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Community Health Workers in the Emergency Department—Can they Help with Chronic Hypertension Care

  • Hypertension and Emergency Medicine (T Rainer and P Levy, Section Editors)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review community health worker (CHW) interventions tailored for hypertension management and to determine if the emergency department (ED) population would benefit from such interventions.

Recent Findings

When working with patients who have one or more chronic diseases, CHW interventions have been very successful in improving health outcomes and are cost-effective. CHWs use a variety of techniques to address social determinants that patients may face that effect how they manage their chronic disease(s). Current CHW interventions in the ED have targeted the “super-user” population.

Summary

CHW-based interventions help address social determinants of patients in a variety of settings, especially in the ED where the physicians have limited resources and time. There is limited information about how CHWs can improve community health outcomes outside of the ED “super-user” population. Future research needs to determine if creating a data-driven CHW intervention for the ED would be effective.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492. https://doi.org/10.1161/CIR.0000000000000558.

    Article  PubMed  Google Scholar 

  2. Fryar C, Ostchega Y, Hales C, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS data brief, no 289. Hyattsville: National Center for Health Statistics; 2017.

    Google Scholar 

  3. Kwan BM, Rockwood A, Bandle B, Fernald D, Hamer MK, Capp R. Community health workers: addressing client objectives among frequent emergency department users. J Public Health Manag Pract. 2018;24(2):146–54. https://doi.org/10.1097/PHH.0000000000000540.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Fawcett KJ Jr, Neff RK, CMF D, Faber JE, Fawcett KJ Jr, Freese Decker CM. Achieving IHI’s triple aim by utilizing core health program with community health workers in rural communities. Fam Community Health. 2018;41(4):255–64. https://doi.org/10.1097/FCH.0000000000000196.

    Article  PubMed  Google Scholar 

  5. Anugu M, Braksmajer A, Jiayu H, Jie Y, Ladowski KL, Pati S. Enriched medical home intervention using community health worker home visitation and ED use. Pediatrics. 2017;139(5):1–11. https://doi.org/10.1542/peds.2016-1849.

    Article  Google Scholar 

  6. Kitzman P, Hudson K, Sylvia V, Feltner F, Lovins J. Care coordination for community transitions for individuals post-stroke returning to low-resource rural communities. J Community Health. 2017;42(3):565–72. https://doi.org/10.1007/s10900-016-0289-0.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lin MP, Blanchfield BB, Kakoza RM, Vaidya V, Price C, Goldner JS, et al. ED-based care coordination reduces costs for frequent ED users. Am J Manag Care. 2017;23(12):762–6.

    PubMed  Google Scholar 

  8. Reed PR. Using community health workers in collaboration with nurse case managers in effecting change in quality of life for heart failure patients: James Madison University. 2016.

  9. Moffett ML, Kaufman A, Bazemore A. Community health workers bring cost savings to patient-centered medical homes. J Community Health. 2018;43(1):1–3. https://doi.org/10.1007/s10900-017-0403-y.

    Article  PubMed  Google Scholar 

  10. Shah MN, Hollander MM, Jones CMC, Caprio TV, Conwell Y, Cushman JT, et al. Improving the ED-to-home transition: the community paramedic–delivered care transitions intervention—preliminary findings. J Am Geriatr Soc. 2018;66(11):2213–20. https://doi.org/10.1111/jgs.15475.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vohra A, Chua R, Besser SA, Alcain C, Basnet S, Battle B, et al. Community health workers reduce rehospitalizations and emergency department visits for low-socioeconomic urban patients with heart failure. J Am Coll Cardiol. 2019;73(9 Supplement 1):856. https://doi.org/10.1016/s0735-1097(19)31463-9.

    Article  Google Scholar 

  12. Blewett LA, Owen RA. Accountable care for the poor and underserved: Minnesota’s hennepin health model. Am J Public Health. 2015;105(4):622–4. https://doi.org/10.2105/AJPH.2014.302432.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Poureslami I, Nimmon L, Rootman I, Fitzgerald MJ. Health literacy and chronic disease management: drawing from expert knowledge to set an agenda. Health Promot Int. 2017;32(4):743–54. https://doi.org/10.1093/heapro/daw003.

    Article  PubMed  Google Scholar 

  14. American Public Health Association. Community health workers. 2019. https://www.apha.org/apha-communities/member-sections/community-health-workers.

    Google Scholar 

  15. •• Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3–e28. https://doi.org/10.2105/AJPH.2015.302987 This is a systematic review of the CHWs workforce (i.e., demographics, funding, programming) involved in chronic disease management.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Allen JK, Dennison-Himmelfarb CR, Szanton SL, Bone L, Hill MN, Levine DM, et al. Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circulation. 2011;4(6):595–602. https://doi.org/10.1161/CIRCOUTCOMES.111.961573.

    Article  PubMed  Google Scholar 

  17. Krantz MJ, Coronel SM, Whitley EM, Dale R, Yost J, Estacio RO. Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings. Am J Public Health. 2013;103(1):e19–27. https://doi.org/10.2105/AJPH.2012.301068.

    Article  PubMed  PubMed Central  Google Scholar 

  18. • Kangovi S, Mitra N, Grande D, Hairong H, Smith RA, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. Am J Public Health. 2017;107(10):1660–7. https://doi.org/10.2105/AJPH.2017.303985 This paper discussed the findings of the first phase of the IMPaCT trial which showed that CHW interventions aid population health management for healthcare systems.

    Article  PubMed  PubMed Central  Google Scholar 

  19. • Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, et al. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Intern Med. 2018;178(12):1635–43. https://doi.org/10.1001/jamainternmed.2018.4630 . This paper discussed the findings of the IMPaCT Multi-Site Primary Care trial that suggests that this kind of intervention can be used to address social determinants of health.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Foster B, Brody A, Berk W, Levy P. Is linkage to care for emergency department based HIV testing among African Americans worse, better, or the same than national averages? Mayor’s Summit for Health Equity in Detroit, 2016. Detroit; 2018.

  21. Fussman C. Health indicators and risk estimates by community health assessment regions & local health departments, State of Michigan selected tables: Michigan Behavioral Risk Factor Surveillance System (Michigan BRFSS)– 2013–2015. Lansing: MDHHS; 2016.

  22. Fussman C. Prevalence estimates for risk factors and health indicators, State of Michigan selected tables: Michigan Behavioral Risk Factor Survey-2015. Lansing: MDHHS; 2016.

  23. Foster B, Brody A, Dawood K, Dawood R, Foley D, Reed B et al. Identifying barriers to controlling blood pressure using the adherence to refills and medications scale in emergency department. ACEP annual meeting. San Diego; 2018.

  24. Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–23.

    Article  PubMed  Google Scholar 

  25. Doran KM, Colucci AC, Hessler RA, Ngai CK, Williams ND, Wallach AB, et al. An intervention connecting low-acuity emergency department patients with primary care: effect on future primary care linkage. Ann Emerg Med. 2013;61(3):312–21.e7. https://doi.org/10.1016/j.annemergmed.2012.10.021.

    Article  PubMed  Google Scholar 

  26. Klauer K. Can social emergency medicine give a different perspective on community health?. ACEP Now [Internet]. 2016. https://www.acepnow.com/can-social-emergency-medicine-give-different-perspective-community-health/. Accessed 10 May 2019.

  27. Basu S, Jack HE, Arabadjis SD, Phillips RS. Benchmarks for reducing emergency department visits and hospitalizations through community health workers integrated into primary care: a cost-benefit analysis. Med Care. 2017;55(2):140–7. https://doi.org/10.1097/MLR.0000000000000618.

    Article  PubMed  Google Scholar 

  28. 2018 Minnesota Statutes, § 256B.0625, subd. 49 (2018).

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, USA

    Bethany Foster, Katee Dawood, Claire Pearson & Phillip Levy

  2. Department of Emergency Medicine, Henry Ford Hospital System, Detroit, USA

    Jacob Manteuffel

Authors
  1. Bethany Foster
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  2. Katee Dawood
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  3. Claire Pearson
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  4. Jacob Manteuffel
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  5. Phillip Levy
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Corresponding author

Correspondence to Bethany Foster.

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Conflict of Interest

Dr. Levy reports grants from Michigan Department of Health and Human Services, during the conduct of the study. The other authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hypertension and Emergency Medicine

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Foster, B., Dawood, K., Pearson, C. et al. Community Health Workers in the Emergency Department—Can they Help with Chronic Hypertension Care. Curr Hypertens Rep 21, 49 (2019). https://doi.org/10.1007/s11906-019-0955-6

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  • DOI: https://doi.org/10.1007/s11906-019-0955-6

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