Discover your biggest under-utilized resource: community health workers
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You put so much time and effort into ensuring your patients receive the best possible COPD care. However, once they’re discharged, long-term outcomes often rest in the hands of the patients themselves. Family and friends can play a crucial role in keeping COPD patients on track, but not every patient has that kind of support system. Even when they do, there’s no guarantee the people around the patient have been educated enough to help steer the patient in the right direction. Community health workers (CHWs) can be the solution you’ve been missing. They serve as cost-effective extensions of the inpatient care team, helping to educate patients and their families and periodically checking in with a watchful eye to make sure things are going smoothly.
I think one of the primary ways that we can tackle COPD readmissions is a utilization of community health workers,”
Chikita Mann, MSN, RN, CCM Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Clarifying a relatively unclear role
The term “community health worker” is a broad name. It encompasses a number of different job titles, and organizations often refer to the role differently. CHWs are often called lay health workers, community health advocates, health coaches, and patient navigators, among other designations.1,2 Even once you nail down the name, the responsibilities and qualifications of the role can also vary. Some CHWs work with patients in clinical settings, like hospitals, but most do their work in the patient’s home or another community setting.1
Contributors
Jerry Krishnan, MD, PhD
Associate Vice Chancellor for Population Health Sciences University of Illinois Hospital and Health Sciences System
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager Department of Respiratory Care at UC Davis Medical Center
Chikita Mann, MSN, RN, CCM Disability RN
Case Manager Supervisor Genex Services, LLC for the State of Georgia
What is a community health worker?3
According to the American Public Health Association (APHA), “Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served.” The trusting relationship that CHWs are able to build with the community allows them to more effectively serve as an intermediary between healthcare providers and local residents. CHWs work to increase public access to high-quality and culturally competent care. In addition to facilitating care, “CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy,” says the APHA.
Community Health Workers programs:
They are individuals within the community that are not necessarily medical. Sometimes they're just people within a community who want to help out.”
They are individuals within the community that are not necessarily medical. Sometimes they're just people within a community who want to help out.”
Chikita Mann, MSN, RN, CCM Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
It’s estimated that roughly one-third of CHWs work on a volunteer basis, but the majority of CHWs hold paid positions.4
Insider insight: How do organizations pay for community health workers?1
A 2017 study found that many CHWs are shifting from community-based non-profit organizations to hospitals and health systems that hire them directly. As a result, many institutions are looking to use grants and short-term contracts to fund their services. The study found that funding sources for community health workers vary greatly, with some programs funded by multiple sources:
Funding Source & percent of programs1
Health plan - 12%
Health system - 20%
Private foundation - 28%
State/local health/social agency - 20%
Federal health/social agency - 36%
Making a personal connection
Because CHWs are typically from the same communities as the patients they serve, they’re well-equipped to make the social connections needed for positive outcomes. They serve as liasons between patients and health systems and help patients better understand and manage their conditions. Having a shared background enables greater collaboration and a higher comfort level from the patient’s perspective, which leads to a more effective delivery of education and information. This type of support can make COPD patients feel better about their condition and treatment process, and that optimistic outlook can go a long way.
CHW case study
Jerry Krishnan, MD, PhD
The patient study
Dr. Jerry Krishnan helped his institution conduct a 1,000-patient study to determine the impact of community health workers.
The patient groupings
The first group of patients received standard care, while the second group of patients received social support from CHWs.
The patient experience scores
1,000 patients randomized into two different groups
The outcome
"At the end of the study, [the community health worker group] had improved patient experience scores,” Krishnan says. “Now, we try to market that to our C-suite.”
By establishing personal connections with patients, CHWs help improve satisfaction and overall mental health.
The eyes and ears of a COPD care team
Community health workers are on the front lines, entrenched in the communities where patients live. By stopping in and touching base with patients to make sure they’re adhering to COPD care plans, and helping them take steps to minimize exacerbations, CHWs are often in a position to raise a red flag if they see something that doesn’t seem right. “They’re basically able to let you know, ‘Hey, I went over to Mrs. Jones’ house the other day and I realized that she's not using her oxygen the way she needs to,’” says Mann. “You can now give Mrs. Jones a call and say, ‘How is everything going? I spoke with the community health worker and they said they noticed that you weren't using your oxygen correctly. Is everything okay?’ That person could actually help be a part of decreasing their readmissions, decreasing the ER visits.” By monitoring patients at home and addressing potential problems early, CHWs can help see to it that concerns are addressed before the situation escalates into a full-blown exacerbation or readmission. “Getting that extra set of eyes on the patient is always really important,” adds COPD case manager Krystal Craddock.
Insider intel: Do community health workers improve outcomes?5
A randomized clinical trial was conducted to measure the impact of CHWs on post-hospital outcomes of patients. The CHWs worked with one group of patients to create individualized action plans to achieve the patients’ goals for recovery, then helped support the patients for at least two weeks. The study found that the patients with access to CHWs: were less likely to have multiple 30-day readmissions
Incorporating CHWs into your COPD care plan
The U.S. Bureau of Labor Statistics projects overall employment of community health workers to grow by 16% between 2016 and 2026.6 There should be plenty of CHWs to go around, so the key will be to convince your C-suite to use them as part of your COPD care plan. As with most things, it will likely come down to ROI.
Insider intel: Are community health workers worth the investment?7
To determine the financial impact of CHWs, researchers looked at costs associated with patients during the nine-month period preceding any interactions with CHWs, and then for the same patients for the nine-month period after outreach by community health workers.
Community health workers yielded more than a 2:1 return on investment
Key findings:
$14,000
less in uncompensated costs per month
$96,000
in annual savings
Increase
in primary care visits
Decrease
in urgent care visits
The Centers for Disease Control has a helpful toolkit for organizations looking to implement a CHW program, including a wealth of information on funding and sustainability. Do plenty of research and don’t be afraid to get creative when trying to find ways to incorporate CHMs or other community advocacy groups. “Don't just think outside the box,” Krishnan says. “Throw away the box and begin from a much broader platform. If we're thinking about developing programs that you want sustained, they have to also have hooks and pulls in different stakeholder constituencies, including the community.” Help your organization start a pilot program, track data, and try to show a positive return on investment by using CHWs. Any evidence you can provide to show improved outcomes and/or cost savings will help get the ball rolling on long-term changes. An inpatient COPD care team only has so many members to go around, and at times, it can feel like your team is stretched far too thin. By partnering with community health workers, you can improve your quality of care and bring benefits to both your patients and your organization. Not only will you extend the reach of your COPD care team, but by boosting patient satisfaction and reducing COPD readmissions, you’ll be able to save your institution money, too.
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Further reading
COPD insider
References 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5269544/ 2. https://www.aamc.org/download/478860/data/communityhealthworkersanunderusedresourcerediscovered.pdf 3. https://nachw.org/wp-content/uploads/2018/10/NACHW_CHW-Definition.pdf?189db0&189db0 4. https://www.ghdonline.org/uploads/Rosenthal_2010_HlthAff.pdf 5. https://www.ncbi.nlm.nih.gov/pubmed/24515422 6. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Health Educators and Community Health Workers, on the Internet at https://www.bls.gov/ooh/community-and-social-service/health-educators.htm (visited February 25, 2019). 7. https://www.ncbi.nlm.nih.gov/pubmed/16520499
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