Community Health Workers as Interventionists in the Prevention and Control of Heart Disease and Stroke

Brownstein, J. Nell; Bone, Lee R.; Dennison, Cheryl R.; Hill, Martha N.; Kim, Myong T.; Levine, David M.

doi:10.1016/j.amepre.2005.07.024

Cited by 204 publications

(176 citation statements)

References 29 publications

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“…Community healthcare workers and other lay providers may help diminish disparities by providing basic preventive care and education to people with otherwise limited access to health care. 200,201 …”

Section: Discussionmentioning

confidence: 99%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

431

261

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Purpose-Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. Results-There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limitedThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 6, 2011. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@woltersklu...

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Section: Discussionmentioning

confidence: 99%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

431

261

View full text Add to dashboard Cite

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“…[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%

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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“…73 Community health workers have contributed to significant improvements in community members' access to and continuity of care and adherence to treatment for the control of hypertension. 74 Community health workers assume multiple roles, including educating patients and communities, counseling patients, monitoring patient health status, linking people with health and social services, and enhancing provider-patient communication and adherence to care.…”

Section: Culture Language and Cvdmentioning

confidence: 99%