| COMING UP |
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Uniform Data System, Jan. 8, 9 QTS, Leadership Session, Feb. 27, 7:30 am - 1:30 pm QTS, Quality Institute, Feb. 27, 1:30 - 4 pm |
In this Issue
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Welcome to Senior Policy Coordinators Kimberly Keymer and Caleb Gilchrist. Welcome to Aza Nedhari, Project Specialist – AWI; and AWI Project Assistants Melissa Salinas and Kevin McNeill. Welcome to Cathy Morales, Director of Community Health Access and the AmeriCorps Community HealthCorp participants. Welcome to Linda Gardiner, RHIO Project Intern. |
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Medical Homes DC |
Community Health Workers: The Bridge to Complete Care
The idea of a “medical home” – a place where patients routinely go for preventive care that also meets their linguistic, cultural, and social needs – requires thinking about the provision of health care in a new and different way. Most of all, it requires a new type of health care professional, someone from the community, trained to work with the community to provide the type of care needed to overcome disparities in health care. As part of the Medical Homes DC initiative, DCPCA launched its Community Health Worker (CHW) program, which has developed a core curriculum to help expand the use of these new professionals in DC’s medically underserved areas. Judy Levy, MHSA, RN, is directing DCPCA’s program and recently gave the key note at the Metropolitan Washington Public Health Association’s annual meeting, on the role of Community Health Workers. Her presentation cited how the wider use of these workers can improve people’s access to services, enhance compliance with regular check-ups and screenings, upgrade the quality and cultural competency of care, and help reduce costs. CHWs are actually already in widespread use around the world, Judy reports, under a variety of different names: patient navigator, outreach educator, family welfare educator, promotora, community health promoter, doula, and apple leader, to name a few. Some of the positions are paid, some are volunteer; training is widely variable; and there is no career ladder or any way to standardize training or certification for quality. In DC, several community health centers are using community health workers to reach patients and their families, especially those whose native language is not English and in populations with higher risk of chronic diseases. The goal of DCPCA’s Community Health Worker program is to develop the profession, with core training, advancement, and certification standards – all toward reaching patient and their families to link them to their medical home. DCPCA will conduct several trainings over the next several months to provide Community Health Workers with an array of services that serve as a bridge to bring vulnerable residents into primary care. The workers will come from the neighborhoods where they will be employed, so patients will feel comfortable with them. The workers themselves will find stable and adequately paid employment, with opportunities for advancement and career mobility. Our core curriculum, with training in common activities and a set of baseline competencies, will create a corps of desirable workers who bring a reliable set of skills to their employers. A certification program that will monitor the quality of the training program and the workers that are trained in the program is a further step in advancing the Community Health Worker profession. Different health care providers and different communities will use these CHWs in many ways, but the possibilities are endless. See the chart below. CONSIDER THE POSSIBILITES Examples of services that can be provided by CHWs
Multiple stakeholders – including health care providers, educational institutions, and insurance companies – are currently involved in the design of the curriculum. We are working with the DC Department of Health and the Community Health Workers already practicing in the community. The curriculum involves a week-long intensive skills training which is hands-on and interactive, using methods such as application and skill-based activities, that have been shown to be effective in educating adults, especially adults who do not have substantial literacy skills. In addition to the week-long core skills training, a supplemental week of training will be offered to those who want to work specifically with chronic diseases, such as diabetes, HIV/AIDS, asthma, cardiovascular disease, and hypertension, all of which are major causes of death and disability in the District. At the end of the training, a credential will be available to certify graduates and their skills. This credential is still in the design stages, and one of the main issues to be resolved is the potential impact of formal training and credentialing on existing traditional CHW programs. Currently, there are CHW credentialing programs in Alaska, Texas, Indiana, and Ohio, which will serve as models for the DC credentialing program. DCPCA is working to develop a partnership with the University of the District of Columbia to permanently house the training and credentialing for the CHW program. To demonstrate the value of CHWs while addressing the unnecessary and costly use of emergency care, DCPCA is developing a pilot Emergency Room intervention program. ERs in the District are overflowing with patients who come in for primary care complaints. In 2003, the last year for which data are available, these primary care cases in the ER cost an estimated $93 million – with Medicaid and the DC HealthCare Alliance picking up the tab for about a quarter of the cost. Clearly, decreasing inappropriate use of the ER to treat primary care cases could create substantial savings, and this has been the finding of several studies in other U.S. cities, including Chicago, Denver, New York, Baltimore, and Corpus Christi. Community Health Worker programs have been shown to improve the bottom line of health care delivery systems and decrease over-utilization of emergency room services. But more importantly, the Community Health Worker is the bridge between patients in need and their medical home, resulting in improved access to care, increases in health-seeking behaviors, and first steps to prevention of chronic diseases. As the program develops, we are looking forward to reaping these same benefits in DC, as the use of Community Health Workers spreads and grows across the District. For more information about opportunities in health care professions through DCPCA, contact Judy Levy, Medical Homes DC AHEC Program Manager, at (202) 638-0252 (ext. 202). |
