Providing Rigorous Analysis for a Promising Health Model – and Support to Underserved Patients

New Dept of Population Health Study Will Assess Community Health Worker Approach to Preventing Diabetes for Patients at VA and Bellevue

Wednesday, July 20 2016

People who are the most at-risk for chronic diseases—often low-income and racial and ethnic minority groups—are typically the least able to access the health support they need.

Enter community health workers, also known as CHWs, a growing contingent of the healthcare workforce who are drawing increased attention in medical journals and in the media for their potential to contribute to reducing health inequality in the U.S.

CHWs work with patients from similar cultural and economic backgrounds to help them manage the complexities of healthcare and ultimately promote health and wellness. They bridge the gap between patients and their primary care providers, arranging or providing transportation to appointments, helping patients maintain a regular medication schedule, and empowering them to improve their diet and exercise. Because they are able to draw on their shared life experiences, CHWs often develop a more trusting relationships with patients than other healthcare professionals might.

CHWs are also relatively low in cost, and as a result of the Affordable Care Act’s emphasis on community-based initiatives, their numbers are rising. There were 48,000 CHWs in 2015, up 27 percent, from 38,000 three years earlier, according to the Department of Labor.

Still, not many healthcare systems use CHWs, and not many insurers reimburse for them. Indeed, more high quality research is needed before a wide swath of the healthcare system is convinced of the value of CHW models and begins to develop blueprints to scale them up.

This fall, a study team from NYU Langone Medical Center’s Department of Population Health will aim to provide exactly this kind of information as they begin a CHW “peer health coach” program. The program is designed to reach underserved patients in two of the New York City’s largest safety-net institutions while conducting a high quality, randomized trial to assess the CHW model’s impact on preventing the onset of type 2-diabetes mellitus.

Funded by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, the $2 million, five-year grant will employ CHW coaches to work with patients in NYC Health+Hospitals/Bellevue and the VA NY Harbor Healthcare System, populations with a disproportionate burden of type 2-diabetes and diabetes risk.

Nearly 25 percent of America’s 8.7 million veterans have type-2 diabetes, and the rate among Bellevue’s 30,000 primary care adult patients is more than 15 percent. (In the general U.S. population, 9.3 percent of adults and children in the U.S. are affected by type 2-diabetes). The disease is a leading cause of death in the U.S. and worldwide, one of the major causes of heart disease and stroke, and a general challenge to quality of life.

Mark Schwartz, MD, FACP (l.) and Nadia Islam, PhD

“Our central premise is that community health workers are uniquely suited to engage fellow patients by encouraging lifestyle change through shared experiences and social support to extend the reach of primary care beyond the clinic visit,” says Mark Schwartz, MD, FACP, professor and vice-chair for education and faculty affairs in the Department of Population Health, who is the principal investigator on the project.

Patients in the experiment group will work with CHW health coaches recruited from their peer groups on making changes to dietary and exercise habits and enrolling in type 2-diabetes prevention programs at the VA and Bellevue.

If successful, the investigators will work with the VA’s Central Office and NYC Health+ Hospitals to translate the model for larger scale implementation.

“Employing community health worker coaches to conduct behavioral counseling, follow-up referral to programs, and education is a promising approach that could extend the capacity of health systems to better prevent and manage chronic conditions,” Dr. Schwartz adds.

The Section for Health Equity within the Department of Population Health has employed CHWs and evaluated the effectiveness of the CHW model in reducing health disparities in underserved communities for over 10 years. Their CHWs work in neighborhoods in Queens and Brooklyn to help peers in the Asian American and other immigrant communities prevent or manage diabetes and hypertension. Activities they support include holding exercise classes after a healthy breakfast and providing blood pressure checks at local mosques and other community spots.

“By serving as a bridge between communities and healthcare systems, the CHWs that we will be embedding into the clinical teams at Bellevue and the VA will help support diabetes prevention efforts that are meaningful and sustainable for community members,” says Nadia Islam, PhD, assistant professor in the Department of Population Health’s Section for Health Equity, who is co-investigator on the new CHW diabetes grant, along with Scott Sherman, MD, MPH

Researchers from the Department of Population Health have also contributed to the literature on how to integrate CHW models into healthcare systems and evaluated best practices on CHW training and program implementation.

by Elaine Meyer