Integrating Community Health Workers Into Medical Homes
Integrating Community Health Workers Into Medical Homes
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DOI：
10.1370/afm.2171
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发表时间：
2018-01-01
影响因子：
4.4
通讯作者：
Call, Kathleen T.
中科院分区：
文献类型：
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作者：
Rogers, Elizabeth A.;Manser, Sarah Turcotte;Call, Kathleen T.
尽管有证据支持社区卫生工作者（CHW）在慢性病自我管理支持中的价值，并且当局呼吁扩大他们在以患者为中心的医疗之家（PCMH）中的作用，但明尼苏达州很少有PCMH将这些卫生工作者纳入其护理团队。我们进行了一项定性研究，（1）确定促进者和障碍，利用CHW模式之间的PCMH在明尼苏达州，和（2）定义的角色发挥了PCMH team.METHODS，我们进行了51个半结构化的，关键线人采访的诊所领导人，临床医生，护理协调员，CHW，和工作人员从9个诊所（5个社区卫生工作者，4个没有）。定性分析包括主题编码与采访topics.RESULTS四个关键的概念性主题出现的促进者和障碍，利用CHW模型：存在的领导人与知识的CHW谁拥护的模型，诊所文化，有利于试点创新与维护既定的护理模式，诊所优先考虑病人的非医疗需求，和领导的可持续发展的看法。这些医护人员进行共同的和临床特定的角色，包括推广，健康教育和辅导，社区资源联系，系统导航，促进临床医生和patient.CONCLUSIONS之间的沟通，我们确定了促进者和障碍，通过CHW的角色的一部分，PCMH护理团队在明尼苏达州和记录他们的角色正在发挥这些设置。我们的研究结果可以用来考虑战略，以提高利用和整合这一新兴的劳动力。
PURPOSE Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team.METHODS We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics.RESULTS Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient.CONCLUSIONS We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce.