Improving Chronic Disease Care by Adding Laypersons to the Primary Care Team

Adair, Richard; Wholey, Douglas R.; Christianson, Jon B.; White, Katie; Britt, Heather; Lee, Suhna

doi:10.7326/0003-4819-159-3-201308060-00007

Cited by 46 publications

(45 citation statements)

References 46 publications

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“…34 Adding CHWs to the primary care team can improve care and coordination for patients with chronic disease at low cost. 35 As part of a care team, CHWs can support care management and provide care coordination across settings, in patients’ homes, and at community locations. For example, when a patient is discharged from a hospital, a CHW can provide follow-up support as the person transitions home and can facilitate follow-up visits with the primary care provider and other providers and services.…”

Section: Results: Areas Of Integration For Chw Into Ppaca Programsmentioning

confidence: 99%

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

Islam

Nadkarni

Zahn

et al. 2015

Journal of Public Health Management and Practice

138

100

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Context The Patient Protection and Affordable Care Act’s (PPACA) emphasis on community-based initiatives affords a unique opportunity to disseminate and scale up evidence-based community health worker (CHW) models that integrate CHWs within health care delivery teams and programs. Community health workers have unique access and local knowledge that can inform program development and evaluation, improve service delivery and care coordination, and expand health care access. As a member of the PPACA-defined health care workforce, CHWs have the potential to positively impact numerous programs and reduce costs. Objective This article discusses different strategies for integrating CHW models within PPACA implementation through facilitated enrollment strategies, patient-centered medical homes, coordination and expansion of health information technology (HIT) efforts, and also discusses payment options for such integration. Results Title V of the PPACA outlines a plan to improve access to and delivery of health care services for all individuals, particularly low-income, underserved, uninsured, minority, health disparity, and rural populations. Community health workers’ role as trusted community leaders can facilitate accurate data collection, program enrollment, and provision of culturally and linguistically appropriate, patient- and family-centered care. Because CHWs already support disease management and care coordination services, they will be critical to delivering and expanding patient-centered medical homes and Health Home services, especially for communities that suffer disproportionately from multiple chronic diseases. Community health workers’ unique expertise in conducting outreach make them well positioned to help enroll people in Medicaid or insurance offered by Health Benefit Exchanges. New payment models provide opportunities to fund and sustain CHWs. Conclusion Community health workers can support the effective implementation of PPACA if the capacity and potential of CHWs to serve as cultural brokers and bridges among medically underserved communities and health care delivery systems is fully tapped. Patient Protection and Affordable Care Act and current payment structures provide an unprecedented and important vehicle for integrating and sustaining CHWs as part of these new delivery and enrollment models.

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Section: Results: Areas Of Integration For Chw Into Ppaca Programsmentioning

confidence: 99%

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

Islam

Nadkarni

Zahn

et al. 2015

Journal of Public Health Management and Practice

138

100

View full text Add to dashboard Cite

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“…We excluded 64 From the database searches we identified 22 references containing potential economic evaluations. Following full-text review, eight 58,83,94,103,114,115,122,123 of these references were excluded and 14 references 59,62,67,69,70,85,87,89,95,105,117,[124][125][126] reporting economic outcomes were included in the review.…”

Section: Study Selectionmentioning

confidence: 99%

“…The included studies were conducted between 1988 and 2013. Thirty-five studies (53%) were parallel-group patient RCTs enrolling 237,025 patients 59,[61][62][63]71,72,75,80,82,[85][86][87][88][89]95,96,98,99,102,103,[107][108][109][111][112][113][114][115][116][117][118][119][120][121][122] and 31 (47%) were cluster RCTs in which the HCP or the health-care setting was the unit of randomisation. 58,60,64-70, 73,74,76-79,81,83,84,90-94,97,100,101,104-106,110,123 These included 6126 clusters (range 6-4125 clusters).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

Lawrenson

Graham-Rowe

Lorencatto

et al. 2018

Health Technol Assess

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“…4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration. [24][25][26] Researchers have explored the experience of CHWs with integration into care teams and examined how health care delivery systems might be 27-31 Experts have outlined implementation barriers (fragmented and disease-specific interventions, lack of clear work protocols, high turnover, variable performance, and a history of low-quality evidence), but argue that these barriers can be overcome through established standards to ensure a skilled CHW workforce, clearly defined roles, concrete implementation strategies, and an expanded scope of reimbursable services to include their services.…”

mentioning

confidence: 99%

Integrating Community Health Workers Into Medical Homes

Rogers

Manser

Cleary³

et al. 2018

Ann Fam Med

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PURPOSE Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. METHODSWe conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics.RESULTS Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient.CONCLUSIONS We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce. 2018;16:14-20. https://doi.org/10.1370/afm.2171. Ann Fam Med INTRODUCTIONC ommunity health workers (CHWs), trusted frontline health workers who have a close understanding of the community served, 1 can be valuable contributors to the team-based and patient-centered care promoted through the patient-centered medical home (PCMH) model. 2 CHWs complement roles played by traditional health professionals through culturally sensitive outreach, patient education, resource identification, case management, care coordination, and patient support. [3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration. [24][25][26] Researchers have explored the experience of ...

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Improving Chronic Disease Care by Adding Laypersons to the Primary Care Team

Abstract: Adding care guides to the primary care team can improve care for some patients with chronic disease at low cost.

Cited by 46 publications

References 46 publications

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

Integrating Community Health Workers Within Patient Protection and Affordable Care Act Implementation

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

Integrating Community Health Workers Into Medical Homes

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