Community Health Workers as Population Health Solutions: The Case of Asthma Chicago Asthma Consortium Helen Margellos-Anast, MPH Director, Community Health Innovations May 10, 2018
Disclosure Statement • I have no relevant disclosures
Presentation Outline • Setting • Problem • Solution • Scaling, Integration and Expansion of CHW Model – Asthma CarePartners – CROWD • Discussion
The Setting
Chicago: An Urban Health Challenge • Roughly 3 million persons ~ 1/3 Black ~ 1/3 Hispanic ~ 1/3 White • Low median household income= $46,877 • Among most segregated US cities • Poverty concentrated on the west and south sides Figure credit: Healthy Chicago 2.0
Sinai Health System • Mount Sinai Hospital Hospital Care • Holy Cross Hospital • Schwab Rehabilitation Hospital • Sinai Children’s Hospital Ambulatory • Sinai Medical Group Care Community • Sinai Community Institute Services Research and • Sinai Urban Health Institute Evaluation
Sinai Urban Health Institute: Who We Are • Leaders in development, implementation and evaluation of innovative approaches to population health • Committed to promoting health via – Community partnership – Data-driven research – Innovative health interventions • Holistic in our approach, recognizing health that extends beyond hospital walls – We meet people where they are
Sinai Urban Health Institute: Our Model All communities thriving in health
The Problem
Urban Health Care Situation 1. Serious mortality and health disparities persist in Chicago’s communities and nationally 2. Disparities relate to race, education, income and other adverse social and environmental determinants 3. Limited access to quality care , barriers navigating health systems , and unmet health and social needs affect well-being 4. Health systems are affected financially by: – high readmission rates – lack of preventive care – low patient engagement – overuse of emergency health services
Our Local Situation: 16-Year Life Expectancy Gap Across L Stops Reference: West Side Total Health Collaborative, What We Heard. Coming Together to Improve Health and Wellness on the West Side, July 2017 Update, p 4.
Sinai Community Health Survey 2.0 General Health Status Health Outcomes Quality of Life Diet & Exercise Drug, Alcohol, and Tobacco Use Health Behaviors Intimate Partner Violence (30%) Sleep Access to Care Health Care Use Clinical Care Insurance Status (20%) Perceptions of Care Vaccinations Health Factors Criminal Justice Experiences Social & Discrimination Economic Factors Food Insecurity Immigration & Acculturation (40%) Religion Physical Neighborhood Safety Housing & Homelessness Environment Policies & Programs Social Cohesion (10%) Full topic list available at www.sinaisurvey.org Adapted County Health Rankings model
Low Income Associated with Poor Health in South and West Sides of Chicago Chicago US $46,877 $51,914 Norwood Park $75,281 W. West Town* $44,108 Gage Park $38,001 Hermosa $37,981 Humboldt Park $35,935 Chicago Lawn $31,406 South Lawndale $30,248 West Englewood $25,625 North Lawndale $21,763
Sinai Asthma Initiatives: Overview Why Asthma? 18
Asthma in Chicago Asthma Inpatient Hospital Discharges, <18 Years old, Chicago, 2014 50 43.2 40 27* 30 17.1 16.2 20 10.5 10 0 Chicago Total Hispanic or Non-Hispanic Non-Hispanic Non-Hispanic Latino Asian or Pacific African White Islander American or Black *Rate per 10,000
In three communities, asthma affects 1 in 5 adults
Sinai Survey 2.0: Takeaways • Important differences in community health status Health needs to be tackled neighborhood by neighborhood • Alarming health inequities continue to exist and demand attention Helping all individuals attain optimal health requires understanding of social factors that impact health
The Solution
Community Health Workers Frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served American Public Health Association CHW Section: http://apha.org/apha-communities/member-sections/community-health-workers
Some other names… • CASE MANAGER • COMMUNITY HEALTH • OUTREACH WORKER • COACH REPRESENTATIVE • PARENT EDUCATOR • COMMUNITY ADVOCATE • COMMUNITY HEALTH • PARENT SUPPORT • COMMUNITY CARE WORKER PARTNER COORDINATOR • COMMUNITY ORGANIZER • PATIENT ADVOCATE • COMMUNITY • COMMUNITY WORKER • PATIENT EDUCATOR ENGAGEMENT SPECIALIST • COMPAÑEROS EN SALUD • PATIENT NAVIGATOR • COMMUNITY HEALTH • FAMILY HEALTH • PEER COUNSELOR ADVISOR ADVOCATE • PEER HEALTH ADVISORY • COMMUNITY HEALTH • HEALTH WORKER • PEER LEADER ADVOCATE • HELPER/SUPPORTER • PEER SUPPORT • COMMUNITY HEALTH • HOME VISITOR/SUPPORT SPECIALIST AIDE WORKER • PEER/TEEN EDUCATOR • COMMUNITY HEALTH • LAY HEALTH ADVISOR • PROMOTOR(A) DE SALUD EDUCATOR • LAY HEALTH EDUCATOR • PUBLIC HEALTH AIDE • COMMUNITY HEALTH • OUTREACH SPECIALIST • RESEARCHER PROMOTER
Why CHWs? • Research has proven effectiveness of CHWs in reducing costs, improving outcomes and increasing client engagement and satisfaction • CHWs address health and social inequities, bridging gap between communities/individuals and service providers • CHWs increase knowledge and self-sufficiency through outreach, navigation, education, informal counseling, social support and advocacy
Sinai Community Health Initiatives: CHW Model “…It may be the very fact that CHWs are not ‘experts’ (i.e., that they most likely do not differ in terms of education, power, or social capital from their clients) that makes them most effective.” Arvey AR, Fernandez ME AJPH: 102 (9). • CHWs are agents of change who are hired from the target community – Knowledge of the community and passion to help others • Extensive multi-dimensional training that includes cultural humility, motivational interviewing, goal-setting, disease management, etc. • CHW interventions tailor to people’s health -related needs • Hire the right people, train them effectively, supervise them appropriately, and CHWs can be transformative
Sinai Asthma Initiatives: Overview • Sinai/SUHI has been testing CHW-led asthma interventions for nearly two decades • Rationale – High prevalence, morbidity and mortality in communities Sinai serves • Goals: – (1) decrease asthma-related morbidity and mortality; – (2) improve quality of life; – (3) decrease costs • CHW-led, intense, individualized, home-based – 3-12 months – Focus on improving medical management and reducing triggers
Sinai Asthma Initiatives: Building the Model Program/Study Name Population Years Funder Published Pediatric Asthma Children coming to ED, 2000- Michael Yes Intervention 1 hospitalized or seeing 2002 Reese Health pulmonologist Trust Pediatric Asthma African American children 2004- Illinois Dept. Yes Intervention 2 on west side 2006 of Pub. Hlth. Controlling Pediatric Children in 6 Illinois 2006- Illinois Dept. Yes (book Asthma through communities with high 2009 of Pub. Hlth. chapter) Collaboration & Educ. asthma hosp. rates Healthy Home, Healthy Children on west side with 2008- CDC Yes (book Child poorly controlled asthma 2011 chapter) Helping Children Breathe Children with poorly 2011- HUD Yes & Thrive in Chicago Public controlled asthma in 6 2013 Housing CHA developments
Sinai Asthma Initiatives: Building the Model Program/Study Name Population Years Funder Published Helping Chicago’s Adults with poorly 2013- HUD Yes (methods) Westside Adults Breathe & controlled asthma on the 2016 Thrive west and southwest side HCWABT – Long-term Adults with poorly 2015- HUD n/a effectiveness controlled asthma on the 2018 west and southwest side Asthma CarePartners Children and adults with 2011- Various No poorly controlled asthma, prese referred by health plan nt CHICAGO Plan Children 5-11 years 2014- PCORI Yes (results visiting 6 area EDs for 2017 forthcoming) asthma
Sinai Asthma Initiatives Four of the interventions paved way for creation of Asthma CarePartners (ACP) program: – Pediatric Asthma Initiative 1: 2000-02 – Pediatric Asthma Initiative 2: 2004-06 – Controlling Pediatric Asthma Through Collaboration and Education: 2006-08 – Healthy Home, Healthy Child: Westside Children’s Asthma Partnership 2008-11 • Grant funded and all rigorously evaluated • Consistent and powerful outcomes • ACP and studies post-2011 further substantiate effectiveness findings
Asthma CarePartners: Care Management Collaboration • Contractual partnerships to embed CHW model into healthcare delivery • Serves patients/members (children and adults) with moderate to severe uncontrolled asthma • CHW-centered home visit intervention
Asthma CarePartners: Care Management Collaboration • Multiple home visits; 3-12 month intervention period • Asthma education, home environmental assessments, medical device training • Development and teaching of Asthma Action Plan • Regular assessments of asthma control via ACT • Consistent and thorough evaluation
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