Introduction:  Chronic disease is a growing problem in the U.S. and a prime factor in increasing health care costs. The negative effects of chronic diseases are rapidly increasing among vulnerable populations such as immigrant and low-income populations. Research shows that Community Health Workers (CHWs) have improved health outcomes for populations who face barriers to health care access, particularly for disease prevention and chronic disease management.  CHWs are frontline public health professionals, typically non-clinicians, who share ethnicity, culture, language, and life experiences with the communities they serve. CHWs reduce health care costs by decreasing ambulatory care-sensitive emergency room visits, hospitalizations, and by improving appropriate and effective health care utilization. However, there is a paucity of studies evaluating  CHW interventions across  multiple diseases and groups using common metrics, especially looking beyond narrow clinical measures and/or subpopulations.  In this study, we evaluate CHWs across several factors and assess their potential to help address rising health care costs in the U.S., including development of a conceptual model.

Objectives:  This study sought to determine 1) Are CHWs effective in chronic disease programs for vulnerable populations? How do these findings vary across different populations, diseases and settings? 2) Can CHWs be effective in various Patient-Centered-Medical-Home/Health-Home (PCMH/HH) settings?  How can CHWs be incorporated into PCMH/HH operations as well as in non-system settings? 3) Are CHWs cost-effective?  What are the policy challenges to scaling up CHW programs to additional communities? 

Methods/Results: This study used mixed methods to integrate three randomized control trial studies involving diabetes and hypertension prevention and/or management for Asian populations in NYC. The programs being evaluated have group and individual components addressing diabetes and hypertension prevention and/or management for NYC Bangladeshis, Indians, Filipinos, and Koreans. Outcome data was collected through in-person surveys of a total of approximately 300 program participants and control group at baseline, midpoint and follow-up. Outcome measures include levels of glucose, hypertension, health-related behaviors, access and utilization. Quarterly intensive interviews were conducted with all 10 program CHWs and analyzed. Informed from the CHW interviews, a set of 27 closed-ended questions were developed to evaluate CHW efficacy and administered to program participants.  Program effectiveness was estimated using a two-group (program vs.control), pre-post analysis. Preliminary findings showed CHWs played a role in improving most but not all outcome measures.  Key variations in results by ethnic group served and disease will be discussed and a comparison in outcomes for CHWs across settings will be presented. Using total program costs, incremental cost-effectiveness was determined by calculating cost per additional  outcome measure. A conceptual model for CHW roles based on results will also be shared, synthesizing the qualitative and quantitative analyses including the relationship between CHWs and both individuals and the health care system.

Conclusion:  CHWs can potentially be cost-effective, considering all relevant costs, in preventing and managing chronic diseases such as hypertension and diabetes in PCMH/HHs as well as non-health care related settings. Results show opportunities exist to improve the health of vulnerable populations and certain ethnic groups with chronic diseases may especially benefit from CHWs.