How Outreach Programs Can Improve Health Outcomes

Feb 1, 2012 | Program Planning & Evaluation, Resources

Many outreach programs serve priority populations that are less likely to use preventive health services and have a higher disease burden compared to the general population. Health outreach programs play a critical role in improving and extending the reach of health care through activities such as health education, case management, basic health screening, and facilitating access to services.  These activities can directly and indirectly improve health outcomes of individuals and communities. 

On December 15th, 2011, Health Outreach Partners (HOP) hosted the national Peer-to-Peer Event, “The Role of Outreach in Improving Health Outcomes” including three panelists: 

  • Yurany Ninco, Outreach Program Coordinator, Family Health/La Clinica;
  • Noelle Wiggins, Founder/Manager, Community Capacitation Center;
  • Edward Zuroweste, Chief Medical Officer, Migrant Clinician’s Network.

Highlighted below are key points, strategies, and recommendations discussed during the event.

 

Why Connect Outreach to Health Outcomes?

It is important to monitor and evaluate outreach efforts to show how health outcomes are improved.  Outreach programs can show they have improved health outcomes by using evidence-based measures, or measures that have been shown to indicate health status. These measures could be related to hypertension, diabetes, prenatal care, cancer care, and other health conditions.

There are three important reasons to connect outreach to improved health outcomes. The first is related to reimbursement for program costs. We need to show the connection between outreach and improving outcomes in order to make outreach a reimbursable service. Second, we need compelling outcomes to show decision makers that outreach workers are integral members of primary care teams. Finally, we want to make sure that we are spending time and effort on activities that are actually changing patients’ behaviors, improving their health status, and enabling them to have a better sense of control over their health needs.

 

Outreach Activities that Improve Health Outcomes

Community Health Workers (Promotores de Salud) and Popular Education are two outreach models that are powerful in improving health outcomes. Activities stemming from these models include:

  • sharing culturally appropriate health education
  • providing informal counseling and social support
  • acting as advocates and connecting people to services
  • supporting ongoing disease self-management skills
  • facilitating community organizing and community empowerment (this can be done by bringing community members together in order to identify their health issues and to develop plans addressing those issues)

Programs can also increase positive health outcomes by strengthening the continuity of care.  This can be done with migrant populations by connecting patients to services in other areas. Migrant Clinician’s Network’s (MCN) Health Network is an excellent resource to bridge case management.

 

The Role of Empowerment in Improving Health Outcomes

Individual and community empowerment are often key in improving health outcomes. Characteristics of empowerment include:

  • gaining a sense of community,
  • perceived control (believing you can make change in your life),
  • perceived control at community level (believing you can make change in your community),
  • critical awareness of the world around you (realizing how you are connected to others and how larger societal structures impact you),
  • and taking action for change.

It is important for programs to foster patient empowerment.  Empowerment occurs when patients realize that they can have an impact on their own health. It also happens when patients know about services available to them and seek out those services.  The educational component of the care team can support and cultivate patient empowerment and self-efficacy. Outreach can play a critical role in ensuring that this type of empowerment education is practiced throughout the care team to maximize the impact on patients.

 

Where to Begin: Measuring and Reporting the Influence of Outreach Programs on Health Outcomes

When outreach programs want to effectively connect their activities to health outcomes, they should use both local knowledge and established data and literature. There are five steps to show that your outreach activities are impacting health outcomes.

  • Step One: Strategically decide what outcomes you want to measure. Start by ask front line staff how they measure success. Front line staff usually knows how they are making a difference in their community. Clinicians will also be an important resource in suggesting outcomes to measure and how they might be best measured at your agency. Find out how other similar organizations and programs have measured success. Commonly used measures include: self-reported health status, community empowerment, increased health knowledge and skills, improved health behavior, social capital, and community competence. Finally, consider what kinds of outcomes will be compelling for decision makers.  This can help the case that outreach programs are vital to primary care services. Compelling outcomes could include:
    • Decreased emergency room utilization or using emergency services less and preventative services more.
    • Changes in chronic disease management. 
    • Reduced health inequity. 
  • Step Two: Select a method and a tool to measure the outcome. This means deciding how to measure the outcomes you have selected. Common methods include surveys, focus groups, interviews, and collecting and sharing stories using digital storytelling (using digital technology to share stories) and photovoice (using participatory photography to document experiences, promote critical dialogue, and promote social action). Be sure to select dependable tools to collect data. Many tools have already been created.  Find them by going to peer-reviewed journal articles, collaborating with universities, and talking with researchers.
  • Step Three: Collect the data. When you are ready to start collecting data, make sure everyone on the team knows why the tools are important and how to use them. Community Health Workers who understand this and receive training in data collection are some of the best data collectors.
  • Step Four: Analyze the data. If your organization does not have resources internally for data analysis, consider seeking outside support from universities or technical assistance providers such as HOP and MCN.
  • Step Five: Present your findings. Consider who needs to know about your findings. Results are often shared through reports to funders, presentations at conferences, posting photovoice projects in public places and government buildings, sharing digital stories online, and publishing articles in peer-reviewed journals.  It is important to communicate what is working and not working with policy makers, advocates, and state, regional, and national organizations and agencies. Examples include state Medicaid agencies, primary care associations, and national technical assistance organizations (such as HOP and MCN).  They can help programs put resources into strategies that work and ensure they do not waste time on strategies that do not work. Within your local community, share as broadly as possible with senior management, board of directors, other staff, local media, and community members. 

When we gather data and share it with individuals and institutions that make decisions, we can push policy and payment systems to support our work in improving health outcomes and eliminating health inequity.

 

Additional Resources and Tools

  • Community Health Worker Evaluation Toolkit https://apps.publichealth.arizona.edu/CHWToolkit/toolkit.htm
  • Take a basic evaluation course at a local community college or university to  increase your ability to collect and use data
  • Use developed curriculum that has been shown to be effective
  • Be on the look-out for funding opportunities related to improving health outcomes using a Community Health Worker intervention.  These opportunities will benefit patients, health centers, outreach programs, and local communities.

 

For More Information on the Organizations Involved on This Call: