IHD Journal Watch: Post-Hospital Community Health Worker Interventions

Post-Hospital Community Health Worker Interventions

Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, Shannon RP, Long JA. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med, published online February 10, 2014, https://archinte.jamanetwork.com/article.aspx?articleid=1828743.

Abstract

Importance—Socioeconomic and behavioral factors can negatively influence posthospital outcomes among patients of low socioeconomic status (SES). Traditional hospital personnel often lack the time, skills and community linkages required to address these factors.

Objective—To determine whether a tailored community health worker (CHW) intervention would improve posthospital outcomes among low-SES patients.

Design, setting and participants—A two-armed, single-blind, randomized clinical trial was conducted between April 2011–October 2012 at two urban, academically affiliated hospitals. Of 683 eligible general medical inpatients (i.e., low-income, uninsured or Medicaid) screened, 237 individuals (34.7%) declined to participate. The remaining 446 (65.3%) were enrolled and randomly assigned to study arms. Nearly equal percentages of control and intervention group patients completed the follow-up interview (86.6% vs 86.9%).

Interventions—During hospital admission, CHWs worked with patients to create individualized action plans for achieving patients’ stated goals for recovery. The CHWs provided support tailored to patient goals for a minimum of two weeks.

Main outcomes and measures—The prespecified primary outcome was completion of primary care follow-up within 14 days of discharge. Prespecified secondary outcomes were quality of discharge communication, self-rated health, satisfaction, patient activation, medication adherence and 30-day readmission rates.

Results—Intervention patients were more likely to obtain timely posthospital primary care (60.0% vs 47.9%), report high-quality discharge communication (91.3% vs 78.7%) and show greater improvements in mental health (6.7 vs 4.5) and patient activation (3.4 vs 1.6). There were no significant differences between groups in physical health, satisfaction with medical care or medication adherence. Similar proportions of patients in both arms experienced at least one 30-day readmission; however, intervention patients were less likely to have multiple 30-day readmissions (2.3% vs 5.5%). Among the subgroup of 63 readmitted patients, recurrent readmission was reduced from 40.0% vs 15.2%.

Conclusions and relevance—Patient-centered CHW intervention improves access to primary care and quality of discharge while controlling recurrent readmissions in a high-risk population. Health systems may leverage the CHW workforce to improve posthospital outcomes by addressing behavioral and socioeconomic drivers of disease.

Bullet points

• Low-socioeconomic-status patients supported by community health workers are more likely to obtain timely posthospital primary care and less likely to have multiple 30-day readmissions.

• Health systems can leverage the CHW workforce to improve posthospital outcomes.