Overview of the Project
Using Community Health Workers to Reduce Disparities in Diabetes Care
Lee Hargraves
University of Massachusetts Medical School
An evaluation of the effects of enhanced training of community health workers (CHWs) to reduce disparities in care in a low-income, racially and ethnically diverse lowpopulation served by community health centers (CHCs)
Collaborative Partners
Community Health Centers in MA Massachusetts League of Community Health Centers University of Massachusetts Medical School Planning Committee that includes,
Massachusetts Diabetes Prevention and Control Program Boston Public Health Commission MassPRO
The CHW Intervention
Curriculum enhancement grounded in the Care Model focused on diabetes self-management selfReviewed and customized for divergent cultural, linguistic, and ethnic groups Multiple training sessions Deployment of CHWs to Collaborative Care Teams
Built Using the Care Model Framework
CHWs connected to community CHWs focused on self-management
CHW Interventions
Outreach to patients in each population of focus Assess self-management, successes and barriers selfExploration of cultural norms Advocacy and connecting to community resources Strengthening of health care relationships
More informed and activated patients
CHW as a team member
Motivational interviewing to teach self-management selfGroup meetings Rely on specific, prescribed interventions using CHW manual
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Community health workers (CHWs) (CHWs) in health care delivery have
gained prominence, proliferated in communities of racial and ethnic minorities, increased access to care for underserved clients, and assisted individual’s navigation of the individual’ traditional health care system.
Recent review studies have demonstrated the impact of CHWs on service delivery
providing culturally relevant health education Assisting with
case management system navigation case finding
Effects of CHWs on health behaviors for diabetes care are mixed
Little is known regarding CHWs impact on self-management goals and practices. selfAdditional research is needed to identify:
specific, replicable characteristics of successful interventions optimal training of CHWs optimal documentation of their activities.
Organizations that acknowledge the contributions of CHWs include
The Institute of Medicine Centers for Disease Control and Prevention American Public Health Association American Association of Diabetes Educators Each recommends including CHWs as important members of the health care team.
Recruiting and retaining CHWs can present challenges
May lack professional training and experience Insufficient training Unrealistic expectations from co-workers coBurnout
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Addressing the challenges
Recruiting from within the participating community health centers Specific training curriculum (45 hour) incorporating Chronic Disease Model Training of co-workers regarding CHW role coTraining of supervisors Ongoing support and training
Project’s Unique Aspects Project’
Baseline data from Diabetes Collaborative Randomized with match paired comparison sites Intensive CHW training with focus on self management of Diabetes Training of health care team to assist integration of CHW CHW Encounter Forms for data collection
Training Community Health Workers
Outreach Worker Training Institute’s Institute’ 45-hour CHW Certification Course 458-Part Training (six hours per week)
8 Outreach core competency sessions 7 Care model and diabetes sessions
Eight Core Competencies
Service Coordination Skills Interpersonal Skills Communication & Interviewing Skills Organizational Skills Presentation & Facilitation Skills Individual & Community Assessment Skills Advocacy and Leadership Skills Cultural Awareness & Sensitivity Skills
Seven Diabetes Components
Diabetes in Diverse Communities Nutrition and Physical Activity for Diabetes Self Management Access, Follow-up, and Supportive Care FollowCross Cultural Beliefs and Diabetes Primary, Nursing, and Specialty Care Individual and Group Teaching Skills Mental Health and Diabetes Management
Self Management Goal Setting
Theme woven throughout curriculum Patient Directed Stages of Change Motivational Interviewing Realistic Goal Setting Role Playing Exercises Documentation (The Encounter Form)
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Training CHW Supervisors
Supervisor Certificate Course
6-Hour training for individuals tasked with overseeing CHWs in the field 2 3-hour weekly sessions 3Supervision strategies, conflict resolution, and professional boundaries Roles and needs of CHWs and their supervisors
Evaluation Components
Quantitative
Patient Surveys Clinical Quality Indicators ACIC Key Personnel Survey
Qualitative
Focus groups with all CHC teams, post intervention CHW patient encounter forms Monthly team narratives Site visit in-depth interviews at all CHCs in-
Next Steps
CHWs become a valued member of the Health Care Team Practice skills learned Acquire new skills Periodic conference calls
Evaluation includes…
analysis of sites with trained CHWs pre/post intervention to control community health centers without CHW Patient Surveys Clinical Outcomes Data Narrative Reports Qualitative data via focus groups and intensive interviews
Clinical Outcome Data
Health Centers collect and post clinical outcome data monthly to Virtual Office
Average HgA1c for Population of Focus Percentage of patients with 2 HgA1c tests in 12 month period Self Management Goal setting Cardiac Risk Reduction
Statins, ACE inhibitors or ARB, ASA, BP, LDL “Thanks for this great opportunity to learn more about diabetes in general and also for the opportunity to share with colleagues working in the same field. Healthy People make a Strong Community.”
A graduate of OWTI’s Diabetes CHW Training OWTI’
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