Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York.
Community health workers
Health equity
Health related social needs
Primary health care
Social care integration
Social determinants of health
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
27 Apr 2024
27 Apr 2024
Historique:
received:
09
02
2024
accepted:
09
04
2024
medline:
28
4
2024
pubmed:
28
4
2024
entrez:
27
4
2024
Statut:
epublish
Résumé
In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY. We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023. There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12). We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.
Sections du résumé
BACKGROUND
BACKGROUND
In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY.
METHODS
METHODS
We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023.
RESULTS
RESULTS
There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12).
CONCLUSIONS
CONCLUSIONS
We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.
Identifiants
pubmed: 38678171
doi: 10.1186/s12875-024-02376-7
pii: 10.1186/s12875-024-02376-7
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
140Subventions
Organisme : Doris Duke Charitable Foundation
ID : 2023-0258
Pays : United States
Informations de copyright
© 2024. The Author(s).
Références
Integrating Social Care into the Delivery of Health Care. Moving Upstream to improve the nation’s health. Washington (DC): The National Academies of Sciences, Engineering, and Medicine; 2019.
Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: World Health Organization; 2010.
County Health Rankings Model: Health Factors: University of Wisconsin Population Health Institute. 2023 [ https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-factors? .
Whitman A, Lew ND, Chappel A, Aysola V, Zuckerman R, Sommers BD. Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. 2022.
Kreuter MW, Thompson T, McQueen A, Garg R. Addressing Social needs in Health Care settings: evidence, challenges, and Opportunities for Public Health. Annu Rev Public Health. 2021;42:329–44.
doi: 10.1146/annurev-publhealth-090419-102204
pubmed: 33326298
pmcid: 8240195
Gottlieb L, Cottrell EK, Park B, Clark KD, Gold R, Fichtenberg C. Advancing Social prescribing with implementation science. J Am Board Fam Med. 2018;31(3):315–21.
doi: 10.3122/jabfm.2018.03.170249
pubmed: 29743213
The CMS Framework for Health Equity. (2022–2032). Baltimore, MD: Centers for Medicare & Medicaid Services; 2022.
New Requirements to Reduce Health Care Disparities. The Joint Commission; 2022.
APHA. Community Health Workers. APHA; [ https://www.apha.org/apha-communities/member-sections/community-health-workers .
Brown O, Kangovi S, Wiggins N, Alvarado CS. Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings. NAM Perspect. 2020;2020.
Knowles M, Crowley AP, Vasan A, Kangovi S. Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States. Annu Rev Public Health. 2023;44:363–81.
doi: 10.1146/annurev-publhealth-071521-031648
pubmed: 37010928
Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, et al. Effect of Community Health Worker support on clinical outcomes of low-income patients across Primary Care facilities: a Randomized Clinical Trial. JAMA Intern Med. 2018;178(12):1635–43.
doi: 10.1001/jamainternmed.2018.4630
pubmed: 30422224
pmcid: 6469661
Patel MI, Kapphahn K, Wood E, Coker T, Salava D, Riley A et al. Effect of a Community Health worker-led intervention among low-income and Minoritized patients with Cancer: a Randomized Clinical Trial. J Clin Oncol. 2023:JCO2300309.
Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, et al. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med. 2014;174(4):535–43.
doi: 10.1001/jamainternmed.2013.14327
pubmed: 24515422
Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, et al. Effects of Social needs screening and In-Person Service Navigation on Child Health: a Randomized Clinical Trial. JAMA Pediatr. 2016;170(11):e162521.
doi: 10.1001/jamapediatrics.2016.2521
pubmed: 27599265
Schechter SB, Lakhaney D, Peretz PJ, Matiz LA. Community Health Worker Intervention To Address Social Determinants of Health for Children Hospitalized with Asthma. Hosp Pediatr. 2021;11(12):1370–6.
doi: 10.1542/hpeds.2021-005903
pubmed: 34849926
Matiz LA, Leong S, Peretz PJ, Kuhlmey M, Bernstein SA, Oliver MA, et al. Integrating community health workers into a community hearing health collaborative to understand the social determinants of health in children with hearing loss. Disabil Health J. 2022;15(1):101181.
doi: 10.1016/j.dhjo.2021.101181
pubmed: 34412985
Flike K, Means RH, Chou J, Shi L, Hayman LL. Bridges to elders: a program to improve outcomes for older women experiencing homelessness. Health Promot Pract. 2023:15248399231192992.
Olsen L, Aisner D, McGinnis JM, editors. The Learning Healthcare System: Workshop Summary. Washington (DC)2007.
: QuickFacts, County B. New York 2022 [ https://www.census.gov/quickfacts/fact/table/bronxcountynewyork/PST045222 .
MMC. Community Health Needs AssessmentImplementation Strategy Report and Community Service Plan 2022–2024. 2022.
Fiori KP, Rehm CD, Sanderson D, Braganza S, Parsons A, Chodon T, et al. Integrating Social Needs Screening and Community Health Workers in Primary Care: the Community linkage to Care Program. Clin Pediatr (Phila). 2020;59(6):547–56.
doi: 10.1177/0009922820908589
pubmed: 32131620
HealthLeads. The Health Leads Screening Toolkit 2023 [ https://healthleadsusa.org/news-resources/the-health-leads-screening-toolkit/ .
Fiori KP, Heller CG, Flattau A, Harris-Hollingsworth NR, Parsons A, Rinke ML, et al. Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx County, New York, USA. BMJ Open. 2021;11(9):e053633.
doi: 10.1136/bmjopen-2021-053633
pubmed: 34588265
pmcid: 8483051
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inf. 2019;95:103208.
doi: 10.1016/j.jbi.2019.103208
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377–81.
doi: 10.1016/j.jbi.2008.08.010
Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, et al. RE-AIM planning and evaluation Framework: adapting to New Science and Practice with a 20-Year review. Front Public Health. 2019;7:64.
doi: 10.3389/fpubh.2019.00064
pubmed: 30984733
pmcid: 6450067
Berman RS, Nguyen HT, Levano SR, Fiori KP. Clinician Champions’ Influence on Social Needs Screening Volumes in Pediatric Practices. Clin Pediatr (Phila). 2023:99228231200404.
Bunce AE, Gruss I, Davis JV, Cowburn S, Cohen D, Oakley J, et al. Lessons learned about the effective operationalization of champions as an implementation strategy: results from a qualitative process evaluation of a pragmatic trial. Implement Sci. 2020;15(1):87.
doi: 10.1186/s13012-020-01048-1
pubmed: 32998750
pmcid: 7528604
Bonawitz K, Wetmore M, Heisler M, Dalton VK, Damschroder LJ, Forman J, et al. Champions in context: which attributes matter for change efforts in healthcare? Implement Sci. 2020;15(1):62.
doi: 10.1186/s13012-020-01024-9
pubmed: 32762726
pmcid: 7409681
DeCamp LR, Yousuf S, Peters C, Cruze E, Kutchman E. Assessing strengths, challenges, and Equity Via pragmatic evaluation of a Social Care Program. Acad Pediatr. 2023.
Foster AA, Daly CJ, Leong R, Stoll J, Butler M, Jacobs DM. Integrating community health workers within a pharmacy to address health-related social needs. J Am Pharm Assoc (2003). 2023;63(3):799–806 e3.
Renaud J, McClellan SR, DePriest K, Witgert K, O’Connor S, Abowd Johnson K, et al. Addressing Health-Related Social needs Via Community resources: lessons from Accountable Health communities. Health Aff (Millwood). 2023;42(6):832–40.
doi: 10.1377/hlthaff.2022.01507
pubmed: 37196207
Washburn DJ, Callaghan T, Schmit C, Thompson E, Martinez D, Lafleur M. Community health worker roles and their evolving interprofessional relationships in the United States. J Interprof Care. 2022;36(4):545–51.
doi: 10.1080/13561820.2021.1974362
pubmed: 34652982
McCarville EE, Martin MA, Pratap PL, Pinsker E, Seweryn SM, Peters KE. Understanding the relationship between care team perceptions about CHWs and CHW integration within a US health system, a qualitative descriptive multiple embedded case study. BMC Health Serv Res. 2022;22(1):1587.
doi: 10.1186/s12913-022-08723-7
pubmed: 36575412
pmcid: 9793519
Allen CG, Escoffery C, Satsangi A, Brownstein JN. Strategies to improve the Integration of Community Health Workers Into Health Care teams: a little fish in a Big Pond. Prev Chronic Dis. 2015;12:E154.
doi: 10.5888/pcd12.150199
pubmed: 26378900
pmcid: 4576500
Malcarney MB, Pittman P, Quigley L, Horton K, Seiler N. The Changing Roles of Community Health Workers. Health Serv Res. 2017;52(Suppl 1Suppl 1):360–82.
doi: 10.1111/1475-6773.12657
pubmed: 28127766
pmcid: 5269544
Rogers EA, Manser ST, Cleary J, Joseph AM, Harwood EM, Call KT. Integrating Community Health Workers Into Medical Homes. Ann Fam Med. 2018;16(1):14–20.
doi: 10.1370/afm.2171
pubmed: 29311170
pmcid: 5758315
Kangovi S, Mitra N, Grande D, Long JA, Asch DA. Evidence-based Community Health Worker Program addresses Unmet Social needs and generates positive return on investment. Health Aff (Millwood). 2020;39(2):207–13.
doi: 10.1377/hlthaff.2019.00981
pubmed: 32011942
Haldar S, Hinton E. State Policies for Expanding Medicaid Coverage of Community Health Worker (CHW) Services: KFF; 2023 [ https://www.kff.org/medicaid/issue-brief/state-policies-for-expanding-medicaid-coverage-of-community-health-worker-chw-services/ .
Assembly Bill AC, STATE OF NEW YORK. 2023–2024 Legislative Session Sess. (2023).
NYCDOH. Community Health Worker Services Policy Manual. 2023.
Armstrong K, Rose A, Peters N, Long JA, McMurphy S, Shea JA. Distrust of the health care system and self-reported health in the United States. J Gen Intern Med. 2006;21(4):292–7.
doi: 10.1111/j.1525-1497.2006.00396.x
pubmed: 16686803
pmcid: 1484714
Shi M, Fiori K, Kim RS, Gao Q, Umanski G, Thomas I, et al. Social Needs Assessment and Linkage to Community Health Workers in a large Urban Hospital System. J Prim Care Community Health. 2023;14:21501319231166918.
doi: 10.1177/21501319231166918
pubmed: 37083206
pmcid: 10126704