In a study conducted at Massachusetts General Hospital, pairing community health workers with hospital inpatients reduced readmissions nearly 50%.
Pairing community health workers with adult accountable care organization-insured hospital inpatients after discharge resulted in a significant reduction in hospital readmissions, a recent research article shows.
Readmissions are a key performance indicator for hospitals. Earlier research has shown that readmissions of adult inpatients within 30 days of hospital discharge are common and about 27% of the readmissions are preventable.
The recent research, which was published by JAMA Network Open, is based on data collected from 550 adult hospital inpatients drawn from six general medicine units at Massachusetts General Hospital in Boston. There were 277 patients placed in the community health worker intervention group and 273 patients placed in a control group receiving standard care, which included routine care from primary care clinics.
The study generated several key data points:
- Compared to the control group, patients in the intervention group were less likely to experience a 30-day readmission (odds ratio 0.44).
- Compared to the control group, patients in the intervention group were less likely to miss clinic appointments within 30 days of hospital discharge (odd ratio 0.56). For the intervention group, 22.0% of patients missed clinic appointments. For the control group, 33.7% of patients missed clinic appointments.
- Compared with control group patients, intervention group patients discharged to rehabilitation had a significant reduction in readmissions. However, intervention group patients discharged to home experienced no significant reduction in readmissions.
- The three most common actions community health workers took were counseling to encourage adherence with clinical care plans (86.3% of patients), psychosocial support (82.7%), and making and confirming clinical appointments (46.2%).
The community health workers (CHWs) had a significant impact, the research article's co-authors wrote.
"In this randomized clinical trial at one academic medical center, a CHW intervention reduced 30-day hospital readmissions in adult general medicine inpatients by nearly 50%. However, subgroup analyses revealed that most of the effect occurred for participants initially discharged to short-term rehabilitation. Intervention participants also were less likely to miss clinic appointments, but no significant reductions in ED visits were noted. These results indicate that CHW interventions may help reduce hospital readmissions and improve preventive care among some clinically complex patients within an ACO," they wrote.
The co-authors speculated on why the CHW intervention achieved readmission reduction for hospital inpatients discharged to rehabilitation rather than hospital inpatients discharged to home. "Potential reasons for this effect may be that CHWs addressed unmet medical and social needs that occurred during the transition from rehabilitation to home and that CHWs improved communication among the patient, rehabilitation staff, and primary physician prior to return to home."
How the community health worker intervention worked
The CHW intervention with adult ACO-insured hospital inpatients after discharge had several primary elements:
- CHWs met with hospital inpatients before discharge and worked with the patients for 30 days, including assistance with clinical access and social resources
- CHWs interacted with patients through telephone calls, text messages, and field visits
- CHWs provided psychosocial support and health coaching through behavioral strategies, including motivational interviewing and goal-setting to improve adherence to clinical care plans
- CHWs addressed patient-identified social needs such as food, housing, and transportation
Interpreting the research
In comments to HealthLeaders, the lead author of the research article speculated on why the CHW intervention achieved fewer missed clinical appointments compared to the control group.
"For the study intervention, CHWs were trained to focus on reinforcing the patient care plan and addressing any unmet need related to social determinants of health including transportation. In these ways, CHW support may have contributed to better support and fewer missed appointments among intervention participants," said Jocelyn Carter, MD, MPH, internist, Department of Medicine, Massachusetts General Hospital.
Participants being insured by an ACO likely had an impact on the study's results, she said. "Pre-existing participant connections to primary care and the ACO network were essential for effective communication between CHWs and clinical teams and for assisting participants with access to post-discharge care. These ACO-associated factors were key to CHWs connecting participants with resources and programs when they needed them most."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
In addition to reducing readmissions, a community health worker intervention for hospital inpatients post-discharge reduced missed clinical appointments.
The three most common actions community health workers took were counseling to encourage adherence with clinical care plans, psychosocial support, and making and confirming clinical appointments.