200207 Integration of community health workers in community-based asthma interventions: Challenges and opportunities

Monday, November 9, 2009

Lucia Rojas Smith, DrPH, MPH , RTI International, Washington, DC
Meera Viswanathan, PhD , Health Services and Economic Research, RTI International, Research Triangle Park, NC
Floyd J. Malveaux, MD , Merck Childhood Asthma Network, Washington, DC
Asthma is a significant public health problem in the United States among children. It is the third-ranking cause of hospitalization among children younger than 15 years of age (Popovic, 2001).

The Merck Childhood Asthma Network (MCAN) funds community-based interventions for children with moderate to severe asthma in Chicago, Los Angeles, New York, Philadelphia, and Puerto Rico. Central to all five sites is care coordination with home visits by trained Community Health Workers (CHWs).

A qualitative evaluation of the MCAN projects identified factors that impacted the effectiveness and sustainability of CHWs in community based programs. Two key factors were the CHW's organizational home and ties to the community. CHWs based in clinical settings as part of an “Asthma Team” reported having fewer challenges to establishing rapport with providers and coordinating asthma care than those CHWs based in community based organizations. However, the latter reported greater capacity for community engagement and trust building. No single model of CHW integration appeared to be best overall. Effective CHW care coordination was contextually driven and addressed specific gaps in the local healthcare system.

A significant barrier to sustaining CHW care coordination is the paucity of evidence demonstrating cost effectiveness. Additional studies that measure the impact of CHW care coordination on health outcomes and health care costs will be needed to further engage key stakeholders such as insurers and providers.

Popovic JC. National hospital discharge survey: annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 2001;13(151):21, Table 10.

Learning Objectives:
1. Describe the organizational and contextual factors that facilitate the effectiveness of CHWs in community-based settings; 2. Describe the challenges and opportunities posed by the use of CHWs in community-based asthma interventions. 3. Describe the implications of the findings for asthma promotion planning and development in vulnerable communities.

Keywords: Asthma, Community Health Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been one of the principal investigators of the work being presented
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.