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J Ambul Care Manage. 2019 Oct/Dec;42(4):242-251. doi: 10.1097/JAC.0000000000000303.

The Impact of Centralized Employment Structure on Community Health Work: A Qualitative Case Study of Community Health Workers and Key Leadership.

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Department of Health Policy & Management, University of Kansas Medical Center, Kansas City (Ms Pothapragada and Drs Saint Onge and Brooks); and Department of Sociology, University of Kansas, Lawrence (Dr Saint Onge).


While community health workers (CHWs) are employed in various arrangements, little is known about the association between organizational structure and CHW experiences. Seventeen in-depth interviews were conducted with CHWs, supervisors, and leadership employed in one centrally organized setting to investigate organizational structure and perceptions of CHW effectiveness. A model that hired employees but assigned them to various settings offered support and unique career advancement opportunities. Coordinated education, ongoing trainings, and persistent supervision were perceived to improve the accuracy of resource information and facilitated collaboration across the health care system with increased health care team communication, offering insights into other organizational structures.

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