share lessons learned from integrating CHWs into a team-based practice, [27][28][29][30][31] but only 1 included descriptions of the preimplementation decision making that led to piloting the CHW model. Their results echoed themes from our study, including having an awareness of the CHW model and influential champions, and building institutional support through documented return on investment.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] Researchers have explored the experience of CHWs with integration into care teams and examined how health care delivery systems might be Elizabeth A. Rogers, MD,MAS 1 designed to effectively embed them. [27][28][29][30][31] Experts have outlined implementation barriers (fragmented and disease-specific interventions, lack of clear work protocols, high turnover, variable performance, and a history of low-quality evidence), but argue that these barriers can be overcome through established standards to ensure a skilled CHW workforce, clearly defined roles, concrete implementation strategies, and an expanded scope of reimbursable services to include their services. 5,6,25,26,32 Little research exists on whether these strategies are sufficient for wide adoption of CHWs within primary care and how clinics make decisions about this adoption.…”

Section: Introductionmentioning

confidence: 99%

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Integrating Community Health Workers Into Medical Homes

Rogers

Manser

Cleary³

et al. 2018

Ann Fam Med

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PURPOSE Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. METHODSWe conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics.RESULTS Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient.CONCLUSIONS We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce. 2018;16:14-20. https://doi.org/10.1370/afm.2171. Ann Fam Med INTRODUCTIONC ommunity health workers (CHWs), trusted frontline health workers who have a close understanding of the community served, 1 can be valuable contributors to the team-based and patient-centered care promoted through the patient-centered medical home (PCMH) model. 2 CHWs complement roles played by traditional health professionals through culturally sensitive outreach, patient education, resource identification, case management, care coordination, and patient support. [3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration. [24][25][26] Researchers have explored the experience of ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integrating Community Health Workers Into Medical Homes

Rogers

Manser

Cleary³

et al. 2018

Ann Fam Med

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“…Although research on CHW integration is limited, our findings suggest Nebraska workplace environments are favorable for CHW integration. In a mixed methods study examining CHW perspectives, communication was identified as beneficial to the well-being of the CHW and to the care team and patient [1]. In particular, CHWs cited important facilitators to CHW integration include having consistent team meetings, training inside and outside of the organization, and ability to stay connected with the community and with other CHWs.…”

Section: Discussionmentioning

confidence: 99%

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

2018

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A statewide Community Health Worker Employer Survey was administered to various clinical, community, and faith-based organizations (n = 240) across a range of rural and urban settings in the Midwest. At least 80% of participants agreed or strongly agreed that items characterized as supervisory support were present in their work environment. Thirty-six percent of respondents currently employed CHWs, over half (51%) of survey respondents reported seeing the need to hire/work with more CHWs, and 44% saw the need for CHWs increasing in the future. Regarding CHW support, a majority of respondents indicated networking opportunities (63%), paid time for networking (80%), adequate time for supervision (75%), orientation training (78%), mandatory training (78%), ongoing training (79%), and paid time for training (82%). Open-ended responses to the question "In your organization, what needs could CHWs meet?" resulted in the largest number of respondents reporting mental health issues as a priority, followed by connecting people with services or resources, educating the public on preventive health, family support, and home care/visitations. Our findings suggest that respondents, who largely have supervisory or managerial roles, view workplace environments in Nebraska favorably, despite the fact that nearly two-thirds of respondents typically work well over 40 h per week. In addition, CHWs could help address mental and physical health needs in a variety of community and clinical settings through primary and secondary prevention activities, such as provision of health screenings, health and nutrition education, connecting people to resources and empowering community members through these activities and more.

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“…Although serving a vital role in connecting patients to the healthcare system, research has shown that CHWs have largely been structurally excluded from major aspects of the healthcare system, including clear roles and workflows within care teams, participation in team meetings and access to electronic health records (EHRs) 5 6. Conversely, when CHWs are integrated into the healthcare system, they are effective at improving healthcare outcomes for patients 6–8. Effective integration of CHWs into the care team allows CHWs to share vital perspectives of the home environment to clinic-based healthcare providers who may have little or no insight into patient’s living situation and psychosocial surroundings.…”

Section: Introductionmentioning

confidence: 99%

“…Effective integration of CHWs into the care team allows CHWs to share vital perspectives of the home environment to clinic-based healthcare providers who may have little or no insight into patient’s living situation and psychosocial surroundings. By expanding community–clinic linkages and connecting CHWs with the healthcare system, CHWs are better able to support both the patients and providers in forming an effective patient-centred care team 6 9…”

Section: Introductionmentioning

confidence: 99%

Community–clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation

et al. 2020

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ObjectiveTo understand providers’ opinions about the Community Outreach and Patient Empowerment (COPE) Project designed to strengthen Navajo Community Health Representative (CHR) outreach to individuals living with diabetes.DesignThis was a qualitative study nested within a larger evaluation of a programme intervention.SettingThe study took place in Navajo Nation and evaluated a programme initiative designed to strengthen collaboration between CHRs and clinic-based healthcare providers and provide structured outreach to individuals living with diabetes in Navajo Nation. The CHR Programme is a formal community health worker programme that exists in most tribal healthcare systems across the USA.ParticipantsHealthcare providers involved in the programme took part in one-on-one interviews.AnalysisWe used thematic analysis for this study. A team of three study staff used open-coding to create a codebook. Coded material were summarised and patterns were identified and tied into a narrative using concept mapping. The study design and instrument construction were guided by a Community Health Advisory Panel.ResultsA total of 13 interviews were completed. Providers acknowledged CHRs as an asset to the clinical team and were enthusiastic about the COPE coaching materials, mentioning they provided a consistent message to CHRs and the community. Providers that led COPE trainings with CHRs valued the face-to-face time and opportunity to build relationships. Providers (n=4) supported CHRs’ access to electronic health record to record patient visits and streamline referrals. Among their requests were having designated personnel to manage referrals with CHRs and a formal system to record modules CHRs have completed.ConclusionProviders participating in COPE activities valued the work of CHRs and endorsed further strengthening relationships and communication with CHRs. Healthcare programmes should consider systems changes to integrate community health workers into clinic-based teams.Trial registration numberNCT03326206; Results.

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Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: “A Little Fish in a Big Pond”

Cited by 39 publications

References 20 publications

Integrating Community Health Workers Into Medical Homes

Integrating Community Health Workers Into Medical Homes

Community Health Worker Employer Survey: Perspectives on CHW Workforce Development in the Midwest

Community–clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation

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