Filipino American Cardiovascular Health SummitJuly 9, 2011

Rhodora Ursua, MPHProject Director

Community Forum

Community Health Needs AssessmentOutreach

Feb 2004 April 2004 Summer 2004 April 2005

Sep 2005

Burgeoning literature demonstrating CHW effectiveness across many different conditions

CHWs address social determinants of health Large workforce - 11,000 in NYS - 120,000 nationally Patient Protection and Affordable Care Act

• Several elements of the federal health reform law can be facilitated through strong CHW participation

• Increase access - Improve quality – Lower costs Patient-Centered Medical Homes, ACO, Health

Homes• CHWs play important role in coordinating care

and helping people manage care

Frontline public health professionals Trusted members of the communities they

serve Shared life experiences with population

served Peer relationships – shared power Agents for change – micro and macro level Empowerment approach to interactions

29 elements identified Required further analysis – Statewide Market Survey

of 226 CHWs and 44 CHW Employers Focus groups, key informant interviews, Community Participatory Ranking (CBPR) Elements fall into three domains

Skills•Outreach/Organizing•Supportive counseling•Adult learning•Behavior change•Advocacy•Observation/Feedback•Env. assessment•Treatment adherence•Health literacy

Qualities•Trustworthy•Community connection•Non-judgmental•Resourcefulness•Creative•Empathic•Peer relationships•Shared experiences

Roles (Scope of Practice)

•Health promotion & coaching•Home-based support•Outreach/Mobilization•Community/Cultural Liaison•Case management•System navigation•Participatory research

Liaisons between communities and health and social service systems• Improve access to health care resources• Improve the quality and cultural appropriateness of

service delivery• Help people integrate disease prevention and

management regimens into their daily life • Organize communities to improve environmental,

physical and social wellbeing• Negotiate cultural & linguistic barriers to health• Help people become active participants in their health

Build community by combating social isolation and exclusion• Community organizing and empowerment

Outreach/Community Mobilizing Strong interpersonal skills Multi-cultural /Bilingual skills Advocacy skills Group facilitation Information exchange

Case Management/Care Coord. Supportive Counseling Goal Setting and Planning Time Management Service Coordination

Home-based Support Safety procedures Environmental assessment Observation and documentation

Health Promotion & Coaching Modeling behavior change Topic specific health care knowledge Chronic disease mgmt framework Adult learning methods

System Navigation Patient navigation Interpretation and Translation Computer skills Ability to access information

Community/Cultural Liaison Community organizing Community advocacy Translation and interpretation

Participatory Research Facilitating translational research Interviewing Documentation

Faith-based organizations/ Health professional associations

Businesses Workers

Apartments Church Events

Health promotion

Link to health providers

Monitor blood pressure

“We have strong connections to the community so we are able to influence people on how to be healthy.  Oftentimes when I do home visits, the participants tell me how thankful they are.  They never thought there would be someone that would go out of their way to visit them and show concern for their health and take

their blood pressure.” –AsPIRE CHW

Data collectionTraining new CHWs

CPR training for household workers from Philippines Nurses Association

•Individual level (i.e. advocate for patient’s needs at physician visits)

•Systems level (i.e. advocate for streamlined referral systems with hospital administrators; public hearings to inform legislators of challenges community faces and recommended solutions)

• Increased access and quality of services• Improved health outcomes• Reduced/eliminated persistent inequities in

health outcomes • Increased social capital & community

connectedness• Promote healthier communities and individuals• Lowered health care costs

fewer resource-intensive ED visits Fewer hospitalizations & re-admissions Increased prevention and use of primary care

Received Allocated intervention

Did not received allocated intervention

-11mmHg Systolic -3mmHg Systolic

-7mmHg Diastolic Diastolic Remained the same

Measured from baseline to 4th months. The differences in the means were significant at p<0.05

All individuals who received allocated intervention exhibited controlled blood pressure at the 4th month survey

32% of those who did not received allocated intervention exhibited uncontrolled hypertension

Received Allocated intervention

Did not received allocated intervention

57% to 86% No Change

Those who never forgot to refill their antihypertensive prescriptions from Baseline to 4th Month

Received Allocated intervention

Did not received allocated intervention

Slight increase from 50% to 53%

No Change

Those who set their appointment before leaving the Doctor’s office

Measured from baseline to 4th months.

Increased access• health insurance coverage increased & more consistent for children

(RCT in Boston)

Lower costs• 38% fewer ED visits• 30% fewer hospitalizations• 27% reduced Medicaid expenses (diabetes) • average savings $2,245 per patient per year • savings of $80,000 to $90,000 per year per CHW(Baltimore)

Return on Investment • ROI of $2.28 per dollar invested (underserved men in Denver) • $7.00 per dollar invested (Denver Health pregnancy testing program)

Cost savings• Decreased per capita expenses 97% in an asthma program (Hawaii)• $24 million over 9 years in Georgia private corp.

Private/Corporate• Improved enrollment and retention (automatic enrollment)• Improved customer satisfaction (QAAR scores)• Improved case-finding (pregnancy & chronic diseases)• ROI (up to 7.0/1.0), Cost Savings ($80,000.00 per CHW/year)

Medicaid Part 1115 Waiver• NYS Maternal Child Health Programs

Team Integration• CHWs as members of reimbursable care teams• PCMH & ACO, Health Homes, Insurance Exchanges

Direct Medicaid/Medicare reimbursement• CHWs as Medicaid/Medicare providers• Supervision

CHWs are valuable in bridging gaps. CHWs help build self-sustaining organizations. CHWs aim to enhance the quality of life through

increasing communities’ self-reliance and confidence through community empowerment as a result of mobilizing fellows with common goals.

CHWs can advocate the implementation of healthcare acts to accommodate the needs of Asian Americans by participating in legislative visits.

CHWs provide a voice for the unjust treatment of certain communities or individuals.

This presentation was made possible by Grant Number R24 MD001786 from NIMHD and its

contents are solely the responsibility of the authors and do not necessarily represent the

official views of the NIMHD.

THANK YOU!

Rhodora Ursua, MPH, Director, Project AsPIRE212-263-3776

rhodora.ursua@nyumc.org

Center for the Study of Asian American HealthNew York University School of Medicine

550 First Ave, VZN Suite 726New York, NY 10016

www.med.nyu.edu/csaah