Shreya Kangovi|Nandita Mitra|Lindsey Norton|Rory Harte|Xinyi Zhao|Tamala Carter|David Grande|Judith A. Long
Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities
University of Pennsylvania|Penn Center for AIDS Research|University of Pennsylvania Health System|Philadelphia VA Medical Center|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|Penn Center for AIDS Research|University of Pennsylvania Health System|University of Pennsylvania|University of Pennsylvania|Philadelphia VA Medical Center
h3importanceh3 addressing social determinants health difficult health systems operationalize h3objectiveh3 assess standardized intervention individualized management patientcentered targets impact delivered community health workers chws across 3 health systems h3design setting participantsh3 2armed singleblind multicenter randomized clinical trial recruited patients 3 primary care facilities philadelphia pennsylvania january 28 2015 march 28 2016 patients resided highpoverty zip code uninsured publicly insured diagnosis 2 chronic diseases recruited patients randomized either chw intervention control arm goal setting followup assessments conducted 6 9 months enrollment data analyzed using intentiontotreat approach june 2017 march 2018 h3interventionh3 participants set chronic disease management goal primary care physician randomized chw intervention received 6 months tailored support h3main outcomes measuresh3 primary outcome change selfrated physical health secondary outcomes selfrated mental health chronic disease control patient activation patientreported quality primary care allcause hospitalization h3resultsh3 592 participants 370 625 female mean sd age 526 111 years participants arms similar improvements selfrated physical health mean sd 18 112 vs 16 99ipi 89 patients intervention group likely report highest quality care odds ratio 18 95 ci 1424 risk difference rd 012ipi lt 001 spent fewer total days hospital 6 months 155 days vs 345 days absolute event rate reduction 69 9 months 300 days vs 471 days absolute event rate reduction 65 reduction driven shorter average length stay difference 31 days 95 ci 633 022ipi 06 lower mean number hospitalizations difference 03 95 ci 06 00ipi 07 among patients hospitalized patients intervention group lower odds repeat hospitalizations 04 95 ci 0209 rd 024ipi 02 including 30day readmissions 03 95 ci 0109 rd 017ipi 04 h3conclusions relevanceh3 standardized intervention improve selfrated health improve patientperceived quality care reducing hospitalizations suggesting health systems may use standardized intervention address social determinants health h3trial registrationh3 clinicaltrialsgov identifiernct02347787