Hiring community health workers is still a relatively new endeavor for most health systems, and hospitals are working through how best to deploy them. Sinai Urban Health Institute (SUHI), the community-engaged research arm of safety net hospital Sinai Chicago, is evaluating the impact of its Community Health Worker (CHW) Support Program in mitigating adverse social determinants of health and addressing inequities.
During a recent webinar put on by the National Center for Complex Health and Social Needs, Yesenia Galvan, M.P.H., program manager at Sinai Chicago, and Melinda Banks, community health worker program coordinator at SUHI, spoke about their experience working to improve population health with a primary focus on communities on the South and West Sides of Chicago.
Galvan and Banks noted that CHWs at SUHI screen patients for unmet social needs and link these patients to community-based resources to address these needs. They spoke about how the CHWs improve connections between the clinical setting and community-based resources.
Although CHWs are new to many health systems, SUHI has actually hired community health workers to address health inequities for over 20 years. CHWs are critical liaisons between patients and their healthcare team, Banks said. “Through our shared lived experiences, we understand the needs and the barriers of the community and we try to bridge that divide between the clinical staff and the patients. Because CHWs share common ground with our patients, we are often better able to establish the relationship of trust needed to successfully identify and address barriers to prevention and disease management.”
Banks spoke about several strategic steps, the first involving health equity and assessment research, which collects the data to assess the needs of the communities being served. This may be through community health assessments or surveys, or publicly available data. “We then disseminate those findings back to the community as well as community-based organizations and policymakers and work with the community to identify the highest-priority issues and then address them,” she said.
Their second strategy is labeled community health innovations, which involves establishing interventions that meet the needs of the community. A third strategy, called evaluation and technical assistance to determine whether the interventions are successful, sustainable and scalable. “None of this is done in a vacuum,” Banks said. “At each of these steps, we collaborate with community members in our work, to ensure we are building trust and acting in ways that respect community needs and each community's unique makeup.”
“We are currently implementing health interventions focused on breast, cervical and colorectal care, asthma, screening for social determinants of health, and pre-diabetes,” she said, adding that they also worked with victims of non-fatal gun violence in the ED.
Galvan spoke about efforts to intentionally integrate CHWs into Sinai Chicago to improve the overall health of the patients with complex needs. “That led to the development of our CHW Support Program, a complex care intervention.”
"What we've seen is that individuals with social needs are more likely to have difficulty self-managing chronic health conditions,” she said. “They are repeatedly no-shows to medical appointments, and they overutilize the emergency. We partnered with Westside United, which brought together four health systems in Chicago to integrate screening for social determinants of health on the west side, which has long been under-resourced and has faced significant health, economic, and social challenges and inequities.”
Galvan and Banks noted that their partnership with the hospital’s social work department has been instrumental to their success. “In the beginning, we were doing rounds with them, and that was great,” Galvan says, “but now it's as simple as them saying, ‘Hey, I have this patient who is at high risk for readmission, because they've been here four or five times in the past six months. Can you please follow up and screen them and see if there are any outside services that you can provide?’”
The program then added other referral sources. “Behavioral health was one of those things that was at the very forefront that we were seeing a big need for when the pandemic hit,” Galvan recalls. “That led us to develop a partnership with behavioral health where they reach out to see if we can work on a patient together, and we can help them provide resources. So behavioral health is now sending us referrals, saying, ‘Hey, I have this patient who needs help with connecting to transportation and a PCP. Can you help them do that?’”
Analyses of their data show that the 30-day readmission rates among referrals who are not being screened for SDOH is at 35.1 percent, whereas the readmission rate for those who are being screened is at 23.6 percent. “Although correlation does not necessarily equal causation, it is still a really, really good sign to see that our patients who are being successfully screened are less likely to be readmitted,” Galvan said. “This is what our data is showing.”
Based on its own experience, the team at Sinai Chicago also has partnered with Swedish Hospital and started to manage the integration of their own CHW pilot at their hospital. “What's happening at Swedish Hospital, which is located on the North Side of Chicago, is very different from what's happening at SUHI, which is located on the West Side of Chicago,” Banks said. “Keeping that in mind, we started to help them build out their pilot to screen patients who are visiting the ED. Our program managers and our data specialists all oversee the work that is being done there.”
Preliminary data shows that Swedish has already screened 370 patients and has been able to provide resources for 343 patients. “That's 343 patients who might not have had a connection to a PCP, might not have understood what a follow-up appointment is, might have needed help with transportation just to get to their appointment,” Banks said. The CHW there is working within the workflows at Swedish and receives referrals from the clinical staff, and the nursing staff in the ED. The CHW can log into Epic and locate potential patients to screen, based on SDOH needs. She's looking for patients who don't have a PCP or someone who might not have insurance. Once she finds a patient to screen, she'll meet with them prior to discharge, collect patient demographics, screen them using the screener and then provide resources and referrals as needed.
Asked about challenges with the program, Galvan said that integration of CHWs is really difficult, even within a single health system. “Integration is always going to be hard,” she said. “Matching up the schedules of clinical and non-clinical staff can be a challenge, she said. “Having to integrate with other departments and advocating for CHWs within departments who might not necessarily have a full understanding of the CHW role has also been a challenge for us.”
