CHWs Changing Outcomes in South Carolina

Quantitative evaluation of partner-submitted quarterly reports is conducted by CRPH. A qualitative evaluation and study, which includes processes such as in-depth interviews with CHWs, photovoice, sharing of success stories, and other approaches, is conducted by CCHA. Both quantitative and qualitative evaluation findings are compiled to illustrate not only the resulting impact of CHWs, but also the unique skills, characteristics, and context—the “how”—behind that impact. 

At the start of the Year 2, participating organizations chose to focus on one or more of the following priority health topics most relevant to the needs of the communities they serve:

• Diabetes (Type II)
• High Need/High-Cost Service Use
• Perinatal Health
• Sickle Cell Disease

Organizations were encouraged to select topics that aligned with their existing CHW workflows. Thanks to continued pilot funding, the Perinatal Health topic was included beginning in the Year 2 project scope.

Data to be collected across sites as appropriate include, but are not limited to:

• Number of individuals reached
• Zip code of individuals’ residence
• Needs identified in screening
• Needs addressed
• Core roles/services provided by CHWs per patient encounter
• Patient demographics
• Referrals to health and social resources
• Medicaid claims data

Additional data specific to each selected health topic is also being collected.

• Increased number of individuals served in underserved areas of the state
• Increased access to social and health resources through community referrals and follow-up
• Increased access to care for individuals with Sickle Cell Disease
• Increased utilization of primary and preventive services by individuals with Type II diabetes and high need/high-cost healthcare utilization
• Increased access to perinatal health services and resources

From November 1, 2021, through the end of Q2 of Year 3 (April 30, 2024), CHWs participating in CHWs Changing Outcomes in SC have served 5,070 unique individuals through over 18,700 encounters.

Overview of Total Reach to Date (Year 1 through Q2 of Year 3)

*Medicaid coverage information includes only participants for whom demographic information was reported.

**Referral closure loops were not reported consistently during Q1 due to reporting transitions. This information in Q2 reflects the referrals with a status reported (closed, open, client did not follow up).

***Indicates total number of CHWs who have contributed to the project data from Year 1 to present.

One major CHW role is addressing social determinants of health and access to care through linkages to services. In Q2, referral closure outcomes were reports for 547 referral records and 55% were closed-loop referrals, meaning that the individual received the service they needed. Further, for sites focusing primarily on addressing social determinants of health, 93% of referrals with closure outcomes indicated resulted in the corresponding service being received. This result is important because for most clinical providers or health systems, only the referral is measured (without the closing of the “loop”), meaning that it cannot be determined if the person indeed got what they needed.

For additional details, please see the two-pagers linked below.

Example 1: At Beaufort Jasper Hampton Comprehensive Health Services (an FQHC), a provider asked the CHW if she was available to work on a weekend. The CHW thought it was for a health fair, but the provider said it was for a patient she was trying to keep out of the hospital who needed a home visit to check on blood pressure. The CHW coordinated the home visit, reviewed medications with the patient, and found out the patient didn’t have a beta blocker. The CHW then notified the provider, who sent in a prescription that day; the patient picked it up next day, which the CHW confirmed when she returned to the patient’s home. By the patient’s follow-up on Tuesday, their blood pressure (BP) was excellent.

Example 2: At James R. Clark Memorial Sickle Cell Foundation (JR Clark), CHWs spend time helping individuals living with sickle cell disease (SCD) with their utility bills when they are struggling to pay them. For individuals living with SCD, extreme high or low temperatures can trigger SCD crises, which in turn results in greater usage of emergency medical services5,6. Additionally, stress can lead to SCD crises5 . While SCD is recognized as a progressive, lifelong disease, CHWs at JR Clark help patients avoid preventable emergency care usage by reducing both exposure to extreme temperatures and financial stress through providing support with utilities.

Example 3: A CHW at AccessHealth Tri-County highlighted how they effectively collaborate with physicians as a member of the patient’s care team. The CHW provides critical supports for the patient, such as helping to make medical information easy to understand and serving as a patient-provider liaison:

‘A lot of my patients… go to the free clinics and I work with the physicians that are there…the patient will see them usually once every [month]. And so…[the physicians] leave notes for me, and I leave notes for them. So i [the patient] saw their endocrinologist and I’m not able to [attend the appointment], I have the notes of what

was said or happened, if any medications change …when I meet with the patient I can further explain, ‘This is the

kind of medication you’re on. This is how you’re supposed to take it. How are you feeling?’ and things like that. Because patients don’t always understand the doctors, honestly… so that opens a door for me because they’re more trusting in me to say…’lt’s making me feel weird or it’s making me not have an appetite,’ or things like that. And so I can relate, I’m like that liaison, I can relay that to the physician, things that the patient doesn’t always feel comfortable saying. Because again, the theme that I do see is a lot of our…underinsured or uninsured [patients} …don’t feel like they have the right to question what their medical provider says when that is absolutely not the case.”

Example 4: Access Kershaw’s CHW connects patients to cancer screenings by collaborating with both providers and local and state resources, in addition to addressing social determinants of health-related needs. The CHW shared an example of a client that was able to receive a life-saving procedure for breast cancer:

“I had a former client come to me needing help getting medicine. She was having a hard time getting to her local FQHC. So after sitting there and talking to her about what was going on … I referred her to CareSouth. At the end of the appointment, the provider asked … ‘Is there anything else you have going on?’ And the client says, ‘Well, I had this lump on my breast.’ The provider turned around. She’s like, “I can see it from here…” [The client had} had this for some time….[a previous] provider [had} said …’you just have dense breasts.’ So [the client] went and had a mammogram. Turns out she did have cancer. CareSouth referred her to McLeod, and she started seeing McLeod, got a double mastectomy. But you know, the good news is, had I not referred her to them and they took care of her and got her connected to McLeod, this patient would not be here.”