Improving Post-hospital Outcomes with Community Health Worker Intervention

Hospitalized patients with low-socioeconomic status were more likely to obtain post-discharge primary care and less likely to have multiple 30-day readmissions to the hospital when they worked with community health workers to create individualized plans for their recovery goals, according to a study by Shreya Kangovi, M.D., M.S., of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

Socioeconomic and other factors can negatively affect post-hospital outcomes. Community health workers (CHWs) are trained laypeople who can work to support patients because traditional hospital personnel often lack the time and community linkages to address those factors, according to the study background.

The authors conducted a randomized clinical trial to examine if an intervention with CHWs would improve post-hospital outcomes among patients of low socioeconomic status (SES).

Hospital inpatients (n=446, i.e. low-income, uninsured or Medicaid enrollees) were randomized to usual hospital care (n=224) or collaboration with CHWs (n=222), who helped patients design an action plan that would help them stay healthy after being discharged from the hospital. The CHWs coached patients to schedule and attend medical appointments, even offering to accompany patients to their first post-hospital appointment. The CHWs provided support to patients for a minimum of two weeks.

Study results indicate that a higher proportion of patients in the intervention obtained post-hospital primary care within 14 days compared with the control group (60 percent vs. 47.9 percent) and fewer had multiple 30-day readmissions (2.3 percent vs. 5.5 percent). Intervention patients also were more likely to report receiving high-quality discharge information and to show greater improvement in mental health. However, there were no differences between patients groups in improvement in physical health, satisfaction with medical care, or medication adherence, according to the results.

“Hospitals have been challenged to transform into comprehensive health systems capable of responding to acute illness with proactive, patient-centered, and community-based care. This study may help inform health systems as they redesign their workforces and care practices to achieve this goal,” the study concludes.

(JAMA Intern Med. Published online February 10, 2014. doi:10.1001/jamainternmed.2013.14327.

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