Using Community Health Workers to Reduce Disparities
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Massachusetts League of Community Health Centers
Massachusetts
Diabetes
Urban, suburban and rural community health centers
Underserved minorities
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PROJECT
A community health worker, formally trained in diabetes management, is added to the health care team.
Project leaders in partnership with the Central Massachusetts Area Health Education Center adapted a nationally-recognized community health worker training program to include information on how to assist patients in their efforts to manage diabetes and improve glycemic control. Each community health worker receives 45 hours of classroom and field-based training and is assigned to care for patients with diabetes at his or her community health center. In addition to the initial training, periodic in-service conference calls are held and three additional training workshops are offered.
Patients meet with the community health worker for 30 minutes before each scheduled appointment or speak with them in advance by phone. The primary objective of each meeting is to help the patient develop a self-management goal. During each meeting an encounter form is completed to help guide the discussion and document what topics were addressed.
RATIONALE
Community health workers can serve as valuable bridges between the treatment regimen medical professionals prescribe
and the day-to-day realities of patients’ lives. Recruited directly from the patient populations they serve community health workers often share similar ethnic and cultural backgrounds, language, traditions, and perspectives. Additionally, they have more time to spend with patients than primary care providers and can help patients navigate the complex health care system.
Often training programs for community health workers are brief and lack comprehensiveness. Formal training gives graduates of the program the knowledge and skills to improve patient outcomes and provides advancement opportunities for existing staff members interested in case management positions.
Keeping in mind the cultural, linguistic and health literacy diversity of the trainees, the improved training curriculum focuses on building skills related to service coordination, interpersonal and organizational relations, communication and interviewing, advocacy, leadership, and cultural awareness. A more general introduction to several health topics was replaced with sessions on the Chronic Care Model, managing chronic disease, and diabetes management.
EVALUATION PLAN
Funded by Finding Answers in 2006.
Fourteen community health centers are participating in the evaluation of this program. After matching on factors such as baseline performance, volume of patients, and ethnic diversity, researchers at University of Massachusetts Medical School are randomly assigning half the health centers a trained community health worker to its diabetes care team while the other half are proceeding with usual care. Information is being gathered on the presence of self-management goals; documentation of HbA1c levels and whether or not they were within range; and cardiovascular measures such as
blood pressure and LDL cholesterol.
After a year of follow-up, researchers are comparing these measures to measures taken at the beginning of the intervention and to measures taken more than two years prior as a result of their existing diabetes registry.
Publications
Community Health Workers Assisting Patients With Diabetes in Self-management
Journal of Ambulatory Care Management. 2012; 35(1): 15–26.
Full Article (may require subscription)
Developing community health worker diabetes training.
Health Education Research. Online 2011.
Full Article (may require subscription)
For More Information
Please Contact:
Joan Pernice, MS, BS
jpernice@massleague.org
J. Lee Hargraves, PhD., MS, BS
lee.hargraves@umassmed.edu
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