Engaging Community Health Workers in the Effort to Prevent Sudden Unexpected Death and Death From Chronic Illness

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To the Editor:
The April 2017 Medical Care article by Litzelman and colleagues discussed a community health worker (CHW) initiative to improve advance care planning among elderly patients.1 An accompanying editorial outlined frameworks to advance similar advance care planning–oriented work.2 We strongly endorse these articles for exemplifying expansion of the scope of CHW initiatives to a broad range of clinical and public health concerns.
CHWs possess community knowledge that enables them to interface between health care systems and communities to improve health care quality, cultural competence, and access.3,4 CHW interventions for chronic illnesses reduce health care utilization and cost, especially among socially isolated populations.5,6 In North Carolina chronic disease is prevalent and within Wake County 15% of all deaths before age 65 are sudden and unexpected.7 Victims are disproportionately poor, male, rurally located, unmarried, and African American.7,8 Notably, CHW have previously bridged gaps between socially isolated populations and health care systems for chronic illness management.9 We recommend extending the successes of CHW interventions to neighborhood-based strategies to identify and address health care disparities applicable to sudden death and ultimately, other illnesses. Herein, interactions in the patient home can establish rapport and enable interventions tailored to patients’ individual social and health needs. Given the complexity of sudden unexpected death, assessments of such interventions should be multifocal. Preliminary goals may include demonstrating feasibility of community engagement and follow-up with individuals at-risk for sudden unexpected death, improving tangible health outcomes (eg, improved hypertension control) and eventually a reduction in the rate of premature, avoidable deaths. This model would enable CHW to simultaneously improve immediate care and research medical barriers for socially isolated patients.
Systemic policies on professional identity, workforce development, and financing are necessary for sustainable CHW inclusion in health care teams.10 In the interterm, interventions of the proposed nature may further the impetus for development of these critical supporting policies. We commend Litzelman et al1 and Calista and Tjia2 for their pioneering work and vision to expand the potential scope of CHW initiatives.
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