Shreya Kangovi|Nandita Mitra|David Grande|Mary L. White|Sharon McCollum|Jeffrey Sellman|Richard P. Shannon|Judith A. Long
Patient-Centered Community Health Worker Intervention to Improve Posthospital Outcomes
University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|Robert Wood Johnson Foundation|Penn Center for AIDS Research|University of Pennsylvania|Penn Center for AIDS Research|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|Robert Wood Johnson Foundation|University of Pennsylvania
importance socioeconomic behavioral factors negatively influence posthospital outcomes among patients low socioeconomic status ses traditional hospital personnel often lack time skills community linkages required address factors objective determine whether tailored community health worker chw intervention would improve posthospital outcomes among lowses patients design setting participants 2armed singleblind randomized clinical trial conducted april 10 2011 october 30 2012 2 urban academically affiliated hospitals 683 eligible general medical inpatients ie lowincome uninsured medicaid screened 237 individuals 347 declined participate remaining 446 patients 653 enrolled randomly assigned study arms nearly equal percentages control intervention group patients completed followup interview 866 vs 869 interventions hospital admission chws worked patients create individualized action plans achieving patients stated goals recovery chws provided support tailored patient goals minimum 2 weeks main outcomes measures prespecified primary outcome completion primary care followup within 14 days discharge prespecified secondary outcomes quality discharge communication selfrated health satisfaction patient activation medication adherence 30day readmission rates results using intentiontotreat analysis found intervention patients likely obtain timely posthospital primary care 600 vs 479 p 02 adjusted odds ratio 152 95 ci 103223 report highquality discharge communication 913 vs 787 p 002 adjusted 294 95 ci 1558 show greater improvements mental health 67 vs 45 p 02 patient activation 34 vs 16 p 05 significant differences groups physical health satisfaction medical care medication adherence similar proportions patients arms experienced least one 30day readmission however intervention patients less likely multiple 30day readmissions 23 vs 55 p 08 adjusted 040 95 ci 014106 among subgroup 63 readmitted patients recurrent readmission reduced 400 vs 152 p 03 adjusted 027 95 ci 008089 conclusions relevance patientcentered chw intervention improves access primary care quality discharge controlling recurrent readmissions highrisk population health systems may leverage chw workforce improve posthospital outcomes addressing behavioral socioeconomic drivers disease trial registration clinicaltrialsgov identifier nct01346462