Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care

Article Figures & Data

Table 1.

Periods of Care Definitions

Period	Goal	Duration	Behavioral Marker/Definition of Success
Outreach	Engage patient	1 day to 7 weeks	Patient and CHW agree to meet face-to-face
Stabilization	Build trust, create alliance	Up to 12 weeks combined	Patient and CHW problem solve for obstacles to self-care
Self-care generativity	Patient commits to self-care	Up to 12 weeks combined	Patient plans self-care, progresses through self-care milestones

Table 2.

Cohort Demographics and Baseline Hemoglobin A_1c Values

Characteristic	Total	Outreach	Stabilization	Self-Care Generativity
Participants, No. (%)	986 (100.0)	267 (27.1)	399 (40.5)	320 (32.4)
Female, No. (%)	605 (61.6)	163 (61.0)	223 (55.9)	219 (68.4)
Male, No. (%)	378 (38.4)	105 (39.3)	174 (43.6)	99 (30.9)
Age, y, mean (SD)	55.7 (10.8)	54.6 (11.4)	57.6 (10.0)	54.9 (10.9)
English preferred, %	60.4	62.9	64.2	53.8
Uninsured, %^{^a}	59.0	56.6	59.4	60.6
Undocumented status, %	11.0	10.0	8.0	16.0
Baseline HbA1c, mean (SD)	10.3 (2.0)	10.5 (2.0)	10.1 (2.0)	10.4 (2.0)

HbA_1c = hemoglobin A_1c.
↵a Includes participants covered by a Bexar County health care installment payment plan graduated by family size and income.

Table 4.

Health Care Utilization Outcomes for Negative Binomial Models

Characteristic	Urgent-Care Visits		Emergency Department Visits		Hospita Visits
Characteristic	Unadjusted, IRR (95% CI)	Adjusted, IRR (95% CI)	Unadjusted, IRR (95% CI)	Adjusted, IRR (95% CI)	Unadjusted, IRR (95% CI)	Adjusted, IRR (95% CI)
Intercept	0.68 (0.55-0.83)	0.45 (0.23-0.88)	0.38 (0.29-0.50)	0.31 (0.14-0.70)	0.15 (0.10-0.22)	0.07 (0.02-0.25)
Stabilization	1.22 (0.93-1.61)	1.11 (0.86-1.44)	2.32 (1.64-3.28)^{^a}	1.74 (1.27-2.39)^{^a}	2.10 (1.29-3.42)^{^a}	2.01 (1.25-3.23)^{^a}
Outreach	1.10 (0.81-1.48)	1.14 (0.86-1.52)	1.60 (1.10-2.38)^{^a}	1.31 (1.01-1.79)^{^a}	1.21 (0.69-2.11)	1.06 (0.60-1.85)
Self-care generativity	Reference	Reference	Reference	Reference	Reference	Reference
Emergency visits prior		…		1.49 (1.38-1.61)^{^a}		…
Hospital visits prior		…		…		2.07 (1.64-2.61)^{^a}
Urgent-care visits prior		1.38 (1.31-1.47)^{^a}		…		…
Age		1.00 (0.99-1.01)		0.99 (0.98-1.01)		1.01 (0.99-1.03)
Sex		0.79 (0.63-1.00)		1.05 (0.80-1.36)		1.32 (0.89-1.98)
Insured		1.26 (1.00-1.59)		1.37 (1.04-1.80)^{^a}		1.39 (0.91-2.1)
Immigrant status		1.08 (0.70-1.65)		0.84 (0.51-1.39)		0.53 (0.25-1.11)
Language preference		1.09 (0.83-1.43)		1.14 (0.82-1.58)		1.23 (0.74-2.04)

IRR = incidence rate ratio.
↵a Statistically significant result.
Note: Health care utilization outcomes—IRRs and 95% CIs for health care events over cohort follow-up, adjusted for age, sex, health insurance status, immigrant status, language preference, and prior year health care utilization. The model yields parameter estimates representing a log-count value (not shown) which are then used as an exponential of e. yielding an interpretable result (shown in table), representing the percentage of the original count units.