This implementation project is complete.
PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.
This PCORI-funded implementation project expanded a community health worker asthma home visit program to new regions in Washington State.
|Asthma is a health problem that can make it hard for people to breathe. More than 25 million adults and children in the United States have asthma. Removing or reducing triggers for asthma symptoms at patients’ homes, like pollen or dust, can help control symptoms.|
What was the goal of this implementation project?
Community health workers, or CHWs, are people from the local community who are trained to teach about health and link people with health care and social services. A PCORI-funded research study showed that a CHW asthma home visit program helped people ages 5–75 with uncontrolled asthma learn about and avoid triggers for their symptoms at home. Compared with people who didn’t receive the program, people who did had more days without asthma symptoms and fewer nights when they woke up because of asthma. They also missed fewer days of work or school and had fewer emergency room, or ER, visits and improved quality of life.
This project expanded the CHW program, which was developed in Seattle and greater King County, to other communities across Washington State to make the program part of standard asthma care.
What did this project do?
The project team put the CHW program in place in four communities with diverse needs in Washington State. The team worked with three regional healthcare organizations and a federally qualified health center within these communities to:
- Develop online tutorials for CHWs who care for patients with asthma
- Develop in-person and virtual training sessions for CHWs, supervisors, and program managers
The project team held online and in-person meetings each month to:
- Train CHWs to provide asthma education, help patients set goals to improve their health, and communicate with children and adults about their health concerns
- Train CHW program managers to prepare their organizations, support and manage CHWs, and work with clinical partners
The project team trained CHWs and CHW managers. Then, the team adapted the program based on feedback from trainees.
Shortly after the launch of the CHW program in January 2020, CHWs had to stop in-person home visits due to COVID-19 social distancing guidelines. To continue the program during the pandemic, the project team adapted their materials for use during phone- and video-based home visits. The team also developed asthma education videos that CHWs could share with patients during remote or in-person home visits, or that patients could watch on YouTube.
The project team provided one-on-one support to CHWs and CHW organizations throughout the project. The team monitored progress and helped tailor the program for each community.
What was the impact of this project?
During the project, 64 CHWs and 22 CHW supervisors in counties across Washington State completed the CHW asthma home visit training program, including in rural and frontier areas.
Once trained, however, CHWs faced COVID-19-related challenges in reaching their patients with asthma. For example, CHWs had trouble signing patients up for home-based care. Also, some health departments and clinics shifted their priorities. Many CHWs had to take on new work, like contact tracing for COVID-19. As a result, the program reached fewer patients with asthma than intended during this project.
Forms completed by trained CHWs showed that:
- 10 of the 64 trained CHWs provided asthma education visits during the project.
- 155 people with uncontrolled asthma received an asthma visit from a trained CHW.
- Most visits (70 percent) occurred by phone.
The training program was well accepted by participants. The project didn’t have sufficient data to assess the impact on the patients served as planned.
All trainees in the project will continue to use the program. Future sites can use the training materials for CHWs, supervisors, and program managers developed through this project to put the asthma home visit program in place. The project team has made these materials publicly available.
More about this implementation project:
Stakeholders Involved in This Project
Publicly Accessible Project Materials
CHW organizations and public health departments or agencies interested in implementing this program can use the training protocols and resources below, which are freely available through the Seattle & King County Public Health Department.
The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.
To document implementation:
To assess healthcare and health outcomes:
*This project did not have sufficient data to complete its planned evaluation.
COVID-19-Related Project Activities
PCORI supplemental funding supported project activities to address needs evolving or emerging in the context of the COVID-19 public health crisis.
The COVID-19 pandemic created new challenges for community health workers (CHWs) in delivering home visits. Also, patients faced new concerns, which CHWs often needed to address before discussing asthma management.
With supplemental funding, the project team adapted protocols to support CHW phone and video visits, as well as home visits. The team also developed education videos to help patients manage asthma and COVID risks during the pandemic. The videos were available in English or Spanish and could be viewed on a smartphone. The project team trained the CHWs and their supervisors on using the updated materials to support their patients.
Related Journal Citations
Study Registration Information
Initial PCORI-Funded Research Study
This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Examining Home Visits from Community Health Workers to Help Patients Manage Asthma Symptoms