Community Health Workers May Reduce Readmissions

Larry Hand

February 11, 2014

A community health worker (CHW) intervention led to improved posthospital access to primary care and fewer recurrent readmissions among a population of low-socioeconomic-status patients, according to a study published online February 10 in JAMA Internal Medicine.

Results of the randomized trial may help inform healthcare system leaders reorganizing workforces to comply with the accountability requirements of the Affordable Care Act.

Shreya Kangovi, MD, from the Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues conducted a single-blind, randomized clinical trial involving medical inpatients at 2 academically affiliated hospitals in Philadelphia between April 10, 2010, and October 30, 2012.

The study involved inpatients aged 18 to 64 years who were expected to be discharged to home (and not long-term care) in 5 Philadelphia Zip code areas where more than 30% of residents live below the federal poverty level and where residents account for more than 35% of all readmissions to study hospitals.

Of 446 patients enrolled, 194 usual care and 193 intervention patients completed the study. Of all study participants, 93.5% were black and 81.0% earned less than $15,000 a year. Most (59.4%) were women, and 39.4% had unmet health needs.

Research assistants used electronic medical records to identify newly admitted patients and conducted interviews to collect sociodemographic and health information. A member of the study team not involved with assessing outcomes randomly assigned consenting patients to either intervention or usual care.

CHWs who were specially trained in motivational interviewing, professional boundaries, and core community health competencies then met with intervention patients to develop recovery goals and provide support to reach those goals. The CHWs also helped patients connect with primary care within 14 days of discharge, the primary outcome measure. The CHWs tailored their support to individual patients, including accompanying some to local recreation centers or helping some with budgeting limited finances.

More intervention patients than usual-care patients completed posthospital primary care follow-up within 14 days (60.0% vs 47.9%; P = .02). Although similar proportions of patients experienced readmissions within 30 days (15.0% vs 13.6%; P = .68), the intervention led to a decrease in recurrent admissions from 40.0% to 15.2% (P = .03).

Multilevel Improvements

Among the main findings, the researchers note, is that although many interventions can improve one aspect of healthcare, such as patient experience, outcomes, or cost savings, "[t]his intervention simultaneously improved patient experience and health outcomes while controlling costly hospital care."

Such an intervention is scalable for health systems, they write, because CHWs used "a standardized approach to create tailored action plans for achieving patients' individual goals." Also, as the intervention was patient-based, rather than disease-based, health systems can employ the same CHWs for a wide range of patients.

Although results of the study might not be generalizable to populations less vulnerable than this study population, the researchers write, "CHWs offer value because they deliver a kind of service that conventional health professionals do not."

In an invited commentary, Harrison J. Alter, MD, from the Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, California, agrees.

"Part of the appeal of the approach in the study by Kangovi et al is that patients and CHWs worked together to find aspects of the patients' lives that, with help, could improve their sense of well-being," Dr. Alter writes. "Finding a comfortable social activity, identifying a food pantry, creating a budget for food — these interventions are not typically identified with medical care, but they lead to a measureable improvement in medical care."

This study was funded by the Penn Center for Health Improvement and Patient Safety, the Leonard Davis Institute of Health Economics, the Penn Clinical and Translational Science Community-Based Research Grant, the Eisenberg Scholar Research Award, the Penn Department of Medicine, the Penn Presbyterian Department of Medicine, the Armstrong Founders Award, and the Penn Presbyterian Bach Fund. The authors and Dr. Alter have disclosed no relevant financial relationships.

JAMA Intern Med. Published online February 10, 2014. Abstract

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