Community health worker (CHW) interventions are effective for improving health behaviors and outcomes and reducing health care costs for people with chronic disease.
CHWs serve communities that have been historically marginalized by traditional health care systems, by facilitating access to needed health care and public health services. This systematic review summarizes current evidence on the effectiveness of integrating CHWs into health care services for people with chronic disease with a focus on impacts related to population health, patient experience, health care costs, and health equity.
The authors examined evidence of effectiveness across dozens of recent randomized control trials and studies on CHW interventions. Models of CHW integration in health care with the strongest evidence included CHWs employed by health care entities, which showed strong evidence in improving health outcomes, and CHWs integrated with payers (e.g., ACOs, Medicaid demonstration projects), which showed reduced costs related to reduced hospital and emergency department utilization. Overall, the authors found strong evidence to support the effectiveness of CHW interventions in improving health behaviors and outcomes for people with chronic disease, including the management of diabetes, hypertension, cardiovascular disease, as well as some emerging evidence related to pregnancy and perinatal outcomes. There is also strong evidence for CHW effectiveness in improving certain cancer screenings and access to primary care. Notably, the authors found a gap in literature on the effectiveness of CHWs in improving health equity measures.
There is growing interest and investment in the U.S. for expanding the CHW workforce. This systematic review reveals strong evidence behind different strategies for integrating CHWs into health care teams to positively impact the health behaviors and health outcomes of people with chronic disease. Because CHWs often work with racial and ethnic minority groups — and are often from these communities themselves — exploring CHW effectiveness on advancing health equity is important for future research.