Community health workers help reduce unnecessary hospital visits

Community health workers can reduce hospital visits by helping patients better manage diabetes, lower their BP and cholesterol, and stay up to date on cancer screenings, a speaker at the Annual Rural Health Conference said.

Community health workers (CHWs) may also reduce health care disparities due to their ability to help patients navigate the health care system, which is “complicated and so fraught with ways to not be eligible or not get into different programs,” Jane Bolin, PhD, JD, BSN, an associate dean for research in the College of Nursing and the deputy director of the Southwest Rural Health Research Center at Texas A&M University, said during the presentation.

She defined a CHW as someone who connects individuals to needed health care and social services, and who is a trusted member of a community with a close understanding of the ethnicity, language, socioeconomic status and life experiences of the community they serve.

To leverage the use of CHWs in rural areas, Bolin and colleagues at the Texas A&M University’s College of Nursing and National Community Health Worker Training Center developed a program known as the Advancing Cancer Training, Information, Outreach and Navigation (ACTION) project to disseminate cancer-related trainings to CHWs. Their goal is to engage with rural and medically underserved communities to improve cancer outcomes.

Studies have shown that integrating CHWs into cancer screening programs can increase awareness, screening rates, referrals and volumes of services performed, according to Bolin.

“The effectiveness of CHWs is becoming very, very clear,” she said. “CHWs have been absolutely critical to our cancer screening prevention and now navigation services.”

She urged other health care systems to begin incorporating CHWs, citing cost effectiveness as another benefit.

“In the end, it is much more cost effective to catch cancer earlier,” she said.

In addition to the ACTION program, Bolin, Heather Clark, DrPH, MPH, a research assistant professor at Texas A&M School of Public Health and Center for Community Health Development, and colleagues collaborated with the National Rural Health Association to develop the Diabetes, Obesity, Nutrition and Exercise (DONE) curriculum. Originally an 8-hour in-person training curriculum, the researchers revised DONE into a 4-hour virtual training that could be continued during the COVID-19 pandemic. Bolin, Clark and colleagues used the DONE curriculum, which is available in English and Spanish, to train hundreds of CHWs in five states in the U.S.

The researchers have surveyed more than 300 CHWs in Texas and California who participated in the program to learn about their work environments. On average, Clark said that the annual salary of CHWs in Texas was $38,000 in Texas and $38,434.64 in California, which were lower than the mean incomes in these states. Participants from both states preferred to be recruited for training via email; they also preferred in-person trainings. The most common barrier for online training for all participants was reliable internet access.

Clark reiterated the cost-effectiveness of CHWs and encouraged physicians to talk to their health systems about the benefits of integrating CHWs.

“In a hospital, the bottom line is important. Patient outcomes are really important,” Clark said. “I think being able to talk to the fact that you are likely to have improved patient outcomes using a case management model is critical. You need to talk their language with respect to money and patient outcomes.”