title: Improving Adherence to Care Recommendations Using a Community Health Worker (CHW) Intervention with the Pediatric Medical Home.
abstract: While CHW interventions improve health outcomes, evidence identifying specific domains of CHW-delivered support resulting in positive outcomes is limited. Our goals were to identify domains of CHW-delivered support that assist families with adhering to recommended pediatric care; and, to identify predictors of successful completion of an enriched medical home intervention (EMHI) using trained CHWs making home visits to provide health education and support positive health behaviors. We performed a prospective descriptive study of 88 families participating in a protocol-based EMHI. Completers (N = 46) finished the program with mutual agreement that the family can independently adhere to recommended clinical care. Non-completers (N = 42) were lost to follow-up or dropped out of the program before reaching this milestone. Using Grounded Theory, two trained coders evaluated CHW tasks recorded in an electronic database and classified these tasks across 17 domains. We assessed predictors of EMHI completion using logistic regression. The 88 EMHI participants were primarily <24 months of age (80 %), Hispanic (56 %), and Medicaid enrollees (67 %). Hispanic families (OR = 2.76, p = 0.04) and those with self-reported program goals to 'facilitate family's creation of a system to keep track of child's medical information' (OR = 3.11, p = 0.02) or a 'newborn-specific goal' (OR = 3.21, p = 0.04), such as feeding and safety tips, were more likely to complete the EMHI compared to their counterparts. The most consistent CHW tasks were supporting medical appointments, medication maintenance, and providing health education. CHW interventions designed to improve health behavior outcomes of 'at-risk' families, including Medicaid enrollees, may benefit from support in goal-setting and strategies to systematically manage their child's medical care.
authors.affiliation: School of Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Justvig
authors.affiliation: College of Arts and Sciences, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Justine
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Caravella
authors.affiliation: Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Minqin
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Program in Public Health, and School of Health Technology and Management, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Benz Scott
authors.affiliation: School of Medicine, Stony Brook University, Stony Brook, NY, USA. susmita.pati@stonybrookmedicine.edu.|Department of Pediatrics, Stony Brook University, Stony Brook, NY, USA. susmita.pati@stonybrookmedicine.edu.
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
mesh_terms: D000293:Adolescent; D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D003150:Community Health Workers; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods*; D011446:Prospective Studies; D000074822:Treatment Adherence and Compliance