April marks the start of National Minority Health month, a time to call attention to the disparities in health and healthcare outcomes that persist among racial and ethnic minorities. The mission to reduce such disparities, as well as those in other populations, is at the heart of PCORI’s Addressing Disparities program, not just this month but every month.
Although the country has made significant strides in recent years to close this gap in health and health care, we still have a long way to go. Community Health Workers (CHWs), who serve as a link between the patient and the healthcare system, are being increasingly used in many settings to address the disparity. To gather evidence about the value of this approach, PCORI is funding a variety of comparative clinical effectiveness research (CER) projects focused on the use of CHWs in providing care to racial and ethnic minorities.
Who are Community Healthcare Workers?
CHWs are community members who work almost exclusively in community settings and serve as connectors between healthcare consumers and providers to promote health among groups that have traditionally lacked access to adequate care, according to the US Centers for Disease Control and Prevention. These individuals have a deep understanding of the communities they serve. By sharing personal, cultural, linguistic, and other characteristics—sometimes including a medical condition—with those they serve, CHWs have the potential to assist patients at risk of experiencing healthcare disparities.
The use of community members in health care is rapidly evolving. Five states now provide a CHW certification program, and seven states have laws authorizing Medicaid reimbursement for CHW services. Across various settings, titles for this position differ. CHWs, community health representatives, promotoras, peer navigators, and patient navigators all have similar functions, and these designations are often used interchangeably.
Currently, almost half of the projects funded by PCORI’s Addressing Disparities program include interventions containing a CHW component, and almost all of those projects target racial and ethnic minority groups.
How Can CHWs Improve the Health of Racial and Ethnic Minorities?
Here are some examples of PCORI-funded projects related to use of CHWs:
- A project based at Boston Medical Center is investigating whether patient navigators lead to more timely care delivery and improve health outcomes by coordinating cancer care services and helping patients address barriers. For hospital accreditation, the American College of Surgeons’ Commission on Cancer requires patient navigators as a part of usual care for cancer patients. The research team will build on this established program by integrating legal support into the services offered by the patient navigators to African American and Latino cancer patients. Patient navigators will receive training on how to assess needs such as unsafe housing or unlawful job termination and then tap into resources to address them.
- A University of Pennsylvania study features a comprehensive CHW model now used in hospital settings that will be adapted for use in primary care settings with patients having multiple chronic conditions. These CHWs receive extensive training in a month-long college-accredited course. The investigators are examining whether these CHWs can help a group of patients, most of whom are African Americans, stay on task with their health goals and participate in shared decision making with their primary care physicians. The CHWs will provide patients with tailored social support and help them navigate the health system. The objective is to have patients participate more in their own health care, receive better-quality care, feel healthier, improve their mental health, achieve better chronic disease control, and require fewer hospitalizations.
- The goal of another study, at Temple University, is to alleviate gaps in health outcomes amongst Asian Americans suffering from chronic hepatitis B virus (HBV) infection. The team will use patient navigators, in conjunction with mobile phone text messaging, to increase adherence to HBV monitoring, which is crucial for identifying early signs of liver damage. The patient navigators, who will be representatives of the Korean, Chinese, and Vietnamese cultures of the patients they are serving, will receive a two-day HBV training. Navigators will hold three educational sessions with each patient and serve as a liaison between the patient and the clinic.
Much remains unknown about the effectiveness of CHWs in easing access to care and garnering better health outcomes. We are evaluating outcomes, especially patient-centered outcomes, of our studies to see how they are filling gaps in current knowledge and to determine PCORI’s role in addressing the gaps that remain. We hope to ultimately provide clear guidance on how CHWs can best be used to reduce disparities amongst racial and ethnic minorities.