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Healthy Legacy

By Brian W. Simpson

For almost three decades, an interdisciplinary team of researchers from the Johns Hopkins Schools of MedicineNursing and Public Health has steadily gathered evidence documenting the effectiveness of using nurse-supervised community health workers (CHWs) to combat chronic disease.

In the late 1970s, the research team hired people from East Baltimore as CHWs and trained them to work with nurse practitioners in Hopkins Hospital's emergency department. The goal was to provide special assistance to patients with high blood pressure. CHWs learned how to measure blood pressure and educate patients about hypertension. CHWs even helped patients schedule clinic appointments and followed up with them afterwards. The team found that CHWs helped patients reduce their high blood pressure and increased the continuity of their care.

Later, a randomized clinical trial with hypertensive urban black males ages 21 to 54 showed that over a five-year period a CHW/nurse practitioner/physician-led intervention improved control of hypertension by 41 percent. And ongoing research indicates that CHWs teamed with a nurse case-manager may be able to reduce emergency department visits and hospitalizations of adults with diabetes (though final results are pending).

Perhaps most important, according to Lee Bone, an associate professor of Health, Behavior and Society, the team's research projects have dispelled the myth that you can't do long-term research among impoverished, inner-city populations. The projects have proven that sustainable research with high rates of follow-up can be achieved among what were thought to be hard-to-reach populations. "This research has in many ways been successful because of the community-academic partnership," says Bone, MPH '77. "The community voice makes research culturally relevant and appropriate, and it provides access to the community. I am dedicated to the model of community-academic partnerships. They are how we build sustainable research programs."

The CHW research team includes Bone and Tiffany Gary from Public Health; David Levine and Frederick Brancati from Medicine; and Martha Hill, >Jerilyn AllenCheryl Dennison and Miyong Kim from Nursing.

"Obviously, [the CHW model] is both feasible and effective," says Bone. "The side benefit for the CHWs is that the training with Hopkins helped them in their own careers. In some ways, it was an economic development model of training and employment for people who wouldn't otherwise have had the opportunity."

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