Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

Allen, Caitlin G.; Brownstein, J. Nell; Jayapaul-Philip, Bina; Matos, Sérgio; Mirambeau, Alberta

doi:10.1097/jac.0000000000000085

Cited by 21 publications

(14 citation statements)

References 24 publications

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“…Strategies to identify and address social determinants of health, which contribute to adverse outcomes among marginalized patient populations, should be explored 33 . For example, the addition of community health workers to the multidisciplinary team has been shown to be a cost‐effective, strategy to improve diabetes control in vulnerable populations 34,35 . Programs which target the development of a diverse clinical workforce that mirrors the nation's demographics may improve clinician‐patient relationships and lead to enhanced patient engagement 36 .…”

Section: Resultsmentioning

confidence: 99%

Racial disparities in treatment and outcomes of children with type 1 diabetes

et al. 2020

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Objective The aim of this study was to assess racial disparities in treatments and outcomes between Non‐Hispanic black (NHB), Hispanic and Non‐Hispanic white (NHW) children with type 1 diabetes (T1D). Methods We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018, and December 31, 2019. Health care utilization (appointment attendance, ED visits, hospitalizations), technology use (insulin pumps, continuous glucose monitors [CGM]) and hemoglobin A1c (HbA1c) were examined for each race/ethnicity and stratified by insurance type (private/government) as a proxy for socioeconomic status (SES). Results Of 1331 children (47% female) with a median (IQR) age of 14.2 (11.5, 16.3) years and T1D duration of 5.8 (3.8, 9) years; 1026 (77%) were NHW, 198 (15%) NHB, and 107 (8%) Hispanic. Government insurance was used by 358 (27%) children, representing 60% of NHB and 53% of Hispanic, but only 18% of NHW children. NHB children had higher HbA1c, more ED visits and hospitalizations, and were less likely to be treated with insulin pumps or CGM than NHW children (P < .001 for all). There were no racial disparities with regard to the number of appointments attended. Conclusions Racial disparities in technology use and diabetes outcomes persist in children with T1D, regardless of insurance status. To ensure equitable care, pediatric healthcare providers should remain cognizant of racial disparities in diabetes treatment. The impact of provider and patient factors should be explored when studying the etiology of these health disparities.

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Section: Resultsmentioning

confidence: 99%

Racial disparities in treatment and outcomes of children with type 1 diabetes

et al. 2020

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“…Recent case studies and reviews of implementation science literature have suggested that a potential barrier to success for new CHW programs can be inadequate connections to clinicians/health care delivery and poorly defined roles. [60][61][62] Future efforts in sustaining this program and others in interventional audiology will rely on expanding training opportunities, interprofessional collaboration, and identifying mechanisms for financial support.…”

Section: Discussionmentioning

confidence: 99%

Interventional Audiology to Address Hearing Health Care Disparities: Oyendo Bien Pilot Study

et al. 2017

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Interventional audiology, specifically community-based outreach, can connect people with the hearing health care system. Community-based participatory research methods were applied in two phases of research to: (1) investigate the needs of families affected by hearing loss in a rural Arizona community on the U.S.-Mexico border; and (2) evaluate an outreach program on hearing health. The needs assessment included interviews with persons with hearing loss and focus groups with family members and the greater community. The needs assessment revealed that despite perceived severity of hearing loss, help-seeking for audiologic care was limited due to barriers, stigma, and low self-efficacy. Results informed development of a community-based pilot study conducted as part of an academic-community partnership between audiology, public health, and community health workers of a federally qualified health center. An outreach program, (hearing wellness), a 5-week, Spanish-language health education program for older adults ( = 21) incorporated communication strategies and behavioral change techniques. Postprogram focus groups revealed increased self-efficacy and decreased stigma. After 1 year, 7 of 9 participants with hearing loss contacted for follow-up had sought some form of hearing-related health care. Future research should further investigate interventional audiology approaches to address health disparities.

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“…62,63 Home visits may extend the clinic's reach, but require new strategies for remote supervision and technology access. 64,65 Decisions about how to best utilize CHW-PCs depend on needs of patients and care teams, clinical workflows, financial viability, and addressing practice burdens while facilitating performance 66,67 and cost-savings. 68 Increasing the presence of CHW-PCs also requires training and clinical integration necessary to build this new workforce, 59,69 including certification, 58 health information technology, and clinical oversight for the breadth of contributions CHW-PCs offer.…”

Section: Provides Limited Medication Reconciliation Without Making Rementioning

confidence: 99%

Roles and Functions of Community Health Workers in Primary Care

et al. 2018

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Community health workers have potential to enhance primary care access and quality, but remain underutilized. To provide guidance on their integration, we characterized roles and functions of community health workers in primary care through a literature review and synthesis. Analysis of 30 studies identified 12 functions (ie, care coordination, health coaching, social support, health assessment, resource linking, case management, medication management, remote care, follow-up, administration, health education, and literacy support) and 3 prominent roles representing clusters of functions: clinical services, community resource connections, and health education and coaching. We discuss implications for community health worker training and clinical support in primary care.

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Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships

Cited by 21 publications

References 24 publications

Racial disparities in treatment and outcomes of children with type 1 diabetes

Racial disparities in treatment and outcomes of children with type 1 diabetes

Interventional Audiology to Address Hearing Health Care Disparities: Oyendo Bien Pilot Study

Roles and Functions of Community Health Workers in Primary Care

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