Community Health Department, The Colorado Prevention Center, Aurora, CO, USA.
Am J Public Health. 2013 Jan;103(1):e19-27. doi: 10.2105/AJPH.2012.301068. Epub 2012 Nov 15.
We evaluated whether a program to prevent coronary heart disease (CHD) with community health workers (CHWs) would improve CHD risk in public health and health care settings.
The CHWs provided point-of-service screening, education, and care coordination to residents in 34 primarily rural Colorado counties. The CHWs utilized motivational interviewing and navigated those at risk for CHD into medical care and lifestyle resources. A software application generated a real-time 10-year Framingham Risk Score (FRS) and guideline-based health recommendations while supporting longitudinal caseload tracking. We used multiple linear regression analysis to determine factors associated with changes in FRS.
From 2010 to 2011, among 4743 participants at risk for CHD, 53.5% received medical or lifestyle referrals and 698 were retested 3 or more months after screening. We observed statistically significant improvements in diet, weight, blood pressure, lipids, and FRS with the greatest effects among those with uncontrolled risk factors. Successful phone interaction by the CHW led to lower FRS at retests (P = .04).
A CHW-based program within public health and health care settings improved CHD risk. Further exploration of factors related to improved outcomes is needed.
我们评估了通过社区卫生工作者（CHW）预防冠心病（CHD）的计划是否能改善公共卫生和医疗保健环境中的 CHD 风险。
CHW 为 34 个主要位于科罗拉多州农村的县的居民提供服务点筛查、教育和护理协调。CHW 采用动机性访谈，引导有 CHD 风险的人进入医疗保健和生活方式资源。一个软件应用程序实时生成Framingham 风险评分（FRS）和基于指南的健康建议，同时支持纵向病例跟踪。我们使用多元线性回归分析来确定与 FRS 变化相关的因素。
在 2010 年至 2011 年期间，在 4743 名有 CHD 风险的参与者中，53.5%接受了医疗或生活方式转介，698 人在筛查后 3 个月或更长时间接受了复查。我们观察到饮食、体重、血压、血脂和 FRS 有统计学意义的改善，在未控制的危险因素人群中效果最大。CHW 成功的电话互动导致复查时 FRS 降低（P =.04）。
公共卫生和医疗保健环境中的基于 CHW 的计划改善了 CHD 风险。需要进一步探讨与改善结果相关的因素。
