1 st Conference September 28, 2016

Transcription

1 1 st Conference September 28, 2016 Discovering the Missing Link to Bridging the Gaps for a Healthier Commonwealth Presented by: Frances J. Feltner, DNP Director University of Kentucky Center of Excellence in Rural Health

2 Let s Talk History Why we need CHWs? Who needs CHWs? What are CHWs doing today? Today s CHW Future CHWs

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5 History of CHWs The use of community health workers has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries. Using community members to render certain basic health services to the communities they come from is a concept that has been around for at least 50 years. (1966) There have been innumerable experiences throughout the world with programs ranging from largescale, national programs to smallscale, community-based initiatives.

6 History Test 1. Who do you go to first when you have a question about your health? 2. Who answers your questions or confirms what your medical provider has told you? 3. Who do you trust to give you informaiton?

7 History of CHWs Most of the CHW programs have work to improve the social determinants of health long before the different organization realized or stated how important it is to help remove the barriers of the people they serve. Social determinants of health are factors in the social environment that contribute to or detract from the health of individuals and communities. These factors include, but are not limited to the following: Socioeconomic status Transportation Housing Access to services Discrimination by social grouping (e.g., race, gender, or class) Social or environmental stressors

8 Who Needs CHWs? The medically underserved or the neediest of the needy. People living in poverty. Residents in rural areas are statistically poorer, less educated and less likely to have medical coverage than those in other parts of the state and nation. Barriers, especially for poor rural people, include lack of knowledge about services, inadequate information on their own conditions, social and cultural inhibitors, lack of money, transportation, and numerous other factor.

9 Rural Challenges Nearly one in four Americans 70 million people live in rural areas. On average, they are older, poorer, more likely to be uninsured, and suffer from higher rates of chronic health conditions than others. Although nearly 25 percent of Americans live in rural areas, only about 10 percent of physicians practice there.

10 Why are CHWs needed? Creating more effective linkages between vulnerable populations and the health care system Managing care and care transitions for vulnerable populations Ensuring cultural competence among health care professionals serving vulnerable populations Providing culturally appropriate health education on topics related to chronic disease prevention, physical activity and nutrition Advocating for underserved individuals to receive appropriate services Providing informal counseling Building community capacity to address health issues CHWs play an important role in community-based research, serving as a bridge between outside researchers and community members. A 2011 publication from HRSA s Office of Rural Health Policy

11 Chronic Disease Burden 145 million people, or almost half of all Americans, live with a chronic condition That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million Almost half of all people with chronic illness have multiple conditions. As a result, many managed care and integrated delivery systems have taken a great interest in correcting the many deficiencies in current management of diseases such as diabetes, heart disease, depression, asthma and others.

12 Those deficiencies include: Rushed practitioners not following established practice guidelines Lack of care coordination Lack of active follow-up to ensure the best outcomes Patients inadequately trained to manage their illnesses

13 Number of deaths for leading causes of death: Heart disease: 614,348 Cancer: 591,699 Chronic lower respiratory diseases: 147,101 Accidents (unintentional injuries): 136,053 Stroke (cerebrovascular diseases): 133,103 Alzheimer's disease: 93,541 Diabetes: 76,488 Influenza and pneumonia: 55,227 Nephritis, nephrotic syndrome, and nephrosis: 48,146 Intentional self-harm (suicide): 42,773

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15 Lung Cancer It s Bad Lung cancer is the leading cause of all cancer deaths in the United States Current 5-year survival for all stages combined is only 16% Worse in KY Kentucky s lung cancer mortality rate dramatically exceeds the national lung cancer mortality rate (73.2 KY vs U.S. deaths per 100,000) The 5-year survival is 52% for those diagnosed at a localized stage, however only 15% of lung cancers are detected prior to spread New USPSTF Recommenda tions (2013) Based on seminal findings of the National Lung Screening Trial, a large randomized trial that found a reduction in lung cancer mortality through low-dose CT (LDCT) lung screening in current or former heavy smokers compared to plain chest x- rays (NLST study team, 2011) The American Cancer Society and the American Association for Thoracic Surgery, among others, have also published formal screening guidelines An Equal Opportunity University

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18 Colon Cancer In 2012 (the most recent year numbers are available) 134,784 people in the United States were diagnosed with colorectal cancer, including 70,204 men and 64,580 women. 51,516 people in the United States died from colorectal cancer, including 26,866 men and 24,650 women. Between 2007 and 2020, the number of deaths is expected to go up 15.2% in men and 8.1% in women, although the rate of cancer deaths per 100,000 people in the United States is expected to keep going down. We expect cancer death rates to drop most for Colorectal cancer (23.4%). Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015.

19 Screening Need The most recent rates were reported in 2012 by the American cancer society: Of adults age 50 and older 63.3 percent had been screened (that s all adults and races- not by gender). In the University of Kentucky 2015 publication (Variation in Colorectal Screening Rates in Kentucky Since the Development of the Colon Cancer Screening Program in 2008), 71.04% of females had been screened and 66.92% of males.

20 CHWs, help us in understanding why people are not being screened TABLE 2 Reported Barriers to Colorectal Cancer Screening at Baseline and Follow-Up Reported barriers Baseline n (%) Follow-up n (%) No Time 13 (2.0) 5 (0.8).058 No transportation 27 (4.2) 19 (3.0).639 No referral from my doctor 207 (32.5) 220 (34.5).440 No means of payment 242 (38.0) 201 (31.6).016 Too ill 25 (3.9) 17 (2.7).209 Worry that I might have cancer 15 (2.4) 7 (1.1).043 Concern about discomfort 54 (8.5) 29 (4.6).005 Embarrassment 16 (2.5) 4 (0.6).007 p Feltner, F., Ely, G., Whitler, E. T., & Dignan, D. (2012). Effectiveness of community health workers in providing outreach and education for colorectal screening in Appalachian Kentucky. Social Work in Health Care, 51 (5), doi: /

21 CHWs are Reaching People Have had a FIT test but no colonoscopy: 321 client s total 100 males (31.2%) 221 females (68.8%) 6.05% of KHP clients 50 years and older have not had a FIT test Have had a colonoscopy but not a FIT test: 1528 total 599 males (39.2%) 929 females (60.8%) 28.8% of KHP clients 50 years and older have had a colonoscopy 5300 total clients age 50 and older 401 males have had both a blood stool and a colonoscopy (34.5%) 761 females have had both a blood stool and a colonoscopy (65.5%) 1162 out of 5300 who have had both types of screening (22%)

22 Stroke in Kentucky In 2013 Kentucky had almost 24,600 non-fatal hospital visits, and approximately 6,826 non-fatal emergency department (ED) visits were attributed to stroke (Kentucky Traumatic Brain Surveillance Project, 2014). Overall government payers were billed over $950 million in 2013 and commercial payers over $225 million for strokerelated care in Kentucky.

23 Kentucky Care Coordination for Community Transition Program (KC 3 T). Keisha Hudson- is our stroke navigator and is lay community health worker from SE Kentucky. Initially received comprehensive training through the Kentucky Homeplace program. Additional training including: The Chronic Disease Self-Management Program - Stanford, Youth Mental Health First Aid Certification through the USA Youth Mental Health First Aid Diabetes Self-Management Program (DSMP) training through Stanford University The Wellness Recovery Action Plan (WRAP )

24 Kentucky Care Coordination for Community Transition Program (KC 3 T). The KC3T navigator performed 516 related services and 412 reviews of educational literature and discharge plans. The participants receiving service from the KC3T navigator had no ED visits within 30 days of discharge compared with 83% of non- KC3T participants (n=12) who had at least one ED visit within 30 days of discharge. Participants in KC3T had no stroke-related 30-day readmissions compared to 42% of non-kc3t participants who were readmitted within 30-days of discharge.

25 Diabetes Belt 68 Kentucky counties 644 counties in 15 states

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27 WRAP Study Cultural Adaptation of Collaborative Care for Depressed Appalachian Women: A Community Health Worker Model PI: Claire Snell-Rood Goal: Identify acceptable methods of educating and providing mental health services for Appalachian women. What is WRAP? The Wellness Recovery Action Plan (WRAP ) is a personalized wellness system designed to help people self-manage their own health. WRAP helps people to: 1) decrease and prevent intrusive or troubling feelings and behaviors; 2) increase personal empowerment; 3) improve quality of life; and 4) achieve their own life goals and dreams. Each person taking part in WRAP creates their own wellness toolkit. Individuals learn to use WRAP through a peer-led and peer-engaged group process led by community health workers. Researchers at the University of Kentucky College of Medicine are conducting research on how WRAP can work for women in Appalachian Kentucky. Why WRAP? This is a program specifically for women who are stressed, overwhelmed, and down. This is a selfmanagement program, which means it can help you to develop your own plan to feel healthier overall. Women especially have a lot to balance between their families, work, and health, which often means that they put themselves last. This is a program that helps you to figure out how to take care of yourself.

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29 Today s CHWs are the Link Community health workers (CHWs) play a significant role in reducing and/or managing chronic illnesses, reducing healthcare costs, and improving the overall health of the population They are also specifically listed as important professionals on the health care team in the Affordable Care Act of 2010

30 Today s CHWs are the Link Evidence gathered over the years makes it clear that support for, and development of, a CHW workforce is a wise investment

31 Today s CHWs are the Link At the federal level, CHWs are recognized as professional members of the health care workforce who effectively address social determinants of health and reduce health disparities (US Department of Health and Human Services)

32 CHWs as Lay Leaders Providing Community Health Coaching: Community Health Worker/Navigator Training Mental Health First Aide The Chronic Disease Self-Management Program (CDSMP) Walk With Ease (WWE) BLS/CPR Diabetes Self-Management Program (DSMP)

33 Montgomery County s The Bridge/El Puente Program Efforts began in 2001 through a partnership with the University of Kentucky s Preventive Medicine Program to identify issues related to the growing Hispanic population. Grant funding from the USDA Fund for Rural America was used to build community support and infrastructure and to identify strategic initiatives to improve the quality of life for this population. The Montgomery County Migrant Population was formed. The first HRSA Rural Health Outreach grant was funded in 2006; Covered a 3-county service area Montgomery, Bath, Menifee Counties; Goals were to improve health care access through: a promotora model; Payment for primary medical and dental care; Improved cultural competency. Funded for a second round in 2009; Goals were primarily the same with the addition of mental health; Begin to think about long-term sustainability, i.e., FQHC

34 Since 1994 Kentucky Homeplace: A Successful Model Served over 152,467 individual clients Provided 4.7M services Valued at $308M dollars ROI $11.56

35 National Support and CHW Recognition Patient Protection and Affordable Care Act of 2010 CDC Division for Heart Disease and Stroke Prevention 2011 National Prevention Council 2011 HHS Action Plan to Reduce Racial and Ethnic Health Disparities 2011 HHS National Health Action Plan to Improve Health Literacy 2010 Agency for Healthcare Research & Quality 2009 American Public Health Association 2009, 2001 Institute of Medicine 2003 American Medical Association 2002

36 One of CDC's four overarching Health Protection Goals is Healthy People in Healthy Places. This goal addresses the idea that the places where people live, work, learn, and play will protect and promote their health and safety, especially those people at greater risk of health disparities. (

37 Future of CHWs We started out on narrow dirt road in developing a network of public, private and community partnerships. Our team members are dedicated and determined to reach our families, patients, neighbors and friends with life saving screening. Working as a team, we can accomplish great things.

38 We need the input of all of you and others to jump into the Delorean and help us to smooth out the bumps and curves. This adventure will take all of us working together to make the Kentucky Association of Community Health Worker the best in the nation!

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