Hawai'i Journal of Medicine & Public Health : a Journal of Asia Pacific Medicine & Public Health

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This paper describes a program model that uses hospital- and community-based patient navigators and social workers to link super utilizers of the hospital system with existing community resources to improve access to services and appropriate care while lowering hospital utilization. A case study is used to illustrate a typical super utilizer patient who is homeless and has psychosocial issues. The navigator's and social worker's roles and approaches are described, and specific community linkages for this case are listed...

The Ke Ku'una Na'au (KKN) navigators were first hired in 2016 at The Queen's Medical Center (QMC) in Honolulu, Hawai'i, with a focus on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults. To our knowledge, QMC was the first acute care hospital in the state to implement the use of community health workers into the health care system as navigators for patient needs in the community following discharge. This article tells the story of our experiences as the 5 patient navigators from the Native Hawaiian community during the first 2 years of the program...

Although acute care facilities have not typically focused on resolving the psychosocial determinants of health, new models are emerging. This article provides details of the Ke Ku'una Na'au (KKN) Native Hawaiian Behavioral Health Initiative implemented in 2016 at The Queen's Medical Center in Honolulu, Hawai'i. The program is focused on reducing hospital readmissions for socially and economically vulnerable Native Hawaiian adults and improving their health care outcomes after hospitalization. The program was piloted on 2 medical units to assist patients who identified as Native Hawaiian, were ages 18 and older, and living with chronic diseases, psychosocial needs, and/or behavioral health problems...

Greater medical and psychological concerns coupled with disparities in income and education and experiences with cultural distress have created an unprecedented demand for health and mental health services for Native Hawaiians. With 75% of the healthcare system moving to a value-based system within the next 2 years, a low-cost workforce that brings added value will be in high demand. The addition of community health navigators to an existing integrated patient-centered medical home may result in a culturally congruent, preventive, and responsive model of wellness that promotes health equity...

Patients with diabetes regularly carry out multiple disease-management behaviors-taking prescribed medications, following diet and exercise regimens, self-monitoring their blood glucose concentrations, and coping emotionally with the condition-that may require ongoing support from community and clinical resources. Diabetes self-management education (DSME) is an ongoing, patient-centered process that helps provide the knowledge, skills, and ability for self-care. Evidence suggests that DSME is most effective when reinforced by community resources, through what are called community-clinical resources...

Chronic diseases impact 60% of Americans, with 42% reporting multiple chronic conditions, and account for $3.3 trillion in annual health care costs. In Hawai'i, about 80% of adults report having at least 1 chronic condition, and more than half of those report having multiple chronic conditions. Health coaching is a technique of engaging patients to help them obtain the knowledge, skills, and confidence to become an active and engaged participant in their health care. Health coaching aims to assist patients with understanding their care plans, exploring their perceptions of their care plans, and working collaboratively with their health care team to implement these plans to improve their overall health...

The Kalihi Valley Instructional Bike Exchange (KVIBE) is an innovative youth bike program housed in Kokua Kalihi Valley Family Comprehensive Services (KKV), a community health center in Honolulu, Hawai'i. KVIBE utilizes a popular education model to raise the social consciousness of its youth participants, who are primarily working class, Indigenous, and native to the Philippines or the Pacific Islands, especially Micronesia. Initially designed as a bike repair program where youth could earn a bicycle through sweat equity, KVIBE has grown into an educational space that teaches bicycle mechanics as well as personal history and identity...

The Medical-Legal Partnership for Children in Hawai'i (MLPC) has worked to address the social determinants of health for low-income patient-families since 2009. Focused on identifying health-harming legal needs, doctors and lawyers work together to assist families with family law, housing, public benefits, education, employment, civil rights, and other concerns. Providing free, direct legal service in the medical setting allows the medical-legal partnership (MLP) team to identify community-wide concerns such as language access violations, racial discrimination, and unfair policies...

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Social and behavioral determinants of health, such as poverty, homelessness, and limited social support, account for an estimated 40% of health burdens and predict critical health outcomes. Many clinical-community linkages specifically focus on addressing such challenges. Given its distinctive history, culture, and location, Hawai'i has unique social factors impacting population health. Local health systems are striving to address these issues to meet their patients' health needs. Yet the evidence on precisely how health care systems and communities may work together to achieve these goals are limited both generally and specifically in the Hawai'i context...

East Hawai'i and its local hospital face unsustainable cost and health care utilization trends. The medical and social service organizations in this region, which includes the city of Hilo and its surrounding area on Hawai'i Island, previously worked in silos regarding coordination of patient care. To mitigate these factors, community initiatives have been implemented to address the needs of high-cost, high-need (HCHN) patients. Can community initiatives that better coordinate medical and social services to directly address social determinants of health improve quality of care and reduce utilization of emergency department (ED) and inpatient (IP) resources? Respected community leaders and diverse stakeholders in East Hawai'i have organized a community to improve health while lowering costs, influence legislative policy, and work collaboratively with the largest health plan in Hawai'i and the local hospital to change health care delivery...

Coordinating the care of terminally ill children is difficult for both parents and the health care team. An underutilized resource is spiritual care, such as that provided by Pacific Health Ministry, a community-based nonprofit established to develop hospital ministry training programs in Hawai'i and provide chaplaincy services to local facilities. This paper describes a training exercise, called the Pediatric Interprofessional Program (PIPP), which is modeled after an adult program, the Hawai'i Interprofessional Training for End of Life Communication in the intensive care unit (HITEC-ICU)...

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This editorial presents the perspectives of allies - a group of governmental, university and public health organizations that support the creation of a professional association for CHWs in Hawai'i. We support the efforts of CHWs as they organize and move towards establishing a professional association. Hawai'i CHWs have held monthly meetings starting in 2017 to discuss variety of issues around their work and share information and experiences. A group of CHWs and allies developed a strategic plan in 2018 in preparation to establish a professional association...

Community health workers (CHWs) have been important contributors to the health and wellness of disenfranchised and minority communities for more than 50 years in the United States. Recently the Centers for Disease Control and Prevention (CDC) recommended several policy initiatives to support and advance the CHW workforce, including formalizing a state-level definition for CHWs. Such state-wide standards can lay the groundwork for health insurance reimbursement for CHW services, help establish a professional identity, and generate cohesion among CHWs...

In 2014, the Hawai'i State Department of Health (HDOH) received funding from the Centers for Disease Control and Prevention (CDC), via the 1422 Cooperative Agreement, to conduct diabetes prevention and hypertension management. To implement one grant-required strategy-the engagement of community health workers (CHWs) to promote community-clinical linkages-the HDOH partnered with the Hawai'i Primary Care Association and 9 federally qualified health centers (FQHCs). This qualitative evaluation case study sought to understand how 3 of the funded FQHCs engaged CHWs, the types of community-clinical linkages the CHWs promoted, and the facilitators of and barriers to those linkages...

Introduction: Community health workers (CHWs) play a vital role in health across Hawai'i, but the scope of this work is not comprehensively collated. This scoping review describes the existing evidence of the roles and responsibilities of CHWs in Hawai'i. Methods: Between May and October 2018, researchers gathered documents (eg, reports, journal articles) relevant to Hawai'i CHWs from health organizations, government entities, colleges/universities, and CHWs. Documents were reviewed for overall focus and content, then analyzed using the Centers for Disease Control and Prevention's 10 Essential Public Health Services as well as the Community Health Worker Core Consensus Project roles to identify workplace roles and gaps...

No abstract text is available yet for this article.

No abstract text is available yet for this article.