Success with CHWs Asthma

Improve outcomes

schoolkidsIncreasingly, Community Health Workers (CHWs) are being hired by hospitals, clinic systems, and local public health agencies to strengthen team-based services to patients and families. CHWs reduce demand on overburdened providers by promoting healthy behaviors and helping patients understand how to access and use care appropriately. 

For example, in one recent clinical trial, CHWs worked with patients to create individualized action plans for achieving patients’ stated goals for post-hospital recovery. The CHWs provided support tailored to patient goals for a minimum of two weeks to determine whether a tailored community health worker (CHW) intervention would improve posthospital outcomes among low-SES patients. As reported in JAMA Internal Medicine, the trial showed that patient-centered CHW intervention improves access to primary care and quality of discharge while controlling recurrent readmissions in a high-risk population.

Another example of the benefit of CHWs is found in Seattle and Boston, where CHW interventions improve childhood asthma in low-income neighborhoods, reducing costly hospital admissions.  In those cities, specially trained CHWs conduct home visits to reinforce provider messages about asthma control; identify and address family needs; and provide home interventions.

More evidence can be found in A Randomized Controlled Trial of Asthma Self-management Support Comparing Clinic-Based Nurses and In-Home Community Health Workers, which describes the Seattle–King County Healthy Homes II Project. It concludes that for asthmatic children living in low-income, multi-ethnic communities, home visits by community health workers (CHWs) coupled with  in-clinic support from asthma nurses further increases the number of symptom-free days and also  improves quality of life for their caregivers.

Published in the Journal of Asthma, Community Health Workers and Environmental Interventions for Children with Asthma: A Systematic Review, provides an overview of CHW-delivered, home-based environmental interventions for pediatric asthma. In brief, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use.

And in a study conducted from 2011-2013, in which more than 750 families of children with asthma received education and support from CHWs, the number of referrals to the care coordination program increased 7-fold, as outlined in, The Impact of Integrating Community Health Workers into the Patient-centered Medical Home.

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Monica Aidoo-Abrahams

CHWs work with the asthma care team to see to it that patients make it to asthma appointments when they are due. If they fail, we call and get them rescheduled; we see to it that they get needed asthma supplies. We also call patients to come in for their flu shots on time and that helps to keep their asthma under better control.

CHWs contribute to improved pediatric asthma scores by keeping up with patients’ appointments, their medication and supplies. We work with the team to update patients’ record. And we help decide who has to come in and who the team can call and interview to help put in the right numbers. — Monica Aidoo-Abrahams, CHW, Pediatric Clinic, Hennepin County Medical Clinic

The power of home visits in improving outcomes

The Guide to Community Preventive Services

This report recommends home-based education and interventions to reduce home environmental triggers of asthma, as well as asthma education and social supports to improve outcomes for children with asthma. Moreover, it endorses the CHW role in carrying out these interventions. Review the findings.