RTI International, Research Triangle Park, NC 27709-2194, USA.
Med Care. 2010 Sep;48(9):792-808. doi: 10.1097/MLR.0b013e3181e35b51.
We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved.
We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus.
We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions.
CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.
我们对社区卫生工作者（CHW）干预措施的结果和成本进行了系统评价。CHW 被期望为服务不足的人群提供更具成本效益的改善健康结果。
我们在美国和英语发表的 1980 年至 2008 年 11 月期间，从 Medline、Cochrane 合作资源和 Cumulative Index to Nursing and Allied Health Literature 中搜索了研究。我们对摘要、全文文章、数据摘要、质量评级和证据等级进行了双重审查，并通过共识解决了分歧。
我们纳入了 53 项关于 CHW 干预措施结果的研究和 6 项关于成本或成本效益的研究。对于结果，有限的证据（5 项研究）表明，CHW 干预措施可以提高参与者的知识，与替代方法或无干预相比。我们发现参与者行为改变（22 项研究）和健康结果（27 项研究）的证据不一。一些研究表明，CHW 干预措施可以比各种替代方案更大程度地改善参与者的行为和健康结果，但其他研究表明，CHW 干预措施提供的好处与替代方案没有统计学上的差异。我们发现有低或中度强度的证据表明，CHW 可以增加某些干预措施的适当医疗保健利用（30 项研究）。6 项具有经济信息的研究提供的数据不足以评估 CHW 干预措施相对于其他干预措施的成本效益。
CHW 可以改善某些健康状况下服务不足人群的结果。CHW 在许多医疗保健领域的有效性需要进一步研究，以解决先前研究的方法学限制，并有助于将研究转化为实践。
