Date of Award

Spring 2021

Project Type

Clinical Doctorate

College or School

UNHM

Department

Nursing

Program or Major

Doctor of Nursing Practice

Degree Name

Other

First Advisor

Tracey Collins

Second Advisor

Donna Pelletier

Abstract

Community health workers provide case management and care coordination services to high-risk members enrolled in Louisiana Department of Health’s Medicaid program. Centers for Medicare and Medicaid Services require states entering contracts with managed care organizations to conduct external quality reviews by an independent External Quality Review Organization. Healthcare Effectiveness Data and Information Set are quality metrics managed by the National Committee for Quality Assurance. These metrics are reported annually and required by Louisiana Department of Health. Community health workers are required to demonstrate quality accreditation and meet state specific requirement compliance through documentation. The aim of this project was to increase community health worker chart audit scores to 100% by May 2021, thereby improving quality accreditation and meeting state contractual compliance. Louisiana’s managed care organizations are required to provide care coordination, medical management, and continuity of care to Medicaid enrollees through a care management program. Services are provided through telephonic and face-to-face outreach. Community health workers are non-clinical personnel and may not have prior training in health care, medical terminology, accreditation agencies or Medicaid programs. Survey Monkey online survey tool was used to conduct pre-test and post-event feedback surveys. The Plan-Do-Study-Act cycle was used to develop and implement an education toolkit. Following development of toolkit, community health workers participated in education trainings and began implementation of the toolkit. Participants’ charts were audited on 13 metrics prior to training. Pre-chart audit scores averaged 82%. One month following CHW training of education toolkit, participant chart audit average scores decreased by two percentage points to 80%. Development of CHW education toolkit did not improve overall chart audit scores. The Community Health Worker Performance Measurement Framework identifies programmatic inputs and community health worker outputs that should be examined for measuring performance. Although community health worker participants support implementation of an education toolkit and agree more training would be beneficial, other motivational factors were indicated.

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