A Randomized Controlled Evaluation of the Effect of Community Health Workers on Hospitalization for Asthma

Fisher, Edwin B.; Strunk, Robert C.; Highstein, Gabrielle R.; Kelley-Sykes, Roslyn; Tarr, Kathleen L.; Trinkaus, Kathryn; Musick, Judith

doi:10.1001/archpediatrics.2008.577

Cited by 87 publications

(108 citation statements)

References 32 publications

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“…These findings are consistent with those of previous randomized controlled trials showing positive benefits for other models of self-management support using peers, registered nurses, or community health workers. [32][33][34][35] Health coaching did not improve control of hypertension 32,39 We found site-related differences in outcomes. Significant clinical improvements were seen with coaching at the larger site A, but not at site B.…”

Section: Discussionmentioning

confidence: 81%

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Willard-Grace

Chen

Hessler

et al. 2015

The Annals of Family Medicine

132

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PURPOSE Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care. METHODSWe conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California. The primary outcome was a composite measure of being at or below goal at 12 months for at least 1 of 3 uncontrolled conditions at baseline as defined by hemoglobin A 1c , systolic blood pressure, and low-density lipoprotein (LDL) cholesterol. Secondary outcomes were meeting all 3 goals and meeting individual goals. Data were analyzed using χ 2 tests and linear regression models.RESULTS Participants in the coaching arm were more likely to achieve both the primary composite measure of 1 of the clinical goals (46.4% vs 34.3%, P = .02) and the secondary composite measure of reaching all clinical goals (34.0% vs 24.7%, P = .05). Almost twice as many coached patients achieved the hemoglobin A 1c goal (48.6% vs 27.6%, P = .01). At the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (41.8% vs 25.4%, P = .04). The proportion of patients meeting the systolic blood pressure goal did not differ significantly.CONCLUSIONS Medical assistants serving as in-clinic health coaches improved control of hemoglobin A 1c and LDL levels, but not blood pressure, compared with usual care. Our results highlight the need to understand the relationship between patients' clinical conditions, interventions, and the contextual features of implementation. 2015;13:130-138. doi: 10.1370/afm.1768. Ann Fam Med INTRODUCTIONC ardiovascular disease is the leading cause of death in the United States, 1 and it accounts for more than $500 billion of health care spending annually.2 Despite the demonstrated effectiveness of pharmaceutical therapies and lifestyle modifications for improving cardiovascular disease outcomes, 50% of people with hypertension, 43% with diabetes, and 80% with hyperlipidemia have not reached their goals for blood pressure, glycemic control, or lipids, respectively. [3][4][5] One-half of patients do not take their chronic disease medications as prescribed, and only 1 in 10 patients follow recommended guidelines for lifestyle changes, such as smoking cessation or weight loss. 6 Minority and low-income communities bear a disproportionate burden of chronic disease and its complications, 7 and they are less likely to engage in effective self-management of their conditions. 8,9 Contributors to this gap in self-management include a lack of patient understanding of, and agreement with, the care plan, and low confidence and motivation to make healthy choices. or were not designed as randomized trials.17-19 They focused on a single condition such as diabetes or hypertension. [16][17][18][19] Medical assistant health coa...

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Section: Discussionmentioning

confidence: 81%

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Willard-Grace

Chen

Hessler

et al. 2015

The Annals of Family Medicine

132

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“…[33][34][35] Five showed no significant difference in ED visits. [36][37][38][39][40] Of the eight pre-post studies, five showed a significant decrease in ED visits relative to a baseline measurement, [41][42][43][44][45] and one had no significant decrease. 46 Two pre-post studies did not indicate statistical significance; of these, one intervention resulted in a decrease in ED visits 47 and one in an increase in ED visits.…”

Section: Emergency Department Visitsmentioning

confidence: 94%

“…34,35,37,39,40,51 One showed a significant decrease relative to the control. 36 Of the seven pre-post studies that assessed hospitalization, all showed a decrease in hospitalizations, 41,[43][44][45][46][47][48] but only five indicated statistical significance. 41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations.…”

Section: Emergency Department Visitsmentioning

confidence: 98%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS: Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION: Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

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“…7 Poor African-American children with asthma assisted by CHW "asthma coaches"-members of the same community-had significantly reduced asthma hospitalization rates compared with the randomized control group. 8 In a randomized controlled trial of low-income patients with poorly controlled diabetes, patients with peer health coaches (other patients with diabetes) had significantly improved HbA1c levels compared with controls. 9 In a randomized controlled trial, patients with diabetes, hypertension, and/or hyperlipidemia who were linked with unlicensed personnel trained as health coaches had significantly improved HgA1c and LDLcholesterol after 1 year compared with non-coached patients.…”

Section: Unlicensed Health Care Personnelmentioning

confidence: 99%

Unlicensed Health Care Personnel and Patient Outcomes

Bodenheimer

2015

J GEN INTERN MED

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A Randomized Controlled Evaluation of the Effect of Community Health Workers on Hospitalization for Asthma

Cited by 87 publications

References 32 publications

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Unlicensed Health Care Personnel and Patient Outcomes

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