The Use of Community Health Workers in Community Health Centers

Area of Science:

• Public Health
• Health Services Research
• Healthcare Workforce Studies

Background:

• Community health centers (CHCs) previously did not report community health workers (CHWs) separately, hindering analysis of CHW utilization trends.
• A change in reporting in 2016 allowed for better tracking of CHWs within CHCs.

Purpose of the Study:

• To analyze trends in CHW employment by CHCs between 2016 and 2018.
• To identify factors associated with CHC's adoption and utilization of CHWs.

Main Methods:

• A two-part statistical model was used to assess CHW adoption probability and full-time equivalent (FTE) usage.
• Difference-in-differences analysis compared non-CHW enabling services FTEs before and after the 2016 reporting change.

Main Results:

• The proportion of CHCs employing CHWs increased from 20.04% in 2016 to 28.34% in 2018.
• Larger CHCs (by patient volume) and those with diverse grant funding were more likely to use CHWs.
• A significant portion of the observed increase in CHW utilization was attributed to changes in reporting categories.

Conclusions:

• While CHC adoption of CHWs increased, a substantial part of this growth resulted from altered reporting practices.
• Financial barriers appear to be a significant factor limiting the expansion of CHW services within CHCs.