Effectiveness of a community health worker cardiovascular risk reduction program in public health and health care settings

Abstract

Objectives: We evaluated whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings.

Methods: The CHWs provided point-of-service screening, education, and care coordination to residents in 34 primarily rural Colorado counties. The CHWs utilized motivational interviewing and navigated those at risk for CHD into medical care and lifestyle resources. A software application generated a real-time 10-year Framingham Risk Score (FRS) and guideline-based health recommendations while supporting longitudinal caseload tracking. We used multiple linear regression analysis to determine factors associated with changes in FRS.

Results: From 2010 to 2011, among 4743 participants at risk for CHD, 53.5% received medical or lifestyle referrals and 698 were retested 3 or more months after screening. We observed statistically significant improvements in diet, weight, blood pressure, lipids, and FRS with the greatest effects among those with uncontrolled risk factors. Successful phone interaction by the CHW led to lower FRS at retests (P = .04).

Conclusions: A CHW-based program within public health and health care settings improved CHD risk. Further exploration of factors related to improved outcomes is needed.

FIGURE 1—

Distribution of the Colorado Heart Healthy Solutions program throughout Colorado. Note. CHW = community health worker.

FIGURE 2—

Flow of program participants including those screened, determined to be at risk for coronary heart disease, and those who received retesting and follow-up phone calls: Colorado Heart Healthy Solutions Program, 2010–2011. Note. OSCAR = Outreach Screening and Referral system.