Electronic Health Record-Assisted Community Health Worker Coaching for Medication Adherence: Adaptation of an Evidence-Based Intervention

Abstract

Background: Community health workers (CHWs) are often employed in healthcare settings to link patients with services and providers to improve the quality and cultural competence of healthcare service delivery, particularly among populations experiencing health inequities. However, limited data exist on strategies to best integrate CHWs into the patient’s clinical team to deliver evidence-based care. Electronic health records (EHRs) may facilitate this integration and support care delivery. The BP Control project uses the EHR to facilitate the delivery of an evidence-based antihypertensive medication adherence coaching intervention by CHWs while integrating CHWs into the clinical team. The methods and process used to adapt the coaching intervention for EHR-assisted delivery by CHWs are described.

Methods: A team from two community health centers, each represented by a medical champion, operations champion, CHW, CHW supervisor and information technology staff, and a university-based practice facilitator, used a co-production methodology to adapt the EHR-assisted CHW-delivered coaching intervention. The practice facilitator led bi-monthly 90-minute meetings to discuss and identify strategies to leverage the EHR. The team identified key skills for the CHW to deliver the intervention and contributed to developing the CHW training curriculum. A smaller team of the CHWs, CHW supervisors and practice facilitator conducted Beta testing and made recommendations for improving functionality. EHR technical adaptations were implemented by an Information Technology consultant.

Findings: Strategies for EHR-assisted CHW-delivered coaching and CHW clinical team integration included: 1) EHR prompts to deliver each step of the evidence-based coaching algorithm, 2) EHR fields to document session information and generate fidelity reports, 3) EHR algorithms to track patient progress/follow up, and 4) EHR prompts to facilitate referrals to CHWs and CHW-initiated messaging to referring providers. The CHW training curriculum included basic medical knowledge (hypertension, medications, adherence) and behavioral counseling (5As, motivational interviewing) skills and addressed comfort utilizing technology and logistical matters of implementing the intervention in a larger care system. This curriculum was implemented via didactic sessions, videos, and role-plays to build skills.

Implications for D&I Research: Our co-production adaptation methodology leveraged EHR potential to improve the delivery of evidence-based interventions by CHWs to improve quality of patient care and address disparities in hypertension control.