COMMUNITY HEALTH WORKERS AND CHRONIC DISEASE PREVENTION HEALTH - PowerPoint PPT Presentation

COMMUNITY HEALTH WORKERS AND CHRONIC DISEASE PREVENTION

HEALTH � “ State of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” World Health Organiza?on

Elimina?ng health dispari?es con?nues to be a priority in the U.S. as first outlined in the Department of Health and Human Services, Health People 2000 report, and later reaffirmed in the Health People 2020 report

SOCIAL DETERMINANTS OF HEALTH The condi?ons in which people are born, grow, live, work, and age, including the health system. These circumstances are shaped by the distribu?on of money, power and resources at global, na?onal and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequi?es – the unfair and avoidable difference in health status seen within and between countries” World Health Organiza?on - WHO �

2014 NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT � ▪ Dispari?es in quality of care remained prevalent and few dispari?es were eliminated ▪ Only half of people with high blood pressure have it controlled ▪ Increase in admission for diabetes pa?ents ▪ People with Asthma who are taking preven?ve medica?on daily/almost daily “Dispari)es in quality and outcomes by income, race, and ethnicity are large and persistent”

LET’S GET HEALTHY CALIFORNIA 2012 ▪ Experiencing unprecedented levels in chronic disease ▪ Alarming high rates of obesity and resul?ng condi?ons such as diabetes, may reverse the progress in increasing life expectancy made over the last 100 years ▪ For the first ?me ever, this genera?on of children may not live as long as their parents ▪ Our health care delivery system is fragmented, uncoordinated, and financially unsustainable ▪ Healthcare costs con?nue to surpass the rate of infla?on

LET’S GET HEALTHY CALIFORNIA 2012 ▪ Maintaining a healthy popula?on is key to California’s future prosperity ▪ Managing of chronic disease required a range of supports outside of the clinical seYng ▪ California is being tasked to reduce rates of: ▪ Adults with high cholesterol who are managing condi?on ▪ Adults with hypertension/controlled HBP ▪ Prevalence of diabetes ▪ Rates of obesity

CHW MODEL HELPS DECREASE CHRONIC DISEASE RATES

COMMUNITY HEALTH WORKER MODEL ▪ Emergent evidence points to the effec?veness of the CHW model in addressing chronic disease. ▪ Our popula?on is aging and suffering from higher rates of chronic disease. ▪ Health care is costly and expenditures con?nue to rise. ▪ Growing movement among health care organiza?ons to adopt the CHW model to address preven?on and chronic disease. ▪ Evidence points to the CHW model as an effec?ve strategy to engage pa?ent, increase preven?on and compliance, and decrease chronic disease rates.

A CHW IS A … .. “… frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trus)ng rela)onship enables the worker to serve as a liaison/ link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of ac)vi)es such as outreach, community educa)on, informal counseling, social support and advocacy.” The American Public Health Associa?on

THE CHW (PROMOTORA) MODEL § Peer educa?on model § Used to reach hard to serve popula?ons § Used to connect popula?ons to needed services “A Model for Building Healthy Communi?es” (The Promotor Model, The California Endowment 2011)

WHY THIS MODEL? ▪ It’s a public health model ▪ Removes barriers ▪ Culturally appropriate ▪ Linguis?cally appropriate ▪ Builds community capacity ▪ Empowers pa?ents/parents/community ▪ Improves community and popula3on health ▪ Addresses the three components of the triple Aim!

CHWS HAVE MANY TITLES ▪ Community Workers ▪ Promotores ▪ Case Manager ▪ Outreach Workers ▪ Enrollment Specialist ▪ Lay Workers ▪ Advocates ▪ Health Educators ▪ Parent Educators ▪ Peer Educators ▪ Health Coaches ▪ Parent Liaisons ▪ Many others ▪ Pa?ent Liaisons

HHS ACTION PLAN TO REDUCE RACIAL AND ETHNIC HEALTH DISPARITIES, APRIL 2011 Strategy II.B: ▪ Promote the use of community health workers and Promotores Ac3ons ▪ II.B.1 Increase the use of Promotores to promote par?cipa?on in health educa?on, behavioral health educa?on, preven?on, and health insurance programs

STATE INNOVATION PLAN GOALS ▪ Popula?on health improvements ▪ Community based interven?ons ▪ Reducing dispari?es “CHWs are a promising strategy to address these goals” Leveraging Community Health Workers within California’s State Innova?on Model July 2013

PROMOTORES/ CHWS Improve Address Popula?on the Triple Health Aim Decrease Health Dispari?es

CHW CONTRIBUTIONS TO THE TRIPLE AIM ▪ CHWs reduce costs through fewer hospitaliza?ons and emergency room visits ▪ Improve health by keeping pa?ents engaged and helping them adhere to their care plan in controlling chronic disease ▪ Improve quality of care by improving u?liza?on and reten?on in care Massachuseds Department of Public Health: Achieving the Triple Aim: Success with Community Health Worker 2015

CHW CONTRIBUTIONS TO THE TRIPLE AIM CHWs reduce costs -Studies showed net cost savings in CHW interven?ons Boston Children’s Hospital – Pediatric Asthma Management Program – Decrease of 68% in ED visits/ 84.8% in hospitaliza?ons CHWs improve health -Studies reveal significant posi?ve changes in chronic disease management Teams working with high risk pa?ents –Ajer 1 yr, pa?ents had sta?s?cally significant improvements (cholesterol, HBP, HbA1c, ) CHWs improve quality of care - CHWs provide educa?on, care coordina?on, and engage pa?ents Diabetes teams – Reduc?on in % of diabetes pa?ents not seen; and clinically significant drops in HbA1c levels Massachuseds Dept of Public Health: Achieving the Triple Aim: Success with Community Health Worker 2015

PENN UNIV HEALTH SYSTEM – IMPACT - CHWs visit pa?ents facing mul?ple chronic condi?ons and help them in naviga?ng the health care system - CHWs help address the “real life issues” (hunger, homelessness, transporta?on, etc) - Ini?ally inpa?ent now also outpa?ent - Results: Reduced readmission rates and beder outcomes - hdp://chw.upenn.edu/impact

TEAM BASED CARE “HEALTH CARE TEAMS”

TEAM-BASED CARE ▪ Team based care is an emerging tool that offers the opportunity to improve health care in America and overcome the central challenges in health care today. ( Ins)tute of Medicine: Best Care at Lower Cost 2011) ▪ An approach to achieving beder health outcomes at lower costs through pa?ent-centered medical homes u?lizing team- based care . (J. Ambulatory Care: Community Health Workers Integra?on into the Health Care Team Accomplishes the Triple Aim in a Pa?ent Centered Medical Home: Findley, et al 2014) Comprehensive and coordinated care improves health outcomes

HEALTH CARE TEAMS ▪ Team-based care is “an opportunity for beder health care in America,” and is widely recognized as an essen?al tool for a more pa?ent-centered effec?ve health care delivery system. ▪ A team climate is associated with beder processes of care for pa?ents with diabetes and beder con?nuity of care, access to care, and pa?ent sa?sfac?on. ▪ Team members are all responsible for ensuring pa?ents receive both clinical and self-management services and support needed. ▪ The addi?on of key skills to the pa?ent care team has significantly improved outcomes in several chronic condi?ons.

TEAM BASED CARE In order for team based care to be effec?ve, it must include a comprehensive approach that addresses popula?on health. In recognizing the important role of the social determinants of health, health care approaches must center on health and not illness, and must recognize that improving health goes beyond the clinical seEng .

PATIENT CARE TEAMS Effec?ve chronic disease preven?on relies on mul?disciplinary care teams ▪ Help pa?ents navigate the complexi?es of the health care system ▪ Wider range of skills and exper?se- coordinates disciplines ▪ Team members take responsibility for popula?on based interven?ons ▪ Team members complement the doctor in cri?cal care func?ons ▪ Pa?ents cared by a team have beder outcomes and improved clinical and health status ▪ CHWs have long played a crucial part in health care BMJ. The role of pa?ent care teams in chronic disease management. Wagner EH 2000

WHAT DO WE KNOW? • Beyond physical health Health Dispari?es • Health is geYng worse Health care teams + CHWs Health • Improve health Care = Beder Health outcomes Teams Outcomes • Improve health CHWs • Address the triple aim

CHWS AND / IN HEALTH CARE TEAMS!