Research Matrix
Cost Benefit: Thirteen published studies were identified which dealt with cost, cost-effectiveness or “return on investment” in CHW activities. Only two of these studies dealt with cost-related measures as a principal topic of the published articles.
| Lead Author | Year | Health Issue | Outcome Measures | Cost Measures |
Barnes-Boyd |
2001 |
Infant mortality reduction |
Mortality rates, program retention, health problems identified, immunization rates |
Implied cost saving potential in that outcomes with nurse-CHW team at least equal to those of nurse-only team (no calculations) |
Beckham |
2004 |
Asthma management |
Reported symptoms, doctor visits, ED visits |
Total per capita costs reduced from $310 to $129; ED costs reduced from $1,119 per participant to $188 |
Black |
1995 |
Failure to thrive (NOFTT) |
Child development measures, parent-child interaction scores |
Costs of intervention “generally consistent with” other home-visiting programs ($1,709-6,200 per year) |
Brown |
2001 |
Diabetes self-management |
Blood measures, health beliefs, diabetes knowledge |
Cost of intervention $384 per person per year |
Fedder |
2003 |
Diabetes management |
ED visits, hospital admissions, quality-of-life indicators |
Cost to Medicaid reduced an average of $2,245 per patient per year |
Krieger |
2000 |
Older adult flu and pneumonia prevention |
Immunization rates |
Marginal cost per additional vaccine administered = $117; options for lower cost discussed |
Krieger |
2005 |
Asthma (indoor triggers) |
Caregiver quality of life; use of urgent health services; symptom days |
Projected four-year net savings $189-721 per participant |
Margolis |
1998 |
Breast, cervical cancer screening |
Screening rates |
Marginal cost per additional exam estimated at $700-750 |
Rodewald |
1999 |
Childhood immunizations |
Immunization rates |
Marginal cost per additional immunization administered = $474. Each $1,000 in program costs also produced additional preventive and other primary care office visits |
Sox |
1999 |
Cancer screenings for women |
Effectiveness of trained Community Health Aides performing clinical exams and Pap smears (Alaska) |
Implied cost saving in reduced travel of clinical personnel to remote villages (no calculations) |
Weber |
1997 |
Mammography |
Rates of mammography use |
Marginal cost of CHW activity per additional mammography performed = $375, equivalent to $11,591 per year of life saved |
Whitley |
2006 |
Primary care utilization |
Utilization, charges and reimbursements |
Cost reduction of $14,244 per month, program cost of $6,229 per month = ROI ratio of 2.28:1 |
Wolff |
1997 |
Mental illness |
Treatment contact, psychiatric symptoms, satisfaction with treatment |
Total cost of treatment less with CHW but not statistically significant: treatment only, $49,510; treatment with CHW team, $39,913; brokered case management, $45,076 |
Bibliography of Community Health Workers Studies & Resources
Community Health Outcomes
Allen, J.,K., & Scott, L.,Benz. Alternative models in the delivery of primary and secondary prevention programs.
American Association of Diabetes Educators. (2003). Diabetes community health workers. The Diabetes Educator, 29(5), 818, 821-4.
Anderson, D., Harris, M., & McCosker, H. (1997). Violence against women: An education program for rural community health workers. The Australian Journal of Rural Health, 5(1), 17-21.
Andrews, J. O., Felton, G., Wewers, M. E., & Heath, J. (2004). Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship : An Official Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 36(4), 358-365.
Brownstein, J. N., Bone, L. R., Dennison, C. R., Hill, M. N., Kim, M. T., & Levine, D. M. (2005). Community health workers as interventionists in the prevention and control of heart disease and stroke. American Journal of Preventive Medicine, 29(5 Suppl 1), 128-133.
Center for Health Outreach, James Madison University. (2006). Final report on the status, impact and utilization of community health workers. (House Document No. 9)
Dennis Keane, Christine Nielsen, and Catherine Dower (2004). UCSF Center for the Health Professions. Community Health Workers and Promotores in California. www.furturehealth.ucsf.edu
Whitley EM. Everhart RM., Wright RA, USA (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor & Underserved. 17(1 Suppl):6-15, 2006.Feb.
Fedder, D. O., Chang, R. J., Curry, S., & Nichols, G. (2003). The effectiveness of a community health worker outreach program on healthcare utilization of west baltimore city medicaid patients with diabetes, with or without hypertension. Ethnicity & Disease, 13(1), 22-27.
Forst, L., Lacey, S., Chen, H. Y., Jimenez, R., Bauer, S., & Skinner, S. et al. (2004). Effectiveness of community health workers for promoting use of safety eyewear by latino farm workers. American Journal of Industrial Medicine, 46(6), 607-613.
Gaffney, K. F., & Altieri, L. B. (2001). Mothers' ranking of clinical intervention strategies used to promote infant health. Pediatric Nursing, 27(5), 510-515.
Gary, T. L., Bone, L. R., Hill, M. N., Levine, D. M., McGuire, M., & Saudek, C. et al. (2003/7). Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban african americans. Preventive Medicine, 37(1), 23-32.
Gasana, J., & Chamorro, A. (2002). Environmental lead contamination in miami inner-city area. Journal of Exposure Analysis and Environmental Epidemiology, 12(4), 265-272.
Healthcare Education Industry Partnership, Health Professionals for Diversity (HPD) Coalition (2005) HPD Digest November 30, 2005. Minnesota Project to Standardize Training for Community Health Worker.
Healthcare Education Industry Partnership, Signature Solution Strategies, LLC.(2006) 2005 Minnesota Community Health Worker Work Force Analysis.
Hill, M. N., Han, H., Dennison, C. R., Kim, M. T., Roary, M. C., & Blumenthal, R. S. et al. (2003/11). Hypertension care and control in underserved urban african american men: Behavioral and physiologic outcomes at 36 months. American Journal of Hypertension, 16(11), 906-913.
Hunter, J. B., de Zapien, J. G., Papenfuss, M., Fernandez, M. L., Meister, J., & Giuliano, A. R. (2004). The impact of a promotora on increasing routine chronic disease prevention among women aged 40 and older at the U.S.-mexico border. Health Education & Behavior : The Official Publication of the Society for Public Health Education, 31(4 Suppl), 18S-28S.
Institute of Medicine (2002). Unequal Treatment: What Healthcare Providers Need to Know About Racial and Ethnic Disporitiies in Healthcare.
Johnson, B. A., & Khanna, S. K. (2004). Community health workers and home-based care programs for HIV clients. Journal of the National Medical Association, 96(4), 496-502.
Kovach, A. C., Becker, J., & Worley, H. (2004). The impact of community health workers on the self-determination, self-sufficiency, and decision-making ability of low-income women and mothers of young children. Journal of Community Psychology, 32(3), 343-356.
Krieger, J., Collier, C., Song, L., & Martin, D. (1999). Linking community-based blood pressure measurement to clinical care: A randomized controlled trial of outreach and tracking by community health workers. American Journal of Public Health, 89(6), 856-861.
Krieger, J. W., Takaro, T. K., Song, L., & Weaver, M. (2005). The seattle-king county healthy homes project: A randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. American Journal of Public Health, 95(4), 652-659.
Laveissiere, C., Meda, A. H., Doua, F., & Sane, B. (1998). Detecting sleeping sickness: Comparative efficacy of mobile teams and community health workers. Bulletin of the World Health Organization, 76(6), 559-564.
Levine, D. M., Bone, L. R., Hill, M. N., Stallings, R., Gelber, A. C., & Barker, A. et al. (2003). The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban african-american population. Ethnicity & Disease, 13(3), 354-361.
Levine, D. M., Bone, L. R., Hill, M. N., Stallings, R., Gelber, A. C., & Barker, A. et al. (2003). For the patient. community health workers help to reduce high blood pressure. Ethnicity & Disease, 13(3), 403.
Lewin, S. A., Dick, J., Pond, P., Zwarenstein, M., Aja, G., & van Wyk, B. et al. (2005). Lay health workers in primary and community health care. Cochrane Database of Systematic Reviews (Online : Update Software), (1)(1), CD004015.
Lukes, S. (2003). Promotora training program invests in oral health. Access, 17(9), 30.
Mack, M., Uken, R., Poers, Jane; People Improving the Community’s Health: Community Health Workers as Agents of Change. Journal of Health Care for the Poor and Underserved 17(2006): 16-25.
Minnesota Immigrant Health Task Force. (2005). Immigrant health A call to action (Print No. 1). Minnesota: Minnesota Department of Health.
Nemcek MA FAU - Sabatier,Rosemary, Sabatier R, Andrews JO FAU - Felton,Gwen, Felton G FAU - Wewers,Mary Ellen, Wewers ME FAU - Heath,Janie, & Heath J. State of Evaluation: Community Health Workers; use of Community Health Workers in Research with Ethnic Minority Women
Nemcek, M. A., & Sabatier, R. (2003). State of evaluation: Community health workers. Public Health Nursing (Boston, Mass.), 20(4), 260-270.
O'Malley, A. S., Sheppard, V. B., Schwartz, M., & Mandelblatt, J. (2004). The role of trust in use of preventive services among low-income african-american women. Preventive Medicine, 38(6), 777-785.
Ozarin, L. D. (1996). The important contribution of community mental health workers. American Journal of Public Health, 86(9), 1319-1320.
Quigley, P., & Ebrahim, G. J. (1994). Women and community health workers promoting community health and development. Journal of Tropical Pediatrics, 40(2), 66-71.
Perez, M., Findley, S. E., Mejia, M., Martinez, J. The Impact of Community Health Worker Training and Programs in New York City. Journal of Health Care for the Poor and Underserved 17: 26-43.
Rosenthal, (1998).A Summary of the National Community Health Advisor Study: Weaving the future http://www.rho.ariona.edu/nchas_files/nchas_summary.htm
Ramontja, R. M., Wagstaff, L. A., & Khomo, N. E. (1998). Urban community health workers: Selection, training, practice and outcomes. Curationis, 21(3), 38-41.
Ramos, I. N., May, M., & Ramos, K. S. (2001). Environmental health training of promotoras in colonias along the texas-mexico border. American Journal of Public Health, 91(4), 568-570.
Sheppard, M. M. (1990). Trust is strengthened through commitment. Plastic Surgical Nursing : Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses, 10(3), 106.
Sheppard, V. B., Zambrana, R. E., & O'Malley, A. S. (2004). Providing health care to low-income women: A matter of trust. Family Practice, 21(5), 484-491.
Sherer, J. L. (1994). Good neighbors make for good health. community health workers educate their own. Trustee : The Journal for Hospital Governing Boards, 47(12), 6-9.
Staten, L. K., Gregory-Mercado, K. Y., Ranger-Moore, J., Will, J. C., Giuliano, A. R., & Ford, E. S. et al. (2004). Provider counseling, health education, and community health workers: The arizona WISEWOMAN project. J.Womens Health.(Larchmt), 13(5), 547-556.
Swider, S. M. (2002). Outcome effectiveness of community health workers: An integrative literature review. Public Health Nursing (Boston, Mass.), 19(1), 11-20.
Vetter, M. J., Bristow, L., & Ahrens, J. (2004). A model for home care clinician and home health aide collaboration: Diabetes care by nurse case managers and community health workers. Home Healthcare Nurse, 22(9), 645-648.
Walker, Damian G.; Stephen, Jan (2005) How do we determine whether community health workers are cost-effective? Some core methodological issues. Journal of Community Health, 30 (3).
Yeo, G. (2005). Role of community health workers in dementia case finding. Journal of the American Geriatrics Society, 53(10), 1829-1830.
Zuvekas, A., Nolan, L., Tumaylle, C., & Griffin, L. (1999). Impact of community health workers on access, use of services, and patient knowledge and behavior. J.Ambul.Care.Manage., 22(4), 33-44.
CHW Professional Development
Bastien, J. W. (1990). The making of a community health worker. World Health Forum, 11(4), 368-372.
Doherty, T. M., & Coetzee, M. (2005). Community health workers and professional nurses:
Defining the roles and understanding the relationships. Public Health Nursing (Boston, Mass.), 22(4), 360-365.
Felix-Aaron, K. L., Bone, L. R., Levine, D. M., & Rubin, H. R. (2002). Using participant information to develop a tool for the evaluation of community health worker outreach services. Ethnicity & Disease, 12(1), 87-96.
Gilson, L., Walt, G., Heggenhougen, K., Owuor-Omondi, L., Perera, M., & Ross, D. et al. (1989). National community health worker programs: How can they be strengthened? Journal of Public Health Policy, 10(4), 518-532.
Hill, M. N., Bone, L. R., & Butz, A. M. (1996). Enhancing the role of community-health workers in research. Image--the Journal of Nursing Scholarship, 28(3), 221-226.
Landon, B., Loudon, J., Selle, M., & Doucette, S. (2004). Factors influencing the retention and attrition of community health aides/practitioners in alaska. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association, 20(3), 221-230.
Love, M. B., Gardner, K., & Legion, V. (1997). Community health workers: Who they are and what they do. Health Education & Behavior : The Official Publication of the Society for Public Health Education, 24(4), 510-522.
Love, M. B., Legion, V., Shim, J. K., Tsai, C., Quijano, V., & Davis, C. (2004). CHWs get credit: A 10-year history of the first college-credit certificate for community health workers in the united states. Health.Promot.Pract., 5(4), 418-428.
Maurana, C.,A., & Rodney, M.,M. Strategies for developing a successful community health advocate program. Family and Community health, 23(1) 40-49.
Nunes Mde, O., Trad, L. B., Almeida Bde, A., Homem, C. R., & Melo, M. C. (2002). Community-based health workers: Building the identity of this hybrid, polyphonic character. Cadernos De Saude Publica / Ministerio Da Saude, Fundacao Oswaldo Cruz, Escola Nacional De Saude Publica, 18(6), 1639-1646.
Ramirez-Valles, J. (2001). "I was not invited to be a [CHW] ... I asked to be one": Motives for community mobilization among women community health workers in mexico. Health Education & Behavior : The Official Publication of the Society for Public Health Education, 28(2), 150-165.
Ramirez-Valles, J. (1999). Women, the welfare state, and their transnational dimension: The case of mexico's community health worker programs. International Journal of Health Services : Planning, Administration, Evaluation, 29(3), 597-621.
Roman, L. A., Lindsay, J. K., Moore, J. S., & Shoemaker, A. L. (1999). Community health workers: Examining the helper therapy principle. Public Health Nursing (Boston, Mass.), 16(2), 87-95.
Shrestha, S. (2003). A conceptual model for empowerment of the female community health volunteers in nepal. Educ.Health.(Abingdon), 16(3), 318-327.
Walker, D. G., & Jan, S. (2005). How do we determine whether community health workers are cost-effective? some core methodological issues. Journal of Community Health, 30(3), 221-229.
Wayland, C. (2002). Acceptable and appropriate: Program priorities vs. felt needs in a CHW program. Critical Public Health, 12(4), 335-350.
Witmer, A., Seifer, S. D., Finocchio, L., Leslie, J., & O'Neil, E. H. (1995). Community health workers: Integral members of the health care work force. American Journal of Public Health, 85(8 Pt 1), 1055-1058.