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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
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