Community ty Health Work rkers ( (CHWs) ) in Research Suppo - - PowerPoint PPT Presentation

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Community ty Health Work rkers ( (CHWs) ) in Research Suppo - - PowerPoint PPT Presentation

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Community ty Health Work rkers ( (CHWs) ) in Research Suppo porting P Patients wi with Asthma The Guidelines to Practi tice (G2P) ) Stu tudy Bradley Kramer and Maria Rodriguez Program Manager and Community Health Worker November

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Community ty Health Work rkers ( (CHWs) ) in Research Suppo porting P Patients wi with Asthma – The Guidelines to Practi tice (G2P) ) Stu tudy

Bradley Kramer and Maria Rodriguez

Program Manager and Community Health Worker November 1, 2018

#PCORI2018

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2 • November 1, 2018

Bradley Kramer and Maria Rodriguez

  • Have nothing to disclose.
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3 • November 1, 2018

Objectives

At the conclusion of this activity, the participant should be able to:

  • Understand the role of Community Health Workers in improving

the health impacts of asthma

  • Identify how members of the research team can build an

infrastructure of support of CHWs and intervention delivery

  • Explain where stakeholder engagement can support CHWs,

expand impact, and increase sustainability of effective interventions.

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4 • November 1, 2018

Acknowledgements

  • FQHC Clinic Partners:
  • Neighborcare Health
  • HealthPoint
  • Medicaid Managed Care Organizations
  • Molina of Washington
  • Community Health Plan of Washington
  • Investigators
  • CHWs
  • Michelle Di Miscio, Joyce McCraney, Safia Mohamed, and Maria Rodriguez

Funding: Research reported was funded through Patient-Centered Outcomes Research Institute (PCORI) AS-1307-05498 Kaiser Permanente of Washington: Community Health & Benefit

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5 • November 1, 2018

Build on past CHW work

  • Research Legacy going back to 1997 at the Health Dept.
  • 10+ Research studies comparing 270 – 660 participants
  • Over 4000 participants served
  • Materials and background: King County Asthma Program
  • http://www.kingcounty.gov/asthma
  • Many in the room too!
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6 • November 1, 2018

Home Intervention: Community Health Workers

  • Lay people from the community
  • Share culture, language and life

experiences with clients

  • Personal experience with asthma
  • Skilled at building trusting and

supportive relationships with clients

  • Bridge between community and service providers
  • Receive ongoing rigorous and standardized training
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7 • November 1, 2018

Core Asthma Service – CHW model

  • 3 home visits
  • Motivational Interviewing
  • Self-management
  • Cultural competence
  • Asthma knowledge

Topics

  • Medication adherence
  • Trigger reduction
  • Home remediation
  • Care coordination
  • Goal setting
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8 • November 1, 2018

CHW: Home Visits

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9 • November 1, 2018

CHW: Home Visits

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10 • November 1, 2018

CHW: Home Visits

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11 • November 1, 2018

New Research Design: Integrated System

Home

CHW Home Visits for self- management support

Plan

Enhanced Case Management ED and Hospitalization Notification Medication Monitoring

Clinic

EHR Enhancement Team and System Redesign Spirometry and Allergy Testing Staff Education

Common Asthma Management Plan Cross-Site Communication and Coordination

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12 • November 1, 2018

Guidelines to Practice (G2P)

  • 551 p

pati tients ts wi with u uncontrolled a asth thma

  • Age

ges 5 5-75 75 Randomi mizat ation:

  • CH

CHW vs

  • vs. N

. No CH CHW Non

  • n-Randomized

ed e elem emen ents:

  • 13 FQHC clin

linic ics in in 2 2 s systems

  • 4 Enhanced

ed a at t the s e start

  • f t

f the t e trial

  • 2 Med

edicaid h hea ealth th p plans

Home Visit Enhanced Clinic Enhanced Health Plan Systems Integration Home Visit Usual Clinic Enhanced Health Plan Enhanced Clinic Enhanced Health Plan Systems Integration Usual Clinic Enhanced Health Plan Patient Home Visit No Home Visit Enhanced Clinic/ Systems Integration No Enhanced Clinic/ No Systems Integration Enhanced Health Plan

I II III IV

Patient

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13 • November 1, 2018

Results: Preliminary

  • CHW intervention had significant results
  • “Enhanced Clinic” intervention had insignificant results
  • Non-Randomized, feasibility study
  • Results lean with some significance to show additional

impact when CHWs were integrated with enhanced clinics

  • Today, I will focus only on CHW findings and discuss their

role in research

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14 • November 1, 2018

Who Participated

Characteristics Total CHW Non-CHW N 551 273 278 Age % 5-17 47.0.% 46.5% 47.5% 18-75 53.0% 53.5% 52.5% Female % 63.0% 61.9% 64.0% Race/Ethnicity % Black 33.9% 31.1% 36.7% White 23.2% 22.7% 23.7% Other 15.1% 16.5% 13.7% Latino/Hispanic 27.8% 29.7% 25.9% Language % English 73.1% 74.4% 71.9% Spanish 19.2% 20.5% 18.0% Somali 7.6% 5.1% 10.1%

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15 • November 1, 2018

Results

CHW Intervention

  • Unadj. Mean

Adjusted difference CHW Non-CHW Coeff. p-value Primary Symptom free days 7.7 6.4 1.27 0.026 Asthma Control (ACT/cACT) 18.1 16.9 1.20 0.009 Quality of Life (AQLA/PAQLA) 5.4 5.1 0.39 0.000 Secondary Nocturnal wakening nights 2.5 3.8

  • 1.22

0.002 Urgent care utilization 1.1 1.7

  • 0.63

0.024 Rescue inhaler: β-agonist use 3.6 4.6

  • 0.92

0.024 Urgent oral steroid use 0.3 0.5

  • 0.14

0.046 Missed work/school days 0.6 1.1

  • 0.51

0.007

  • Unadj. Mean is the unadjusted mean for participants in the study group who completed the exit interview.

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16 • November 1, 2018

Results

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17 • November 1, 2018

Results

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18 • November 1, 2018

Supportive Research Team

Community Health Worker

Program Manager Nurse / Clinical Lead

Training Core: Motivational Interviewing Expert

Community Advisory Board Dept Admin / Peer Staff Program Coordinator Evaluation Core

Supervisory:

  • Program
  • Clinical – Nurse, Social worker, or Physician

Ongoing Professional Development:

  • Motivational Interviewing
  • Self-care

Evaluation Core:

  • Missing data and quality improvement

Other support:

  • Program Coordinators
  • Health Department supports
  • Partnerships and overall program advisory
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19 • November 1, 2018

Partnerships

Community Health Worker

Home Environment (BP) Primary Care Clinic (BP) Health Plan (Medicaid MCO) (BP) Child Care/ School Nurses (EP) Pharmacy (EP) Medical Legal/ Tenant Rights Orgs (EP) Weatherization (EP)

Basic Programming (BP) Expanded Programming (EP)

Basic:

  • Home Environment / Medical Adherence
  • Primary Care Team
  • Health Plan – Care Manager

Expanded:

  • Medical Legal Partnership or Tenants’ Rights
  • Weatherization – home improvements
  • Pharmacy
  • School / Child Care
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20 • November 1, 2018

Pursuing Sustainable Programming

  • Social Partnerships: Weatherization and Healthy Housing
  • Medicaid MCOs
  • Integrated Health System: Medicaid 1115 Waiver
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21 • November 1, 2018

Learn More

  • www.pcori.org
  • info@pcori.org
  • #PCORI2018
  • http://www.kingcounty.gov/asthma
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22 • November 1, 2018

Questions?

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23 • November 1, 2018

Thank You!

Bradley Kramer and Maria Rodriguez

Program Manager and Community Health Worker November 1, 2018