CHW Interventions

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Filipino American Cardiovascular Health Summit
July 9, 2011
Rhodora Ursua, MPH
Project Director
Feb 2004
Outreach
April 2004
Community
Forum
Summer 2004
April 2005
Community
Health Needs
Assessment
Sep 2005
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Burgeoning literature demonstrating CHW
effectiveness across many different conditions
CHWs address social determinants of health
Large workforce - 11,000 in NYS
- 120,000 nationally
Patient Protection and Affordable Care Act
• Several elements of the federal health reform law
can be facilitated through strong CHW participation
• Increase access - Improve quality – Lower costs
Patient-Centered Medical Homes, ACO, Health Homes
• CHWs play important role in coordinating care and
helping people manage care
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Frontline public health professionals
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Trusted members of the communities they
serve
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Shared life experiences with population served
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Peer relationships – shared power
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Agents for change – micro and macro level
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Empowerment approach to interactions
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29 elements identified
Required further analysis – Statewide Market Survey
of 226 CHWs and 44 CHW Employers
Focus groups, key informant interviews,
Community Participatory Ranking (CBPR)
Elements fall into three domains
Skills
•Outreach/Organizing
•Supportive counseling
•Adult learning
•Behavior change
•Advocacy
•Observation/Feedback
•Env. assessment
•Treatment adherence
•Health literacy
Qualities
•Trustworthy
•Community connection
•Non-judgmental
•Resourcefulness
•Creative
•Empathic
•Peer relationships
•Shared experiences
Roles (Scope of Practice)
•Health promotion & coaching
•Home-based support
•Outreach/Mobilization
•Community/Cultural Liaison
•Case management
•System navigation
•Participatory research
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Liaisons between communities and health and social
service systems
• Improve access to health care resources
• Improve the quality and cultural appropriateness of service
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delivery
Help people integrate disease prevention and management
regimens into their daily life
Organize communities to improve environmental, physical and
social wellbeing
Negotiate cultural & linguistic barriers to health
Help people become active participants in their health
Build community by combating social isolation and
exclusion
• Community organizing and empowerment
Outreach/Community Mobilizing
Strong interpersonal skills
Multi-cultural /Bilingual skills
Advocacy skills
Group facilitation
Information exchange
System Navigation
Patient navigation
Interpretation and Translation
Computer skills
Ability to access information
Community/Cultural Liaison
Community organizing
Community advocacy
Translation and interpretation
Participatory Research
Facilitating translational research
Interviewing
Documentation
Case Management/Care Coord.
Supportive Counseling
Goal Setting and Planning
Time Management
Service Coordination
Home-based Support
Safety procedures
Environmental assessment
Observation and documentation
Health Promotion & Coaching
Modeling behavior change
Topic specific health care knowledge
Chronic disease mgmt framework
Adult learning methods
Faith-based organizations/ Health professional associations
Businesses
Workers
Apartments
Church Events
Link to health providers
Monitor blood pressure
Health promotion
“We have strong connections to the community so we are
able to influence people on how to be healthy. Oftentimes
when I do home visits, the participants tell me how
thankful they are. They never thought there would be
someone that would go out of their way to visit them and
show concern for their health and take
their blood pressure.” –AsPIRE CHW
Training new CHWs
Data collection
CPR training for household workers from
Philippines Nurses Association
•Individual level (i.e. advocate for
patient’s needs at physician visits)
•Systems level (i.e. advocate for
streamlined referral systems with
hospital administrators; public hearings
to inform legislators of challenges
community faces and recommended
solutions)
• Increased access and quality of services
• Improved health outcomes
• Reduced/eliminated persistent inequities in health
outcomes
• Increased social capital & community connectedness
• Promote healthier communities and individuals
• Lowered health care costs
 fewer resource-intensive ED visits
 Fewer hospitalizations & re-admissions
 Increased prevention and use of primary care
Received Allocated
intervention
Did not received
allocated intervention
-11mmHg Systolic
-3mmHg Systolic
-7mmHg Diastolic
Diastolic Remained the
same
Measured from baseline to 4th months. The differences in the means
were significant at p<0.05
 All
individuals who received allocated
intervention exhibited controlled blood
pressure at the 4th month survey
 32%
of those who did not received
allocated intervention exhibited
uncontrolled hypertension
Those who never forgot to refill their antihypertensive
prescriptions from Baseline to 4th Month
Received Allocated
intervention
57% to 86%
Did not received allocated
intervention
No Change
Those who set their appointment before leaving the
Doctor’s office
Received Allocated
intervention
Did not received allocated
intervention
Slight increase from
50% to 53%
No Change
Measured from baseline to 4th months.
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Increased access
• health insurance coverage increased & more consistent for children (RCT in
Boston)
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Lower costs
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38% fewer ED visits
30% fewer hospitalizations
27% reduced Medicaid expenses (diabetes)
average savings $2,245 per patient per year
savings of $80,000 to $90,000 per year per CHW(Baltimore)
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Return on Investment
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Cost savings
• ROI of $2.28 per dollar invested (underserved men in Denver)
• $7.00 per dollar invested (Denver Health pregnancy testing program)
• Decreased per capita expenses 97% in an asthma program (Hawaii)
• $24 million over 9 years in Georgia private corp.
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Private/Corporate
• Improved enrollment and retention (automatic enrollment)
• Improved customer satisfaction (QAAR scores)
• Improved case-finding (pregnancy & chronic diseases)
• ROI (up to 7.0/1.0), Cost Savings ($80,000.00 per CHW/year)
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Medicaid Part 1115 Waiver
• NYS Maternal Child Health Programs
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Team Integration
• CHWs as members of reimbursable care teams
• PCMH & ACO, Health Homes, Insurance Exchanges
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Direct Medicaid/Medicare reimbursement
• CHWs as Medicaid/Medicare providers
• Supervision
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CHWs are valuable in bridging gaps.
CHWs help build self-sustaining organizations.
CHWs aim to enhance the quality of life through increasing
communities’ self-reliance and confidence through
community empowerment as a result of mobilizing fellows
with common goals.
CHWs can advocate the implementation of healthcare acts
to accommodate the needs of Asian Americans by
participating in legislative visits.
CHWs provide a voice for the unjust treatment of certain
communities or individuals.
This presentation was made possible by Grant
Number R24 MD001786 from NIMHD and its
contents are solely the responsibility of the
authors and do not necessarily represent the
official views of the NIMHD.
THANK YOU!
Rhodora Ursua, MPH, Director, Project AsPIRE
212-263-3776
[email protected]
Center for the Study of Asian American Health
New York University School of Medicine
550 First Ave, VZN Suite 726
New York, NY 10016
www.med.nyu.edu/csaah
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