By Kirstin Q. Siemering, DrPH
In these last days of summer, Dave Kindig has quit town to go fishing. But out in the stream, his thoughts are still focused on improving population health. Lately we’ve been thinking about how to effectively bring attention to recent and relevant scientific publications in a way that’s interesting and appealing to people who aren’t necessarily academics. Your ideas and suggestions for how to do this are most welcome. Please send us an email or comment below and tell us what you think!
Speaking of literature, E. Lee Rosenthal and colleagues’ article Community Health Workers: Part of the Solution recently came across our desks. It appeared in the July issue of Health Affairs and brings attention to a topic that deserves attention in light of the recent achievements in healthcare reform.
Those of you not very familiar with Community Health Workers (CHWs) should know that they are extremely diverse and therefore not so easily defined. While many have a role in healthcare delivery (such as in health education, case management, interpreting and patient advocates), they also engage in activities that broadly support community health (such as outreach, organizing, capacity building, and even research). CHWs are often recruited and hired on the basis of their relationships to and knowledge of underserved communities rather than their having specific health-related expertise or credentials.
One reason for the growing spotlight on CHWs is their potential to control costs while improving outcomes. CHWs are just one example of a larger trend towards decentralization that includes primary care providers doing specialty work in outpatient clinics, nurse practitioners based in retail clinics, and home-based diabetes self management.
But unlike most health professionals, CHWs have no universally accepted education or training program to formalize and legitimize their role. Training requirements vary from state to state and range from on-the-job training to very structured, state-supported credentialing programs.
The American Public Health Association’s position statement in support of CHWs points to research demonstrating CHWs’ effectiveness in improving healthcare access, quality, and outcomes. However, the wide range of CHW preparation, roles and activities makes evaluation of CHWs very difficult. We still have much to learn about their potential to improve the lives of underserved communities and to make public programs more effective.
The Patient Protection and Affordable Care Act of 2010 will add to our understanding by supporting the implementation and evaluation of CHW programs. Over $4 million is being made available in 2010 for Patient Navigator Outreach and Chronic Disease Prevention Demonstration projects (with additional annual allocations through 2014). Additional funds will likely be made available through other federal funding mechanisms, including Grants to Promote Positive Health Behaviors and Outcomes Community Transformation Grants.
The Health Affairs article noted above highlights the work of two states that have led the way on CHW policy issues. Both Massachusetts and Minnesota have implemented policies to facilitate utilization of CHWs (e.g., in Minnesota CHW services are reimbursable under Medicaid). CHW advocates have identified the following policy priorities: sustainable financing, workforce development resources, occupational regulation, and guidelines for common research and evaluation measures.
CHWs could turn out to be an important piece in solving our healthcare and community health puzzle. Time will tell, given sufficient resources to develop and test innovative and resourceful policy and practice approaches.
Kirstin Q. Siemering DrPH is a researcher with the University of Wisconsin Population Health Institute.
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