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首页> 外文期刊>Hawaii medical journal >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：社区卫生工作者行动：3个社区保健中心的糖尿病预防和高血压管理的社区临床联系

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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，夏威夷州卫生署（HDOH）收到了疾病控制和预防中心（CDC）的资金，通过1422年的合作协议进行糖尿病预防和高血压管理。实施一个必要的策略 - 社区卫生工作者（CHW）的参与促进社区临床键 - HDOH与夏威夷初级保健协会和9名联邦合格的医疗中心（FQHC）合作。这种定性评估案例研究试图了解3个资助的FQCS符合CHW，社区临床联系的类型如何促进CHW，以及这些联系的促进者和障碍。评估人员于2018年4月进行了2名半结构化集团访谈，其中6名管理员/临床医生和7个CHWS。转账采访，并禁止分析了识别主要主题。首先，CHWS使用赠款提供的资源以及其他资源制作多个内部和外部联系。其次，由于个体患者，地理和经济限制，CHWS面临屏幕临床联系的障碍。第三，CHW有与建立社区临床联系有关的未满足的专业需求，包括专业发展，网络和倦怠。报销和支付机制是对CHW职位可持续性的全部挑战，因为特定疾病特定的资金和完全缺乏报销结构使CHW位置不稳定。因此，由于资金来源的这种拼凑而言，CHW在FQCS上履行了许多特定的作用，这涉及CHWS倦怠的经历。本研究的政策含义包括资金和报销稳定，因此FQCS可能一致地互动和支持CHW劳动力以满足其患者的复杂需求。 CHW的更多专业发展机会是建立可持续资源网络的必要条件。

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