Project Summary

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

  • Regional Medicaid (1115) waiver partners
  • American Lung Association
  • Community Health Plan of Washington
  • UnitedHealthcare
  • Coordinated Care
  • Washington State Health Care Authority
  • Washington State Department of Health CHW Program

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.

For more information about these materials, please contact the project team at [email protected] or [email protected].

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.

Project Achievements

  • Developed a comprehensive package of resources for CHWs who care for patients with asthma, including:
    • 10 interactive online training modules
    • Curricula for case-based in-person or virtual trainings
    • Curricula for CHW supervisor and program manager trainings
    • Protocols to support phone- and video-based asthma home visits
    • Patient educational videos and resources
  • Trained 86 CHWs, CHW supervisors, and CHW program managers
  • Provided CHW asthma home visits to 155 low-income patients with poorly controlled asthma

Implementation Strategies

  • Adapted the CHW asthma home visit program by modifying protocols to work with sites’ existing resources and workflows, transferring roles from research staff to site staff, and creating processes and materials to support phone- and video-based visits.
  • Provided sites with tools to support implementation, including supervisor checklists.
  • Provided educational materials to patients, as handouts and videos.
  • Trained CHWs, CHW supervisors, and CHW program managers to deliver the CHW asthma home visit program, including shadowing opportunities.
  • Used a phased implementation approach.
  • Created a learning collaborative.
  • Identified and prepared champions at sites.
  • Provided technical assistance to CHWs and CHW organizations, including practice facilitation and consultation.

Evaluation Outcomes*

To document implementation:

  • Number of Medicaid patients with severe, uncontrolled asthma receiving CHW visits
  • Fidelity to intervention protocol
  • Adaptations to program delivery
  • Implementation facilitators and barriers

To assess healthcare and health outcomes:

  • New referral pathways established with other care providers
  • Self-management goal setting and goals met
  • Symptom-free days
  • Rescue medication use
  • Missed school or work
  • Self-rated asthma control
  • Urgent care use (hospitalizations, ER visits)

*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.

Project Information

Bradley Kramer, MPA
James Stout, MD, MPH
Public Health - Seattle & King County
Disseminating Community Health Worker Training from the Guidelines to Practice (G2P) Project

Key Dates

November 2018
September 2021

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


Project Status
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
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Last updated: April 4, 2023