Background Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. Objectives This systematic review synthesized evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost effectiveness of such interventions in vulnerable populations with chronic, non-communicable conditions. Search methods Four electronic database searches, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane, and hand searches of reference collections were undertaken to identify randomized controlled trials published in English before August 2014. Selection A total of 934 unique citations were screened initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and six companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Data collection and analysis Data were extracted by 4 trained research assistants (RA) using a standardized data extraction form developed by the authors. Subsequently, an independent RA reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by two RAs who extracted relevant study information. Inter-rater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. Main results All but 4 studies were conducted in the U.S. The two most common areas for CBHW interventions were cancer prevention (n=30) and cardiovascular disease risk reduction (n=26). The roles assumed by CBHWs included: health education (n=48), counseling (n=36), navigation assistance (n=21), case management (n=4), social services (n=7), and social support (n=18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n=9) and supervision procedures (n=24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n=21) and cardiovascular risk reduction (n=16). Eight articles documented cost effective analysis and found that integrating CBHWs into the healthcare delivery system was associated with cost-effective and sustainable care. Conclusions CBHW interventions appear to be effective when compared to alternatives and also cost-effective for certain health conditions particularly when partnering with low-income, underserved, and racial a...

Objective Hearing impairment is highly prevalent, but little is known about hearing health care among older minority adults. Method We analyzed nationally representative, cross-sectional data from 1,544 older adults ≥70 years with audiometry and hearing care data from the 2005-2006 and 2009-2010 National Health and Nutritional Examination Surveys. Results After adjusting for age and speech frequency pure tone average, Blacks (odds ratio [OR] = 1.68, vs. Whites) and those with greater education (OR = 1.63, ≥college vs.

Objective: To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery.Study Design: Cross-sectional analysis. Methods: Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using crosstabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.Results: Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio [OR] , increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.Conclusion: Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.

The HEARS (Hearing Equality through Accessible Research & Solutions) intervention is feasible, acceptable, low risk, and demonstrates preliminary efficacy. HEARS offers a novel, low-cost, and readily scalable solution to reduce hearing care disparities and highlights how a community-engaged approach to intervention development can address disparities.