Intervention Utilizing Community Health Workers Improves Quality of Patient Care and Reduces Hospitalizations
BACKGROUND:
Individualized Management for Patient-Centered Targets (IMPaCT) is a standardized intervention in which community health workers (CHWs) provide tailored social support, navigation, and advocacy to help low-income patients achieve health goals. The model has previously been tested and found to be successful for hospitalized patients and outpatients with multiple chronic health conditions. This randomized trial assessed the scalability and effectiveness of IMPaCT in three primary care settings that provide treatment to low-income patients: one VA medical center, a federally-qualified health center, and an academic family practice clinic. Study participants (n=592) were residents of eight high-poverty zip codes in Philadelphia, PA, who had received a diagnosis of two or more targeted chronic diseases (diabetes, obesity, tobacco dependence, and hypertension), at least one of which was in poor control. Patients selected one of their chronic conditions that was in poor control as the focus of the intervention; most selected tobacco dependence or obesity. Between January 2015 and March 2016, 288 patients were assigned to goal setting only, while 304 patients were assigned to goal setting in addition to CHW support. CHWs provided 6 months of hands-on, tailored support that included coaching, social support, advocacy, and navigation to help patients achieve action plans. Outcomes were measured at baseline, 6, and 9 months. The primary outcome was self-rated physical health; secondary outcomes included self-rated mental health, patient-selected chronic disease control, patient activation, all-cause hospitalization, and the proportion of patients reporting high-quality care.
FINDINGS:
- Compared to those in the control group, those in the intervention (CHW) group, including Veterans, had nearly twice the odds of reporting high-quality primary care, were less likely to be re-hospitalized within 30 days of discharge (12% vs. 28%), and spent fewer total days in the hospital at 6 months (155 days vs. 345 days; absolute event rate reduction, 69%) and 9 months (300 days vs. 471 days; absolute rate reduction, 65%).
- Patients in the CHW intervention group also had lower odds of repeat hospitalizations, including 30-day readmissions.
IMPLICATIONS:
Using a structured CHW intervention to address patients' social needs improves quality of care and lowers utilization.
LIMITATIONS:
- It is unknown whether effects of the IMPaCT intervention persisted after the 9-month trial.
- The study could not measure hospitalization of Veterans that occurred in non-VA hospitals.
AUTHOR/FUNDING INFORMATION:
Dr. Long (co-Director) is part of HSR&D's Center for Health Equity Research and Promotion (CHERP). Dr. Long earned Diffusion of Excellence Shark Tank Gold Status for the IMPaCT intervention.
Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, Grande D, and Long J. Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial. JAMA Internal Medicine. December 1, 2018;178(12):1635-1643.
