A community health worker program to improve chronic disease outcomes at a community health center

Throughout the world, community health workers (CHWs) are a critical component of the health care system, serving as health educators, advocates, and links to medical and public health systems, and providers of preventive and acute care. The attributes CHWs bring to infra-structure-poor areas of the world apply to the developed world as well, particularly in settings that serve vulnerable and disadvantaged populations. Brookside Community Health Center serves a largely Latino community in Boston. Community members suffer from higher rates and poorer outcomes from diabetes and asthma than their non-Hispanic-white counterparts. Community members experience specific challenges to optimal health due to cultural and language barriers, immigrant and legal status, education, literacy, poverty, and residence in violent and resource-poor communities, despite the many successes community health centers have demonstrated in reducing barriers and providing culturally appropriate care. In 2008, through funding provided by the Massachusetts Department of Public Health, we developed a program to incorporate a CHW into our multi-disciplinary model of care for type 2 diabetes and asthma. Through intensive home- and health-center visits, client- and family- centered health education, advocacy, and case-management, the CHW identifies and addresses patient-specific and systemic factors in order to improve health outcomes. Patient and provider satisfaction are enhanced by adding a team member who is flexible and responsive to the diversity of patients' circumstances, and not bound by standard metrics of “productivity.” We will describe program development and implementation, and the impact of the CHW on disease outcomes and broader measures of quality and satisfaction.