Community Health Worker Home Visits for Medicaid-Enrolled Children With Asthma: Effects on Asthma Outcomes and Costs

Campbell, Jonathan D.; Brooks, Marissa; Hosokawa, Patrick; Robinson, J. C.; Song, Lin; Krieger, James

doi:10.2105/ajph.2015.302685

Cited by 126 publications

(92 citation statements)

References 15 publications

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“…13 School-based telemedicine and community health care workers are also a potential avenue to increase access to specialty asthma care in underserved populations. 14–16 …”

Section: Componentmentioning

confidence: 99%

Creation and implementation of SAMPRO™: A school-based asthma management program

Lemanske

Kakumanu

Shanovich

et al. 2016

Journal of Allergy and Clinical Immunology

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Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.

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“…13 School-based telemedicine and community health care workers are also a potential avenue to increase access to specialty asthma care in underserved populations. 14–16 …”

Section: Componentmentioning

confidence: 99%

Creation and implementation of SAMPRO™: A school-based asthma management program

Lemanske

Kakumanu

Shanovich

et al. 2016

Journal of Allergy and Clinical Immunology

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“…8, 21, 33–84 Approximately half (9/17) were identified in peer-reviewed literature. 36, 46–48, 54, 60, 63, 64, 76, 77, 80, 81, 83, 84 An additional 25 U.S. programs providing ≥1 asthma-related home visit reported cost savings without ROI data (Table E3). …”

Section: Asthma-related Home Visit Programsmentioning

confidence: 99%

“…Most programs (12/17) operated in urban settings 33–36, 42–44, 46–49, 60, 62, 65–67, 70, 71, 73–75, 80, 81, 83, 84 , and information was not available for the remaining 5 programs. 37–41, 54, 59, 76–79, 85 Program descriptions indicated health insurance plans operated or served as partners in over one-third (6/17) of programs.…”

Section: Asthma-related Home Visit Programsmentioning

confidence: 99%

“…RCTs were conducted for 2 programs 80, 81, 83, 84 , and a comparison group (non-randomized) was used to assess 4 additional programs. 46–49, 75 Evaluation methodology was not available for 2 programs.…”

Section: Asthma-related Home Visit Programsmentioning

confidence: 99%

“…A few program descriptions also included outcomes such as shorter hospitalization length-of-stay, fewer intensive care unit admissions, and reduced urgent care or unscheduled office visits. 36, 54, 59, 60, 66, 80, 84, 85 …”

Section: Asthma-related Home Visit Programsmentioning

confidence: 99%

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Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions

Hsu

Wilhelm

Lewis

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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The health and economic burden of asthma in the United States is substantial. Asthma self-management education (AS-ME) and home-based interventions for asthma can improve asthma control and prevent asthma exacerbations, and interest in health care-public health collaboration regarding asthma is increasing. However, outpatient AS-ME and home-based asthma intervention programs are not widely available; economic sustainability is a common concern. Thus, we conducted a narrative review of existing literature regarding economic outcomes of outpatient AS-ME and home-based intervention programs for asthma in the United States. We identified 9 outpatient AS-ME programs and 17 home-based intervention programs with return on investment (ROI) data. Most programs were associated with a positive ROI; a few programs observed positive ROIs only among selected populations (e.g., higher health care utilization). Interpretation of existing data is limited by heterogeneous ROI calculations. Nevertheless, the literature suggests promise for sustainable opportunities to expand access to outpatient AS-ME and home-based asthma intervention programs in the United States. More definitive knowledge about how to maximize program benefit and sustainability could be gained through more controlled studies of specific populations and increased uniformity in economic assessments.

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Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Schriger,

Knowles,

Daglieri

et al. 2024

JAMA Health Forum

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ImportanceCommunity health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes.ObjectiveTo identify barriers and facilitators to implementing an evidence-based CHW model.Design, Setting, and ParticipantsThis qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling.InterventionThe disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans.Main Outcomes and MeasuresInterview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains.ResultsOf a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs’ interpersonal skills and life experiences. Program-specific facilitators included the model’s strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity.Conclusions and RelevanceThese findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.

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Community Health Worker Home Visits for Medicaid-Enrolled Children With Asthma: Effects on Asthma Outcomes and Costs

Abstract: A streamlined CHW asthma home visit program for children with uncontrolled asthma improved health outcomes and yielded a return on investment of 1.90.

Cited by 126 publications

References 15 publications

Creation and implementation of SAMPRO™: A school-based asthma management program

Creation and implementation of SAMPRO™: A school-based asthma management program

Economic Evidence for US Asthma Self-Management Education and Home-Based Interventions

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

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