The United States has experienced remarkable improvements in public
health and medical progress throughout much of the twentieth
century, including major advances in pharmaceutical and medical
device innovation and gains in life expectancy. These improvements,
however, have not been accessible to all parts of U.S. society.
Substantial disparities in life expectancy, health, and health care
persist. Although many actors-including health care systems,
insurers, health care providers, and patients-contribute to these
disparities, bias, discrimination, and stereotyping during the
clinical encounter also explain health care disparities. Experts
recommend reducing fragmentation in health care systems, improving
awareness on the part of health care providers of these problems,
strengthening culturally competent approaches to the delivery of
health care, and increasing the diversity of the health care
workforce, as strategies to reduce health care disparities. A core
component in recommendations to address healthcare disparities is
the involvement of the community: specifically, the involvement of
community health workers (CHWs). The RTI International-University
of North Carolina at Chapel Hill Evidence-based Practice Center
(RTI-UNC EPC) conducted a systematic review on outcomes of CHW
interventions. The review addressed four key questions (KQs): KQ 1.
How do CHWs interact with participants? Specifically, what is the
place of service, type of service, type of educational materials
used, duration of interaction with participants, and length of
followup? KQ 2. What is the impact of CHWs on outcomes,
particularly knowledge, behavior, satisfaction, health outcomes,
and health care utilization? KQ 3. What is known about the
cost-effectiveness of CHWs for improving health outcomes? KQ 4a.
What are characteristics of training for CHWs in the outpatient
setting? KQ 4b. Are particular training characteristics associated
with improved outcomes for patients?
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