Rhode Island expanded the roles of certified community health workers (CCHWs) in cardiovascular disease and diabetes mellitus management to determine if patient health behaviors and clinical outcomes improved with support from specialty trained CCHWs.
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Cardiovascular disease (CVD) is the leading cause of death in the United States.[1] Despite the increasing health threat CVD presents to thousands of Rhode Islanders, control of key CVD risk factors remains poor. According to the Centers for Disease Control and Prevention (CDC), two major risk factors for CVD are hypertension and high cholesterol.[1] In 2021, approximately one in three Rhode Islanders reported ever having been diagnosed with hypertension (32.9%) and high cholesterol (33.9%).[2] In addition to hypertension and high cholesterol, Type 2 diabetes mellitus (DM) is considered a major controllable risk factor for CVD.[1] Individuals living with diabetes are two times more likely to die from CVD, compared to individuals who do not have diabetes.[3] In Rhode Island, diabetes prevalence has steadily increased throughout the years and was reported at 10.4% in 2021 among adults.[2]
To prevent and manage CVD and its risk factors, it is important that patients are educated on chronic disease management and supported by all members of the care team. Integrating community health workers (CHWs), who offer lived experience and can connect with community members, in the care team is an effective strategy in providing services and support for chronic disease management.[4]
To achieve greater prevention and management of CVD, Rhode Island Department of Health’s Diabetes, Heart Disease, and Stroke Program (RIDHDS) expanded the roles of certified CHWs (CCHWs) for chronic disease, with a focus on CVD and DM from 2020-2023. The Rhode Island Department of Health introduced specialty training on CVD and DM to enhance the CCHWs’ ability to work on CVD/DM-related strategies within clinical and community settings. RIDHDS investigated if patient health behaviors and clinical outcomes improved with specialty trained CCHW support. The expansion program consisted of two phases—an infrastructure phase, in which patients were assigned to a CCHW who did not receive CVD/DM specialty training, and performance phase, in which patients were assigned to a CCHW who had recently completed the training. The methods, evaluation, and findings from this expansion are described in our publication, “Evaluation of a Cardiovascular Disease/Diabetes Mellitus Expansion Program for Community Health Workers Employed by Rhode Island Community Health Teams.”
Our Findings
- There were individual-level improvements in clinical values for hypertension, high cholesterol, and diabetes for patients after receiving support from a CCHW in each phase.
- The average differences in clinical values (blood pressure, total cholesterol, and hemoglobin A1c) experienced by patients in the infrastructure phase and performance phase were similar, thereby indicating little impact on chronic disease outcomes by specialty trained CCHWs.
- Patients reported that their confidence in managing their blood pressure, high cholesterol, and/or diabetes increased from baseline to follow-up after receiving support from a CCHW, whether specialty trained or not.
Recommendations
- CCHWs should be incorporated into interventions that aim to improve patient behaviors and confidence in managing their chronic conditions.
- CCHWs should be included in the design and development of expansion programs to make informed decisions and ensure the program is feasible within their workflows and capacity.
- Further data collection and evaluation are needed to determine the long-term effects of CCHW intervention and support for patients with chronic conditions.
- An evaluation of the specialty training and differences in activities of CCHWs may identify the significance of CCHWs being trained in chronic disease management.
- Those wanting to implement a similar expansion program should recruit a demographically diverse patient sample and increase the time between collection of baseline and follow-up clinical values. A longer period between baseline to follow-up, such as 6 months to 1 year, may detect more meaningful changes.
To learn more about our expansion program, read “Evaluation of a Cardiovascular Disease/Diabetes Mellitus Expansion Program for Community Health Workers Employed by Rhode Island Community Health Teams” in the July 2024 special issue of the Journal of Public Health Management and Practice.
Acknowledgements
I would like to acknowledge and thank the co-authors for their work on this expansion program and the article: Justan T Baker, MPH; Breanne M DeWolf, MA; Megan N Sheridan, MS RD; Elise M George, MPH; and Nancy A Sutton, MS RD.
References
- CDC. Heart Disease Facts. https://www.cdc.gov/heartdisease/facts.htm. Reviewed May 2023.
- State of Rhode Island, Department of Health. Behavior Risk Factor Surveillance Survey [2021].
- American Heart Association. Cardiovascular Disease and Diabetes. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks/cardiovascular-disease–diabetes. Reviewed May 2021.
- Centers for Disease Control and Prevention. Addressing Chronic Disease Through Community Health Workers: A Policy and Systems-Level Approach. 2nd ed. Atlanta, GA: Centers for Disease Control and Prevention. https://www.cdc.gov/dhdsp/docs/chw_brief.pdf. Published April 2015.
About the Author
- Cali McAtee is a Senior Public Health Epidemiologist and Program Evaluator at the Rhode Island Department of Health. Her work concentrates on chronic disease; physical activity and nutrition; Alzheimer’s disease and related dementias; and maternal and child health.
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