Abstract
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
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References
American Public Health Association (APHA) (n.d.). Community health workers. https://www.apha.org/apha-communities/member-sections/community-health-workers.
Bureau of Labor Statistics (n.d.). Community health workers. http://www.bls.gov/soc/2010/soc211094.htm.
Lehmann, U., & Sanders, D. (2007, January). Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. http://www.who.int/hrh/documents/community_health_workers.pdf.
Arvantes, J. (2010, July 28). Health care reform law will increase demand for preventive services, say experts. http://www.aafp.org/news/government-medicine/20100728hcreformprevent.html.
United States Department of Health and Human Services, Health Resources and Services Administration, & National Center for Health Workforce Analysis. (2013). Projecting the supply and demand for primary care practitioners through 2020. Rockville, Maryland: US Health Resources and Services Administration. http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/projectingprimarycare.pdf.
Whitley, E. M., Everhart, R. M., & Wright, R. A. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor and Underserved, 17(1), 6–15.
Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Hirsch, G. R., Willaert, A. M., Scott, J. R., … Fox, D. J. (2010). Community health workers: Part of the solution. Health Affairs, 29(7), 1338–1342.
Witmer, A., Seifer, S. D., Finocchio, L., Leslie, J., & O’Neil, E. H. (1995). Community health workers: Integral members of the health care work force. American Journal of Public Health, 85(8), 1055–1058.
California Health Workforce Alliance (2013). Community health workers, promotores and the triple aim: Taking innovation to scale. http://www.phi.org/resources/?resource=taking-innovation-to-scale-community-health-workers-promotores-and-the-triple-aim.
Centers for Disease Control and Prevention (CDC). (2011). Addressing Chronic Disease Through Community Health Workers: A Policy and Systems-Level Approach. http://www.cdc.gov/dhdsp/docs/chw_brief.pdf.
Institute for Clinical and Economic Review (ICER). (2013, May 24). Community Health Workers: A Review of Program Evolution, Evidence on Effectiveness and Value, and Status of Workforce Development in New England. http://icer-review.org/wp-content/uploads/2011/04/CHW-Draft-Report-05-24-13-MASTER1.pdf.
Kim, K., Choi, J. S., Choi, E., Nieman, C. L., Joo, J. H., Lin, F. R., … Han, H. (2016). Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: A systematic review. American Journal of Public Health, 106(4), e3–e28.
Hostetter, M., & Klein, S. (2015, December). In Focus: Integrating Community Health Workers into Care Teams. http://www.commonwealthfund.org/publications/newsletters/transforming-care/2015/december/in-focus.
Minore, B., & Boone, M. (2002). Realizing potential: Improving interdisciplinary professional/paraprofessional health care teams in Canada’s northern aboriginal communities through education. Journal of Interprofessional Care, 16(2), 139–147.
Pittman, M., Sunderland, A., Broderick, A., & Barnett, K. (2015). Bringing Community Health Workers into the Mainstream of US Health Care. http://www.astho.org/community-health-workers/IOM-Community-Health-Worker-Report/.
Fuller, J. (1995). Challenging old notions of professionalism: How can nurses work with paraprofessional ethnic health workers? Journal of Advanced Nursing, 22(3), 465–472.
Findley, S., Matos, S., Hicks, A., Chang, J., & Reich, D. (2014). Community health worker integration into the health care team accomplishes the triple aim in a patient-centered medical home. Journal of Ambulatory Care Management, 37(1), 82–91.
Patient Centered Primary Care Institute. (2016, April 27). Integrating Community Health Workers (Chws) in Your Practice. Webinar. http://www.pcpci.org/sites/default/files/webinar-related/CHW%20Webinar_PCPCI%20Format_FINAL.pdf.
O’Brien, M. J., Squires, A. P., Bixby, R. A., & Larson, S. C. (2009). Role development of community health workers: An examination of selection and training processes in the intervention literature. American Journal of Preventive Medicine, 37(6), S262–S269.
Siemon, M., Shuster, G., & Boursaw, B. (2015). The impact of state certification of community health workers on team climate among registered nurses in the United States. Journal of Community Health, 40(2), 215–221.
Allen, C. G., Escoffery, C., Satsangi, A., & Brownstein, J. N. (2015). Strategies to improve the integration of community health workers into health care teams: A little fish in a big pond. Preventing Chronic Disease, 12, E154.
Arvey, S. R., & Fernandez, M. E. (2012). Identifying the core elements of effective community health worker programs: A research agenda. American Journal of Public Health, 102(9), 1633–1637.
Centers for Medicare & Medicaid Services. (2017, April 4). Health Care Innovation Awards. https://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/.
Rojas-Smith, L., Amico, P., Hoerger, T., Jacobs, S., Payne, J., & Renaud, J. (2017). Evaluation of the Health Care Innovation Awards: Community Resource Planning, Prevention, and Monitoring, Third Annual Report. Baltimore, Maryland: Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services. https://downloads.cms.gov/files/cmmi/hcia-communityrppm-thirdannualrpt.pdf.
QSR International (n.d.). Run a coding comparison query. http://help-nv10.qsrinternational.com/desktop/procedures/run_a_coding_comparison_query.htm.
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This publication was made possible by Contract Number HHSM-500-2010-00021I from the US Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.
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Payne, J., Razi, S., Emery, K. et al. Integrating Community Health Workers (CHWs) into Health Care Organizations. J Community Health 42, 983–990 (2017). https://doi.org/10.1007/s10900-017-0345-4
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DOI: https://doi.org/10.1007/s10900-017-0345-4