The first day back from our holiday break was spent putting together some new office desks. There were five giant boxes just waiting to be assembled, so, we rolled up our sleeves and got to work. Fortunately, we had built desks like these before, and vaguely remembered how all the pieces got assembled. One of the steps is using wood glue in all the joints, which seems unnecessary when you’ve got so many screws and dowels holding it all together; however, the wobbly desk from the first round of assembly proved that hypothesis incorrect. This time we made sure to carefully glue all the joints. It took a little more time, but the outcome is more than worth the effort, as the sturdy desks will last longer and work better.
In the same way, sometimes we don’t see just how important some small parts of a high-functioning health care system can be to its overall function. One example is the lack of successful integration of community health workers (CHWs) into primary care settings. CHWs are frontline public health workers who have a deep cultural understanding of their community and they are able to utilize that knowledge to help improve health outcomes. They have been shown to positively impact the health of the communities they serve. CHWs are often the bridge between individuals, their home, their community, and the health care system.
Research indicates that involving CHWs in treatment teams leads to better long-term outcomes and helps reduce health care costs (PDF); yet, it is not a common practice throughout the health care setting to integrate these community members. While they are uniquely qualified to do their job, hospitals are often resistant to hire CHWs because they lie outside their core competency and reimbursement remains a challenge for many health systems.
In Colorado, efforts are underway to test and implement CHW-models. Tri-County Health Network recently received support to test a program focused on prevention outreach in rural Colorado that was used to screen community members for diabetes and cardiovascular disease. Under the program, CHWs were hired to refer patients to appropriate services and hold them accountable for their health care decisions, which resulted in lowered cholesterol levels and blood pressure for at-risk patients. The success of the program required the buy-in of the clinics, development of trusting relationships, and a strong referral system between clinics and CHWs.
When community health workers are properly integrated into the health care system, we can expect real, effective change to occur. The gaps in care that exist between the patient’s home and their provider’s office are larger than they seem, and a little bit of investment in a program like CHWs can make the whole system more functional and stable—just like our new desks.