Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers.

Krieger, James; Collier, Cheza; Song, Lin; Martin, Donald

doi:10.2105/ajph.89.6.856

Cited by 94 publications

(128 citation statements)

References 34 publications

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“…Of those, all measured scheduled outpatient visits, such as scheduled primary care provider appointments or maintenance appointments for a chronic condition. Three of six RCTs showed a significant increase in visits relative to a control, 39,51,60 while three had no significant change. 38,40,61 One pre-post study found no significant change in clinic visits, 41 and a single cohort study saw a significant increase in ambulatory care.…”

Section: Scheduled Outpatient Visitsmentioning

confidence: 84%

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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Section: Scheduled Outpatient Visitsmentioning

confidence: 84%

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

et al. 2016

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“…22 After standard screening events, only a minority of those found to have elevated BP pursue medical follow-up. Extensive interval tracking and appointment reminders by community health workers has been shown in 1 study to increase short-term clinic appointment keeping among low-income individuals, including African-American men.…”

Section: Study 1: Research Staff Interventionmentioning

confidence: 99%

“…Extensive interval tracking and appointment reminders by community health workers has been shown in 1 study to increase short-term clinic appointment keeping among low-income individuals, including African-American men. 22 However, it is unknown whether the effect can be sustained and can improve HTN control. Here we found that, without the enhanced behavior theory-based intervention, even repeated documentation of elevated out-of-office BP together with standard health education did not motivate most men to seek medical follow-up.…”

Section: Study 1: Research Staff Interventionmentioning

confidence: 99%

Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men

et al. 2007

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Abstract-Barbershops constitute potential sites for community health promotion programs targeting hypertension (HTN) in black men, but such programs have not been evaluated previously. Here we conducted 2 nonrandomized feasibility studies to determine whether an enhanced intervention program of continuous blood pressure (BP) monitoring and peer-based health messaging in a barbershop lowers BP more than standard screening and health education (study 1) and can be implemented by barbers rather than research personnel (study 2). In study 1, we measured changes in HTN treatment and BP in regular barbershop customers with poorly controlled HTN assigned for 8 months to either an enhanced intervention group (nϭ36) or a contemporaneous comparison group (nϭ27). Groups were similar at baseline. BP fell by 16Ϯ3/9Ϯ2 mm Hg in the enhanced intervention group but was unchanged in the comparison group (PϽ0.0001, adjusted for age and body mass index). HTN treatment and control increased from 47% to 92% (PϽ0.001) and 19% to 58% (PϽ0.001), respectively, in the enhanced intervention group, whereas both remained unchanged in the comparison group. In study 2, barbers were trained to administer the enhanced intervention continuously for 14 months to the entire adult black male clientele (nϭ321) in 1 shop. Six barbers recorded 8953 BP checks during 11 066 haircuts, thus demonstrating a high degree of intervention fidelity. Furthermore, among 107 regular customers with HTN, treatment and control increased progressively with increasing intervention exposure (PϽ0.01). Taken together, these data suggest that black-owned barbershops can be transformed into effective HTN detection, referral, and follow-up centers. Further research is warranted. Key Words: population science Ⅲ special populations Ⅲ blood pressure measurement/monitoring Ⅲ blacks Ⅲ hypertension H ypertension (HTN) is more prevalent, more severe, and causes disproportionate numbers of premature disabilities and deaths from heart attack, stroke, and end-stage renal disease in blacks than in all other racial/ethnic groups in the United States. [1][2][3] HTN is present in 40% of blacks, with blood pressure (BP) being controlled with medication to a recommended value of Ͻ140/90 mm Hg in less than one-third of these affected high-risk individuals. 2,4 In the other two-thirds, HTN either is untreated or undertreated.Among black women, HTN treatment rates are high, and most of the uncontrolled HTN occurs under the watchful eye of the healthcare system. 2,5 Black men have less frequent contact with the healthcare system and considerably lower rates of HTN detection and treatment. 2,[5][6][7][8] The black church has been a conventional site for medical outreach and HTN screening programs. 9,10 However, regular church attendance is much less common among black men than women. 6,11 To reach a larger fraction of the at-risk male population, we approached the black-owned barbershop, a cultural institution that regularly attracts large numbers of black men and provides an open forum for dis...

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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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Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers.

Cited by 94 publications

References 34 publications

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

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

Barbershops as Hypertension Detection, Referral, and Follow-Up Centers for Black Men

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

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