The Launch of Massachusetts Community Health Worker Certification: Findings From the Massachusetts Community Health Worker Workforce Surveys.

OBJECTIVES: The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy. METHODS: We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch? RESULTS: Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations. CONCLUSIONS: Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce.

Recruitment of sexual minority and heterosexual colorectal cancer survivors through US cancer registries.

PURPOSE: Describe the process, outcomes, and costs of cancer registry recruitment and enrollment of sexual minority and heterosexual non-metastatic colorectal cancer survivors into an observational survivorship study. METHODS: We recruited stage I-III colorectal cancer survivors from four US cancer registries. Potential participants were screened for eligibility, and all eligible sexual minority and every 10th heterosexual survivor was invited to participate in a 45-min telephone interview. RESULTS: We mailed study packets to 17,855 individuals and obtained 6370 screening surveys of presumed eligible individuals. After screening, there were 182 eligible sexual minority and 5568 eligible heterosexual survivors. Of the 719 invited survivors, 127 sexual minority and 353 heterosexual individuals participated in the interview. There were some small differences in personal and neighborhood sociodemographic characteristics for the survivors who screened eligible and completed the interview relative to the registry sample. The per-participant direct costs were about $40, $120, and $1425 in the registry, screened eligible, and interviewed samples, respectively. CONCLUSIONS: Although we did not observe substantial selection biases, the costs of enrolling a representative sample were high. IMPLICATIONS FOR CANCER SURVIVORS: Inclusion of sexual orientation and gender identity as standard demographic questions in cancer registries is needed for reliable and cost-efficient monitoring of population health.

Community-Based HIV and Viral Hepatitis Fellowship Evaluation: Results from a Qualitative Study.

PURPOSE: The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows' perceptions of the program and its impact on their current positions and career trajectories. METHODS: Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data. RESULTS: Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program's commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care. CONCLUSION: As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.

Evaluating the impact of community health worker certification in Massachusetts: Design, methods, and anticipated results of the Massachusetts community health worker workforce survey.

Background: Professional certification of community health workers (CHWs) is a debated topic. Although intended to promote CHWs, certification may have unintended impacts given the grassroots nature of the workforce. As such, both intended effects and unintended adverse effects should be carefully evaluated. However, there is a lack of published literature describing such effective evaluations with a robust methodology. In this methods paper, we describe a key component of evaluating CHW certification in Massachusetts-the Massachusetts CHW Workforce Survey. Methods: Design of the surveys was informed by a program theory framework that delineated both positive and negative potential impacts of Massachusetts CHW certification on CHWs and CHW employers. Using this framework, we developed measures of interest and preliminary CHW and CHW employer surveys. To validate and refine the surveys, we conducted cognitive interviews with CHWs and CHW employers. We then finalized survey tools with input from state and national stakeholders, CHWs, and CHW employers. Our sample consisted of three frames based on where CHWs are most likely to be employed in Massachusetts: acute care hospitals, community-based organizations, and ambulatory care health centers, primarily community health centers and federally qualified health centers. We then undertook extensive outreach efforts to determine whether each organization employed CHWs and to obtain CHW and CHW employer contact information. Our statistical analysis of the data utilized inverse probability score weighting accounting for organizational, site, and individual response. Anticipated results: Wave one of the survey was administered in 2016 prior to launch of Massachusetts CHW certification and wave two in 2021. We report descriptive statistics of the three sample frames and response rates of each survey for each wave. Further, we describe select anticipated results related to certification, including outcomes of the program theory framework. Conclusions: The Massachusetts CHW Workforce Survey is the culmination of 5 years of effort to evaluate the impact of CHW certification in Massachusetts. Our comprehensive description of our methodology addresses an important gap in CHW research literature. The rigorous design, administration, and analysis of our surveys ensure our findings are robust, valid, and replicable, which can be leveraged by others evaluating the CHW workforce.

Comparison of Patient Experience between a Practice for Homeless Patients and Other Practices Engaged in a Patient-Centered Medical Home Initiative.

Despite its increasing popularity, little is known about the patient-centered medical home (PCMH) model in primary care settings serving homeless populations. Our objective was to understand how patient experience differs between a PCMH demonstration practice designed for homeless people in Massachusetts and other practices participating in the same statewide initiative. The study population included 194 homeless patients and 1,868 patients from comparison practices. Patient experience was compared on key measures of patient-centeredness, while applying case-mix adjustment to control for sociodemographic and clinical factors. The practice for homeless patients scored higher than the comparison group on self-management support and behavioral health integration, while being equivalent on three other measures. Potential areas for improvement include measures related to communication, front desk staff, and timely appointments. We discuss possible explanations for the observed pattern of results in the context of the unique challenges faced by a practice designed to serve individuals experiencing homelessness.