The Blog to Transform Advanced Care
Advancing Care through Innovation, Observation and Collaboration.
As outlined in our 2021 Policy Agenda and Core Principles for Care Models, health equity is an essential priority in developing new practice and policy around care for people with serious illness. This is especially true where stark disparities exist, such as in the utilization of palliative care and advance care planning. Research shows that people of color are less likely to access palliative care services and engage in advance care planning (ACP) than their white counterparts. There is a need for innovative strategies to address these disparities and advance health equity. A recent study performed by researchers at The John Hopkins Hospital demonstrated how Community Health Workers (CHW) can increase access to palliative care and advance care planning for people in marginalized communities living with serious illness. C-TAC board member and Senior Clinical Advisor, Dr. Ravi Parikh, underscores the implications of exploring implementation strategies for care models for serious illness that include CHWs:
“Community health workers represent a key opportunity to engage in advance care planning and symptom management outside of the physician’s office – and often in a more culturally competent way particularly for communities of color and non-English-speaking populations. The study [performed by researchers at Johns Hopkins Hospital] shows that, as opposed to health systems and CHWs working in silos, they can actually work together and increase “cross-talk” to improve important patient-centered outcomes. Community health workers are the future of [care for serious illness].”
As liaisons between healthcare systems and communities, CHWs are uniquely positioned to advance health equity in care for serious illness by improving access to services shown to improve end-of-life outcomes, such as ACP and palliative care. As we shape the future of healthcare, CHWs can play a powerful role in care models built around our Core Principles. Keep reading for 5 reasons why this gives CHWs a role in the future of care for serious illness.
- CHWs are members of the communities they serve and can therefore overcome cultural and communicative barriers to accessing palliative care and engaging in advance care planning. CHWs often speak the language of the patients they serve and are able to overcome obstacles pertaining to health literacy, language-barriers, and lack of cultural competency from healthcare systems. They are equipped with a deep understanding of the people they serve which enables them to engage in difficult conversations around end-of-life care.
- Research supports the effectiveness of CHWs in improving health outcomes and care quality. Care models that include CHWs have undergone extensive evaluation to show that quality of care and health outcomes improve with their implementation. The Johns Hopkins Hospital study further supports the effectiveness of CHWs by demonstrating improvement in ACP utilization and palliative care referrals.
- CHWs can provide components of palliative care that do not require a clinician. Services, such as advance care planning, have been shown to improve end-of-life outcomes. CHWs can introduce these conversations to community members in a culturally-appropriate way. Utilizing CHWs in this way can mitigate access issues exacerbated by workforce shortages among clinicians.
- CHWs can help coordinate care in fragmented healthcare systems. CHWs training can incorporate multiple areas of care to streamline communication between a seriously ill patient and fragments of the healthcare system they may interact with, such as care teams and hospice services.
- The CHW workforce infrastructure may include less educational and licensing barriers than other clinical positions. CHW training can be tailored to the needs of specific populations, such as people living with serious illness, without financial barriers related to educational or licensing requirements. As a result, members of disenfranchised communities are better able to enter the CHW workforce and serve the communities they know.
Countless innovations and groundbreaking strategies to improve quality and advance health equity will shape the future of care for serious illness. CHWs offer a robust opportunity to transform care delivery at the community level for people living with serious illness. Dr. Parikh asserts that we have work to do in order to take full advantage of this opportunity. According to him, “We just need to design systems and payment structures – including transitioning to alternative payment models that “have teeth” – that can actually empower CHWs rather than hinder them.”