Community Health Workers Combat Readmission

Kangovi, Shreya; Long, Judith A.; Emanuel, Ezekiel J.

doi:10.1001/2013.jamainternmed.82

Cited by 22 publications

(10 citation statements)

References 7 publications

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“…IMPaCT is an intervention in which community health workers provide patients of low socioeconomic status with coaching, social support, advocacy and navigation in order to help them reach health goals [22, 23, 36]. The intervention has been described in detail elsewhere [19, 21, 22], but briefly, consists of three stages: goal-setting, tailored support and connection with long-term support.…”

Section: Design and Methodsmentioning

confidence: 99%

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

Kangovi

Mitra

Turr

et al. 2017

Contemporary Clinical Trials

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Upstream interventions – e.g. housing programs and community health worker interventions-address socioeconomic and behavioral factors that influence health outcomes across diseases. Studying these types of interventions in clinical trials raises a methodological challenge: how should researchers measure the effect of an upstream intervention in a sample of patients with different diseases? This paper addresses this question using an illustrative protocol of a randomized controlled trial of collaborative-goal setting versus goal-setting plus community health worker support among patients multiple chronic diseases: diabetes, obesity, hypertension and tobacco dependence. At study enrollment, patients met with their primary care providers to select one of their chronic diseases to focus on during the study, and to collaboratively set a goal for that disease. Patients randomly assigned to a community health worker also received six months of support to address socioeconomic and behavioral barriers to chronic disease control. The primary hypothesis was that there would be differences in patients’ selected chronic disease control as measured by HbA1c, body mass index, systolic blood pressure and cigarettes per day, between the goal-setting alone and community health worker support arms. To test this hypothesis, we will conduct a stratum specific multivariate analysis of variance which allows all patients (regardless of their selected chronic disease) to be included in a single model for the primary outcome. Population health researchers can use this approach to measure clinical outcomes across diseases.

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Section: Design and Methodsmentioning

confidence: 99%

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

Kangovi

Mitra

Turr

et al. 2017

Contemporary Clinical Trials

Self Cite

View full text Add to dashboard Cite

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“…It aims to build CHW workforce capacity through grants to promote the community health workforce (Section 5307) and the community health center fund (Section 10503). ACA provisions also support the inclusion of CHWs in reimbursable services, such as patient navigator programs (Section 3509) (58).…”

Section: Affordable Care Act Opportunities For Peer Supportmentioning

confidence: 99%

Peer Support in Health Care and Prevention: Cultural, Organizational, and Dissemination Issues

Fisher

Coufal²,

Parada³

et al. 2014

Annu. Rev. Public Health

107

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As reviewed in the article by Perry and colleagues (2014) in this volume, ample evidence has documented the contributions of peer support (PS) to health, health care, and prevention. Building on that foundation, this article discusses characteristics, contexts, and dissemination of PS, including (a) fundamental aspects of the social support that is often central to it; (b) cultural influences and ways PS can be tailored to specific groups; (c) key features of PS and the importance of ongoing support and backup of peer supporters and other factors related to its success; (d ) directions in which PS can be expanded beyond prevention and chronic disease management, such as in mental health or interventions to prevent rehospitalization; (e) other opportunities through the US Affordable Care Act, such as through patientcentered medical homes and chronic health homes; and ( f ) organizational and policy issues that will govern its dissemination. All these demonstrate the extent to which PS needs to reflect its contexts-intended audience, health problems, organizational and cultural settings-and, thus, the importance of dissemination policies that lead to flexible response to contexts rather than constraint by overly prescriptive guidelines.

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“…Safety-net hospitals typically have limited resources for new initiatives and professional staff. Less costly community health workers (CHWs) 19 , 20 have increased medical follow-up with primary care and specialists, [21][22][23] improved adherence to medical regimens, 24,25 and provided meaningful social support. 22 These competencies may NIH Trial Registration ClinicalTrials.gov identifier: NCT01619098…”

Section: Introductionmentioning

confidence: 99%

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

et al. 2015

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BACKGROUND: Evidence-based interventions to reduce hospital readmissions may not generalize to resourceconstrained safety-net hospitals. OBJECTIVE: To determine if an intervention by patient navigators (PNs), hospital-based Community Health Workers, reduces readmissions among high risk, low socioeconomic status patients. DESIGN: Randomized controlled trial. PARTICIPANTS: General medicine inpatients having at least one of the following readmission risk factors: (1) age≥60 years, (2) any in-network inpatient admission within the past 6 months, (3) length of stay≥3 days, (4) admission diagnosis of heart failure, or (5) chronic obstructive pulmonary disease. The analytic sample included 585 intervention patients and 925 controls. INTERVENTIONS: PNs provided coaching and assistance in navigating the transition from hospital to home through hospital visits and weekly telephone outreach, supporting patients for 30 days post-discharge with discharge preparation, medication management, scheduling of follow-up appointments, communication with primary care, and symptom management. MAIN MEASURES: The primary outcome was in-network 30-day hospital readmissions. Secondary outcomes included rates of outpatient follow-up. We evaluated outcomes for the entire cohort and stratified by patient age >60 years (425 intervention/584 controls) and ≤60 years (160 intervention/341 controls). KEY RESULTS: Overall, 30-day readmission rates did not differ between intervention and control patients. However, the two age groups demonstrated marked differences. Intervention patients >60 years showed a statistically significant adjusted absolute 4.1 % decrease [95 % CI: −8.0 %, -0.2 %] in readmission with an increase in 30-day outpatient follow-up. Intervention patients ≤60 years showed a statistically significant adjusted absolute 11.8 % increase [95 % CI: 4.4 %, 19.0 %] in readmission with no change in 30-day outpatient follow-up. CONCLUSIONS: A patient navigator intervention among high risk, safety-net patients decreased readmission among older patients while increasing readmissions among younger patients. Care transition strategies should be evaluated among diverse populations, and younger high risk patients may require novel strategies.KEY WORDS: care transitions; continuity of care; health care delivery; patient safety; underserved populations. J Gen Intern Med 30(7):907-15

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Community Health Workers Combat Readmission

Cited by 22 publications

References 7 publications

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

Peer Support in Health Care and Prevention: Cultural, Organizational, and Dissemination Issues

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

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