Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma

Parker, Edith A.; Israel, Barbara A.; Robins, Thomas G.; Mentz, Graciela; Lin, Xihong; Brakefield-Caldwell, Wilma; Ramirez, Erminia; Edgren, Katherine K.; Salinas, María Antonieta Flores; Lewis, Toby C.

doi:10.1177/1090198106290622

Cited by 130 publications

(108 citation statements)

References 33 publications

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“…Two of four RCTs demonstrated a significant decrease relative to control, 40,53 and two showed no significant decrease relative to control. 54,55 Of the four pre-post studies measuring this outcome, three demonstrated a statistically significant decrease, 41,44,45 and one showed a non-significant increase.…”

Section: Emergency Department Visitsmentioning

confidence: 86%

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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Section: Emergency Department Visitsmentioning

confidence: 86%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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“…Such home visits reduce exposure to triggers, decrease symptoms and urgent healthcare use, and increase quality of life. 7,[53][54][55][56][57][58][59][60][61][62] Visitors assess home environmental conditions, tailor education on how to eliminate triggers to the client's sensitization status and exposures found in the home, provide trigger reduction resources (eg, vacuums, cleaning supplies, bedding encasements, and referral to smoking cessation), help with cockroach and rodent integrated pest management, make minor repairs, and provide social support. Importantly, visitors build trusting relationships with clients, thus enhancing their effectiveness in motivating behavior changes.…”

Section: Interventions To Reduce Exposure To Triggersmentioning

confidence: 99%

“…Important questions regarding home visits remain unanswered regarding the relative merits of different types of home visitors (programs have employed various types of visitors, such as CHWs, sanitarians, nurses, and doctors, 57 with current evidence showing no difference in outcomes 53,55,58 ), the most cost-effective intensity and duration of the intervention, the possibility of substituting telephone contact for some of the follow-up visits, the durability of intervention effect, and the role of home visits in higherincome and more privileged populations generally not included in existing studies. Further research to address these issues is warranted.…”

Section: Where To Go From Herementioning

confidence: 99%

Home is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment

Krieger

2010

Pediatric Allergy, Immunology, and Pulmonology

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Asthma remains the most common chronic condition of childhood. Strong evidence has linked exposure to allergens and other triggers commonly found in homes to allergen sensitization and asthma incidence and morbidity. A growing body of evidence has demonstrated that a home visit strategy that includes an environmental component that addresses multiple triggers through multiple interventions is effective. Such home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. To make home visits widely available will require health-care payor reimbursement, government and health plan funding, training and certification of home visitors, and active referrals from health-care providers. However, a strategy based solely on education and behavior change is limited, because it cannot adequately reduce exposures due to adverse housing conditions. Therefore, approaches that address substandard housing are needed. These include remediation of existing housing and construction of new asthma-friendly homes. Most studies of remediation have made relatively narrow and focused improvements, such as insulation, heating, or ventilation. Outcomes have been mixed. Studies of new asthma-friendly homes are in their infancy, with promising pilot data. Further investigation is needed to establish the effectiveness of improving housing. A final strategy is improving housing quality through policy change, such as implementation of healthy housing guidelines for new construction, enhancement and increased enforcement of housing codes, and assuring smoke-free multi-unit homes. The combination of home visits, improved housing construction, and policy change has great potential for reducing the global burden of asthma.

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“…Examples of CHW roles include providing health education, performing patient navigation, and directly delivering medical services, such as immunizations 26 . CHW programs have targeted many diseases-diabetes 27-30 , cancer [31][32][33][34][35] , cardiovascular disease [36][37][38][39] , and asthma [40][41][42][43][44] in addition to focusing on general health promotion 45 and maternal/child health [46][47][48] .…”

Section: Introductionmentioning

confidence: 99%

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

et al. 2010

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Our randomized trial of a promotora-led educational intervention demonstrated improved Pap screening rates, in addition to increased knowledge about cervical cancer and self-efficacy. The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them. Future research should evaluate such programs on a larger scale, and identify novel targets for intervention.

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Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma

Cited by 130 publications

References 33 publications

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Home is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment

Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women

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