january 2018  -

Community Health Workers and GW Cardiology - 
A Bridge to Better Cardiac Care  

The 21 st century "Doctor-Patient Relationship" no longer just means your doctor. This modernized "relationship" comprises a team that includes physicians, nurse practitioners, physician assistants, and pharmacists.  The GW Heart & Vascular Institute is leading an innovative program expanding the medical team by adding community health workers (CHWs) to interface with our patients and their healthcare providers. 

Managing cardiovascular disease is complicated. Keeping track of blood pressure, diet, glucose, and multiple medications can be challenging to any individual, but especially to those facing socioeconomic challenges. Our motto is to help those individuals to "get healthy and keep healthy." 

CHWs augment patient care by providing culturally appropriate health advice on disease prevention and management. For the past three years, the GW Heart & Vascular Institute's cardiologists have supported CHWs assisting patients with heart failure, hypertension, diabetes, and coronary artery disease. Trained by our GW Cardiology staff and our DC-based partner, the Institute for Public Health Innovation, our CHWs meet with patients in their homes and/or our office to clarify medications, prescription refills, transport to clinic appointments, monitoring of weight, blood pressures, blood glucose values and dietary advice. During these home visits the CHWs frequently are in direct contact with our cardiology nurse practitioner, Linda Bostrom, or the patient's physician. Our CHWs also assist patients with "social determinants of health" including housing, food access, insurance issues, job opportunities, and other social services. 

The result of this program has been improved patient self-management, better cardiac health, and reduced hospital readmissions. Recurrent hospitalizations are very common among patients with heart failure. In our first year adding CHWs to our cardiology team lowered the 30-day re-hospitalization for our DC heart failure patients from 23 percent to 11 percent. This program has been expanded to assist patients who live outside of DC, and those followed by non-GW cardiologists.    

Drs. Gurusher  Panjrath and Richard Katz, along with our nurse practitioner Linda Bostrom, supervise our three CHWs, Tim Mavritte , Meia Jones, and Kimberlee Desomeaux . Tim, Meia, and Kim had the opportunity to present the results of our GW experience at the national CHW meetings in 2016 and 2017. Our patients uniformly are enthusiastic about the personalized GW "Doctor-Patient Relationship."  

Support of these programs are made possible by partnerships with GW Hospital, AmeriHealth, and Institute for Public Health Innovation.