· The coming of the Affordable Care Act (ACA) is designed to shift patient care from episodic encounters to continuous community based partnerships.
· Elsewhere in the world, community health workers (CHWs) have been used effectively to improve health outcomes, reduce heath care costs and create jobs in infectious disease (TB, HIV), maternal child health and chronic disease management.
· CHWs are paid, full time lay provider members of community health systems.
o Sub-Saharan Africa is training, deploying and integrating one million CHWs into the health system via a targeted campaign.
o Brazil’s CHWs are part of family health teams that care for 110 million people.
o India employs 600,000 CHWs paid through a fee-for-service system for primary care functions.
· CHWs cost less, reduce readmissions and help address root causes of preventable chronic disease while remaining embedded in the community helping to strengthen long-term community relationships.
Relevance to the EM Physician:
As frustration with non-compliant patients mounts and the impact of the ACA looms, CHWs integrated into American communities may be just the answer we haven’t yet considered to help reduce ED overcrowding and improve our patients’ outcomes.
University of Maryland Section of Global Emergency Health
Author: Emilie J.B. Calvello, MD, MPH
References
Singh,P. Chokshi, D. Community Health Workers – A Local Solution to a Global Problem. NEJM. 2013, 369: 894 – 896.
