Metrics for Evaluating Community Health Workers: Challenges and Opportunities

Introduction: Community Health Workers seem to have great potential to reduce disparities and their use has been rapidly increasing. However, current research is not fully conclusive on CHWs' effectiveness. Few studies have integrated evaluations with common metrics, especially looking beyond narrow clinical measures and/or subpopulations. Objectives: This study sought to determine 1) What is the current state of knowledge about metrics used in evaluating community health workers 2) What new metrics would be beneficial in evaluating CHWs and 3) What are the challenges in developing these new metrics. Methods: A review of the literature and current practices was performed. Intensive interviews were conducted with CHWs for three programs developed to target diabetes or hypertension for Asian-Americans in NYC. These programs used a CBPR approach in collaboration between NYU School of Medicine and community partners in NYC. Measures were made consistent across interventions and metrics developed to evaluate outcomes; metrics were related to the Community Health Worker theoretical change mechanism model developed. Measures involving long-term impact such as finding or using a medical home as well as short-term utilization and clinical measures were developed or enhanced. Results/Conclusion: Current metrics are not fully adequate to capture all aspects of the critical roles of Community Health Workers and need to demonstrate their impact in the long-term as well as short-term across multiple interventions and populations. Standardizing and/or creating new metrics and developing a framework incorporating what is unique to CHWs would of great value in improving the health of vulnerable populations.