BUILDING A COMMUNITY HEALTH

WORKER PROGRAMThe Key to Better Care,

Better Outcomes, & Lower CostsPresentation ID: 066

Disclosure

Today’s presenters do not have any relevant financial interests presenting a conflict of interest to disclose.  Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation.   

AONE is authorized to award one hour of pre-approved ACHE Qualified Education credit (non-ACHE) for this program toward advancement, or recertification in the American College of Healthcare Executives.

Note: AONE will follow up directly with specific language for those speakers that disclosed a conflict of interest

The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on

Accreditation.

Objectives

1) Describe the value of community health care workers as part of the mainstream health care system in a manner that will effectively communicate the importance of these programs to hospital executives and board members.

2) Describe how to integrate and implement a community health worker program into a hospital or healthcare system in a cost effective manner. 

3) Apply tools and resources to aid in implementation of a Community Health Worker Program in any healthcare setting.

 

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RWJF Executive Nurse Fellows

• Loraine Frank-Lightfoot, DNP, MBA, RN, NEA-BC• Beth A. Brooks, PhD, RN, FACHE• Sheila Davis, DNP, ANP, FAAN• Pamela A. Kulbok, DNSc, RN, PHCNS-BC, FAAN• Shawanda Poree, MBA, BSN, RN• Lisa Sgarlata, MSN, MS, RN, FACHE

.

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THE CHW ROLE: Why Now?

History and Background

“As the demand for care increases, so will the role of community health workers”

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Twenty percent of the people in the U.S. have inadequate or no access to primary care.

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The healthcare system in the United States is undergoing a monumental transformation. Escalating costs have limited the public’s ability to access affordable, high-quality health and medical care. With the implementation of the Patient Protection and Affordable Care Act (U.S. House of Representatives, 2010), commonly called the Affordable Care Act (ACA), healthcare insurance coverage will expand to an estimated 32 million people by 2014, with millions more to follow in the years to come.

Obviously there is a need for novel approaches to provide access to primary care – approaches that will help hospitals and health systems to decrease readmissions and emergency department visits; increase patient adherence; improve health and wellness; reduce risk; prevent disease; and meet population needs identified by ACA-mandated Community Health Needs Assessments.

CHW Interventions Produce Cost Savings

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FORMULATING THE CHW ROLE

CHW ROLE

• History of the role– Global– USA

• Definitions of the role– ACA, APHA, WHO,BOL, HRSA

• Uni-modal vs. Polyvalent• CHW compared to other roles

– CNA, MA, HHA

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The ACA defines community health worker as “an individual who promotes health or nutrition within the community in which the individual resides.” Per the Act, a CHW promotes health in the following ways:

•By serving as a liaison between communities and healthcare agencies•By providing guidance and social assistance to community residents•By enhancing community residents’ ability to effectively communicate with healthcare providers•By providing culturally and linguistically appropriate health or nutrition education•By advocating for individual and community health•By providing referral and follow-up services or otherwise coordinating care•By proactively identifying and enrolling eligible individuals in federal, state, local, private, or nonprofit health and human services programs

A Widely Accepted and

Recognized Concept

FORMULATING THE ROLE

• Education– Type, setting

• Performance Management• Tools, Job Aids• Workload

– Catchment area• Outcomes

– Triple Aim13Building a Community Health Worker Program

STRATEGIC STAKEHOLDERS

STRATEGIC STAKEHOLDERS

• External– Community agencies

• Internal– Senior leadership– Medical staff– Care team members

• Talking Points• Tailor the message

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IMPLEMENTATION CONSIDERATIONS

Implementation Best Practice

• What drives developing a CHW program?• What size and scope does my community

need?• Program management

– Who is involved?– Who runs the program?– How to supervise?– What tools are needed?

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Implementation Best Practices

• Education of existing staff• Monitor effectiveness• Liability and safety issues• The business case

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Implementation Best Practices

• Elements of successful programs:– Recruitment– The CHW Role– Training –

• Initial• Ongoing

– Equipment and Supplies– Supervision– Evaluation

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Implementation Best Practices

• Elements of Successful Programs (cont.)– Incentives– Community Involvement– Referral System– Opportunity for Advancement– Documentation & Information Management– Linkages to Health Systems– Program Performance Evaluation

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Implementation Best Practices – Patient Sources

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CASE STUDIES

WOOSTER COMMUNITY HOSPTIAL

& PARKVIEW REGIONAL MEDICAL

CENTER & AFFILIATES

Wooster Community Hospital

Who we are . . .

• 172 Open / Staffed Beds• 6,100 Admissions• 1,100 Births• 33,000 ED Visits• 1,000 Employees• Payroll - $38 million• Net Revenue: $107 million

Program Inception

• Opportunity to address:– Readmission issues– Complex patients– Community Need– Physician (unrecognized) need

• Opportunity for:– Partnership with local college– Increased positive community perception

• “The right thing to do”

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The Program – A Partnership

Wooster Community Hospital & College of Wooster

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Program Components: Students as Health Coaches

• Student Selection• Student Preparation / Education

– Semester long course – Shadowing– CPR – Clinical Competency Assessment

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Program Components: Participants & Process

• Patient Referrals & Enrollment• Detailed Assessment• Motivational Interviewing• Comprehensive Care Plan• Intervention• Evaluation

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Wooster Community HospitalCCN Screening and Patient Identification

Identification Sources:•CCN – Date Review•Practitioner Identification•Community Referral

Screening Site:•Hospital•Patient’s Home•Practitioner’s Office

In-Patient Screening Identification

Screening

Data Review

Chronic Diagnosis

Screen(refer to diagram

below)

Other Diagnosis

Review patient’s Healthcare Utilization

Decline screening

Program introduction and Overview

Screened

Program interest expressed

Not Screened

No Utilization

No further actionRisk tool performed

Needs identifiedNo needs

No further action

Obtained consent

RefusedConsent signed

Offer Follow-Up phone callComplete CCN Care Plan and notify PCP of enrollment in program

Start

If > 2 hospitalizations or ED visits in last 6 months OR

If history of chronic medical problem

yes no

END

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Program Components: Tools

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Program Components: Tools

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Care Plan

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Disease Specific Care Plan

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Program Components: Staff

• Program Director: 1 FTE• Physician Medical Directors: 0.1 – 0.2• LPN: 1.5 FTE• Social Worker: 0.5 FTE• Dietician, Pharmacist, Therapist: PRN• Health Coaches

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Program Components: Evaluation

• Data collection• Results

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Results

• 54% Reduction in Admissions• 26% Decrease in use of the ED• 100% Compliance with correct medication

use (med boxes)• Smoking cessation• HgA1C – goal achievement• BP goal achievement – 100%

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CASE STUDIES

WOOSTER COMMUNITY HOSPTIAL&

PARKVIEW REGIONAL MEDICAL CENTER &

AFFILIATES

Parkview Health

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Parkview Regional Medical Center & Affiliates

Who we are . . .

• Open / Staffed Beds: 807• Discharges: 41,927 • Births: 4,444• ED Visits: 168,093• Employees: 9,002• Payroll - $623 million• Net Revenue (Operations): $1.35 billion

Care Continuum

• Community Nursing– School Nurses– Community Agencies

• Aging & In-home Services• Discharge Clinics• Home Healthcare & Hospice• EMS House Calls• Tele Health• Nursing Homes

– Extended Care– Mobile Care

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Where Do CHWs Fit?

• Care Advisors & Transitional Care Nurses

• Physician Practice Based?• Hospital Based?• Home Health Based?

• Paramedic? Qualifications? Students?• Elective College Course

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Key Recommendations & Take-Aways

Clear expectations & outcomes– Student vs. patient focus

•Budget for equipment– Medication Boxes: $300 purchase & $20 / mo. software

– Tele-health Units: $2,500 purchase & $60 / mo. software

•Clear patient outcomes – “What do we want to accomplish?”•Feedback – patients and CHWs•Administrative support •Clear roles & job descriptions

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Questions and Resources

CHW GUIDEBOOK

AONE Webpage:http://www.aone.org/resources/building-a-community-health-worker.shtml

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Contact Us

• Loraine Frank-Lightfootloraine.frank-lightfoot@parkview.com or frank-lightfoot.1@osu.edu 260-266-1022

• Beth Brooks beth.brooks@resu.edu773-252-5313

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Special Thanks

• Alex Davis Wooster Community Hospital Manager, Community Care Network330-263-8478

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