摘要：Objectives. We explored the benefits of using community health worker (CHW) encounter forms to collect data on patient interactions and assessed the effectiveness of these forms in guiding and directing interactions. Methods. A 1-page standardized encounter form was developed to document topics discussed during visits with diabetes patients. A portion of the form was designed to be used as a script to guide the interaction and assist patients in setting appropriate self-management goals. Data were also collected via CHW work logs and interviews with CHWs and their supervisors to validate findings. Results. Data were collected for 1198 interactions with 540 patients at 6 community health centers. Self-management goals were set during 62% of encounters. With respect to the most recent self-management goal set, patients who had set a challenging goal were more likely to be in the action stage of change than in other stages. Work logs revealed that CHWs engaged in a number of activities not involving direct patient interactions and thus not captured on encounter forms. Conclusions. Evaluating and monitoring CHWs’ daily activities has been challenging. Encounter forms have great potential for documenting the work of CHWs with patients. Community health workers (CHWs) have gained prominence in health care delivery, supporting strategies that recognize the influence of an individual’s community and environment on health outcomes. 1 CHWs have proliferated in racial/ethnic minority communities, frequently serving as liaisons between individuals and the health care system. Many organizations, including the Institute of Medicine, the Centers for Disease Control and Prevention, the American Public Health Association, and the American Association of Diabetes Educators, have acknowledged the contributions of CHWs, particularly as a resource for increasing access to care for vulnerable individuals, and recommend including CHWs as important members of health care teams. 2 – 5 Recent reviews 6 – 8 have demonstrated the impact of CHWs on the delivery of necessary services, including provision of culturally relevant health education, case management, system navigation, and case finding. Despite these promising developments, evaluating and monitoring CHWs’ daily activities has been challenging. In only a few studies 9 – 11 have CHWs been used to collect data for research and evaluation. These studies have focused on patients’ characteristics and preferences or barriers to receiving care rather than on activities of CHWs and their work with patients. Davis et al. 12 used CHW logs to periodically document services provided to patients living with diabetes in addition to conducting semistructured interviews with a subset of patients receiving those services. This approach was useful in identifying ways in which CHWs assisted patients. Although logs were successful in providing a snapshot of CHWs’ activities, they were not designed to monitor daily activities, provide information for ongoing supervision, or guide interactions between CHWs and patients. 12 Recommendations from the CHW literature often include the need for collecting consistent data regarding activities and interactions with patients. 13 During the second year of a Massachusetts statewide diabetes health disparities collaborative with support from the Robert Wood Johnson Foundation’s Finding Answers program, we randomly selected 6 of 12 participating community health centers (CHCs) to be assigned specially trained CHWs. We added CHWs to the CHCs’ health care teams to assist patients with self-management goal setting, one of the 6 components of the chronic care model. 14 , 15 CHWs were assigned a population of patients with type 2 diabetes who had been working with a “provider champion” and his or her team for the duration of the collaborative. We used a diabetes self-management CHW certificate course developed in collaboration with the Central Massachusetts Area Health Education Center Outreach Worker Training Institute to train CHWs. The curriculum for this training was designed to prepare individuals in basic CHW skills, with a focus on supporting patients with diabetes; CHWs were also provided training on assessing patients’ readiness to change their self-care behaviors and facilitating self-management goal setting. In addition, 1-hour conference calls were scheduled every 6 weeks to provide feedback regarding encounter form data, opportunities for networking, and formal presentations on topics of interest identified by either CHWs or their supervisors. In this study, we explored the effectiveness of using a CHW encounter form to collect data pertaining to patient interactions. We also assessed ways to use these forms to guide and direct interactions.
