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首页> 美国卫生研究院文献>Hawaii Journal of Health Social Welfare >Community Health Workers in Action: Community-Clinical Linkages for Diabetes Prevention and Hypertension Management at 3 Community Health Centers
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Community Health Workers in Action: Community-Clinical Linkages for Diabetes Prevention and Hypertension Management at 3 Community Health Centers

机译：社区卫生工作者的行动：3个社区卫生中心的社区临床联系用于糖尿病预防和高血压管理

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In 2014, the Hawai‘i State Department of Health (HDOH) received funding from the Centers for Disease Control and Prevention (CDC), via the 1422 Cooperative Agreement, to conduct diabetes prevention and hypertension management. To implement one grant-required strategy—the engagement of community health workers (CHWs) to promote community-clinical linkages—the HDOH partnered with the Hawai‘i Primary Care Association and 9 federally qualified health centers (FQHCs). This qualitative evaluation case study sought to understand how 3 of the funded FQHCs engaged CHWs, the types of community-clinical linkages the CHWs promoted, and the facilitators of and barriers to those linkages. Evaluators conducted 2 semi-structured group interviews with 6 administrators/clinicians and 7 CHWs in April 2018. The transcribed interviews were deductively and inductively analyzed to identify major themes. First, CHWs made multiple internal and external linkages using resources provided by the grant as well as other resources. Second, CHWs faced barriers in making community-clinical linkages due to individual patient, geographic, and economic constraints. Third, CHWs have unmet professional needs related to building community-clinical linkages including professional development, networking, and burnout. Reimbursement and payment mechanisms are an all-encompassing challenge to the sustainability of CHW positions, as disease-specific funding and a complete lack of reimbursement structures make CHW positions unstable. Thus, CHWs fulfill a number of grant-specific roles at FQHCs due to this patchwork of funding sources, and this relates to CHWs' experiences of burnout. Policy implications of this study include funding and reimbursement stabilization so FQHCs may consistently engage and support the CHW workforce to meet their patients' complex, diverse needs. More professional development opportunities for CHWs are necessary to build sustainable networks of resources.
机译：2014年，夏威夷州卫生部（HDOH）通过1422合作协议获得了疾病控制与预防中心（CDC）的资助，用于开展糖尿病预防和高血压管理。为了实施一项需要拨款的策略（社区卫生工作者（CHW）的参与以促进社区与临床的联系），HDOH与夏威夷初级保健协会和9个联邦合格的卫生中心（FQHC）合作。该定性评估案例研究旨在了解3个获得资助的FQHC如何与CHW接触，CHW促进的社区与临床的联系类型以及这些联系的促进者和障碍。评估人员于2018年4月与6名行政人员/临床医生和7名CHW进行了2次半结构化的小组访谈。对转录的访谈进行了演绎和归纳分析，以确定主要主题。首先，社区工作者利用赠款提供的资源以及其他资源建立了多个内部和外部联系。其次，由于个别患者，地理和经济方面的限制，社区卫生工作者在建立社区临床联系方面面临障碍。第三，社区卫生工作者在建立社区与临床之间的联系方面有未满足的专业需求，包括专业发展，网络和倦怠。报销和支付机制是CHW职位可持续性的一个全面挑战，因为针对特定疾病的资金和完全缺乏报销结构使CHW职位不稳定。因此，由于资金来源的分散，CHW在FQHC履行了许多特定于赠款的角色，这与CHW的工作倦怠有关。这项研究的政策含义包括稳定资金和偿还费用，因此FQHC可以始终如一地参与和支持CHW员工队伍，以满足其患者复杂而多样的需求。社区卫生工作者需要更多的专业发展机会，以建立可持续的资源网络。

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