CHWs

Impact of CHWs on Use of Healthcare Services in the United States: A Systematic Review

Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS

J Gen Intern Med. 2016 Dec 5. [Pubmed Abstract]

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…

Impact of CHWs on Elderly Patients’ Advance Care Planning and Health Care Utilization: Moving the Dial

Litzelman DK, Inui TS, Griffin WJ, Perkins A, Cottingham AH, Schmitt-Wendholt KM, Ivy SS

Med Care. 2016 Nov 21. [Pubmed Abstract]

Background
Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences.

Objective
To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment.

Research Design
A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation.

Subjects
The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white.

Measures
Documentation of ACP conversation in electronic health record fields and health care utilization outcomes.

Results
In this target population ACP documentation rose from 3.4% (pre-CCA…

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using MI-based approaches in a public primary care center in São Paulo, Brazil

do Valle Nascimento TM, Resnicow K, Nery M, Brentani A, Kaselitz E, Agrawal P, M and S, Heisler M

BMC Health Serv Res. 2017 Jan 13;17(1):32. [Pubmed Abstract]

Background
Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil.

Methods
Nineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary…