The costs of an outreach intervention for low-income women with abnormal Pap smears.
ABSTRACT Follow-up among women who have had an abnormal Papanicolaou (Pap) smear is often poor in public hospitals that serve women at increased risk for cervical cancer. This randomized controlled trial evaluated and compared the total cost and cost per follow-up of a tailored outreach intervention plus usual care with the total cost and cost per follow-up of usual care alone.
Women with an abnormal Pap smear (n = 348) receiving care at Alameda County Medical Center (Alameda County, California) were randomized to intervention or usual care. The intervention used trained community health advisors to complement the clinic's protocol for usual care. We assessed the costs of the intervention and the cost per follow-up within 6 months of the abnormal Pap smear test result.
The intervention increased the rate of 6-month follow-up by 29 percentage points, and the incremental cost per follow-up was 959 dollars (2005 dollars). The cost per follow-up varied by the severity of the abnormality. The cost per follow-up for the most severe abnormality (high-grade squamous intraepithelial lesion) was 681 dollars, while the cost per follow-up for less severe abnormalities was higher.
In a health care system in which many women fail to get follow-up care for an abnormal Pap smear, outreach workers were more effective than usual care (mail or telephone reminders) at increasing follow-up rates. The results suggest that outreach workers should manage their effort based on the degree of abnormality; most effort should be placed on women with the most severe abnormality (high-grade squamous intraepithelial lesion).
SourceAvailable from: Nell Brownstein[Show abstract] [Hide abstract]
ABSTRACT: The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.Health Education Research 01/2009; 24(4):622-33. DOI:10.1093/her/cyn063 · 1.66 Impact Factor
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ABSTRACT: INTRODUCTION: The community health worker (CHW) model is a popular method for reaching vulnerable populations with diabetes. This study assessed implementation and effectiveness of the model within diabetes programs. METHODS: Four databases were searched to identify diabetes programs implementing the CHW model. Corresponding articles were reviewed and semi-structured interviews were conducted with directors of each program. RESULTS: Eight studies met inclusion criteria for review and their program managers were interviewed. Five CHW roles were identified: educator, case manager, role model, program facilitator, and advocate. Roles, responsibilities and training varied greatly across programs. Selected outcomes also varied, ranging from physiologic measures, to health behaviors, to measures of health care utilization and cost. CONCLUSIONS: Research regarding application of the community health worker model in diabetes management is limited and consensus regarding the scope of the CHW's role is lacking. Future studies should rigorously examine how best to integrate this promising model into chronic disease management.Journal of Health Care for the Poor and Underserved 01/2008; DOI:10.1353/hpu.0.0077 · 1.10 Impact Factor
Article: Phase One Literature Review