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.
Bibliographical noteFunding Information:
All clinic leaders described the influence of care team redesign mandates required for PCMH certification. CHW clinic leaders viewed these certification mandates as an opportunity for workforce innovation. Respondents were descriptive of their innovative culture: “We [are] constantly doing research on…how will [patients] really benefit? We’re constantly trying to improve” (care coordinator). CHW clinics secured grant funding to partially support an initial CHW pilot program. “We got money from [funder]…I think that was what made the decision to hire CHWs” (clinic manager). Some “started small” to work out “the kinks” in implementation. A CHW described the integration process as stepwise, at times with skeptical team members: “So I think at first…nobody knew [eg], why is she even a clinic employee? [Some] care team members seemed to get it before the clinic doctors did.” Clinic staff directly observed benefits, supporting notable successes. “I honestly think [CHW integration] has been all benefit” (medical director), and establishing “credibility and trust from the board and the clinic” (care coordinator supervisor). These pilots provided data to decision makers to support the CHW role in on-going clinic operations. One physician leader described expansion as “widespread acknowledgement that [CHW integration] is a good thing…that is spreading within [our health system].”
© 2018, Annals of Family Medicine, Inc. All rights reserved.
- Community health workers
- Health workforce
- Medical home
- Primary care