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Inquirer Daily News

Archive: October, 2012

POSTED: Thursday, October 4, 2012, 3:00 AM

Maybe, if the practice of medicine goes the way Temple University's associate vice dean of health care services Paula L. Stillman thinks it will, community health workers will move from the margins to an integral part of patient care.

And if that happens, what is basically an ad hoc profession will probably require standards and definitions and core competencies and regulation. Stillman wants Temple to be a pace-setter in that conversation.

"Here's the problem," said Stillman, a physician and Temple University Health System's vice president of health care services. "People use the term community health worker without defining what the person's background is, what the level of care is and a lot of the studies that examine the outcomes are soft studies or stories."

POSTED: Wednesday, October 3, 2012, 7:56 AM

So, who gets the savings? Let's assume that community health workers are successful, as Michael "Chris" Gibbons says they were in Baltimore, in reducing the number of babies who end up in the neonatal intensive care unit. All good, right? Maybe.

All good for everyone except doctors who specialize in that kind of care. 

"The issue of saving money is a complicated one," said Gibbons, associate director of the John Hopkins Urban Health Institute. "The question becomes savings to whom?" 

POSTED: Tuesday, October 2, 2012, 7:18 AM

Michael "Chris" Gibbons doesn't doubt for a moment that the kind of community health workers being trained at Temple University Hospital can make a difference in health outcomes. But paying for them is a whole 'nuther story, as I reported in my story in the Philadelphia Inquirer.

"These programs suffer because of funding," said Gibbons, a surgeon who is the associate director of the John Hopkins Urban Health Institute in Baltimore where community health workers have long been part of the program. Community health workers "can't get paid through the same mechanisms that doctors get paid -- fee for service through Medicaid or Medicare" or other insurance. 

Instead, he said, his program has to rely on flavor-of-the-month funding, although he didn't use those words. Ten years ago, his program had eight community health workers, now it has two. "You have to be a revenue-generating personnel to get paid," he said. Otherwise, "you have to find funding either through philanthropy or research."

POSTED: Monday, October 1, 2012, 6:59 AM

Imagine what would happen if you were the last health professional who saw an abused woman alive before her boyfriend beat her to death. In the scenario I described yesterday, imagine that you had said nothing. Imagine that you had said something. Imagine that something had gone terribly wrong. Can you picture the guilt, the remorse? 

Health care, education, social work. Where are the boundaries? There is so much responsibility, such great need and resources are few -- the resources of the system, our own personal resources, our own personal strength, our own personal capacity. 

When I was reporting on the story on community health workers that appeared in the Philadelphia Inquirer, I asked the director, Paula Stillman, vice president of health care services at Temple University Hospital, about the psychological training given to these workers. Frankly, I wasn't satisfied with the answer. Basically, the answer was, when these workers feel uneasy, when they feel beyond their capacity, they should call their supervisors. 

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