An Ohio hospital trains liberal arts college students as community health workers. After the first year, patients enrolled in the program had a 26% reduction of ED use and 51% reduction in hospital readmissions.
When I was working as an RN, I had a unit director who used to say, "There's three sides to every story—her side, his side, and what really happened, which is usually someplace in the middle."
She applied that concept to mediating employee squabbles, but the idea relates to patients, too. It could be said there are three sides to every admission (and readmission)—what's observed in the inpatient setting, what the patient says, and what's really going on in the patient's home.
AlexSandra Davis, RN, BSN
AlexSandra Davis, RN, BSN, recently experienced this when a patient was referred to Wooster (OH) Community Hospital's Community Care Network, a program that trains and uses college students as community health workers. Both the patient and her case manager said she was safe to go home, but when Davis, who is manager of the Community Care Network, got to the woman's residence she saw the third side of the story.
"I got in the home and she didn't have her medication, she didn't have her breathing treatments, she didn't have a nebulizer, she didn't have a glucometer to check her blood sugar," says Davis. "But when you asked her if she was OK to go home, she'd say, 'I'm fine to go home.'"
If left unchecked, those issues could have led to a hospital readmission. Wooster's Community Care Network, a partnership between the hospital and The College of Wooster, was launched in 2013 to prevent situations like this.
The Beginnings of an Idea
"I was interested in doing some things with transition of care and really looking at readmissions and patients bouncing back to either readmission or to the ED," says former Wooster CNO Loraine Frank-Lightfoot, RN, DNP. "We already had a good readmission rate, but this was something that could reach even more people and make more of a difference."
Frank-Lightfoot, now CNO at Parkview Regional Medical Center and Affiliates in Ft. Wayne, IN, knew that as manager of Wooster's home health and private duty divisions, Davis had done some preliminary work with the organization's cardiologists to prevent readmissions among heart failure patients. She had also heard about how Barry Bittman, MD, was using college students as community health workers in Meadville, Pa.
"We went and saw what he was doing there… and said, 'You know we think that's something we could really implement at Wooster,'" Says Frank-Lightfoot. So Davis reached out to the college to talk about collaborating on a similar program to train Wooster students as health coaches.
"I met with the dean of the program that they have there for exponential learning. We talked about this program and Barry Bittman's concept and what we were going to be doing," Davis told me. "At that time we really didn't have a good understanding of exactly how we were going to pull this off."
Developing the Curriculum
Davis and her counterpart from the college, Carol Sedgwick, worked with Bittman and his staff to develop what is now Wooster's Community Health Network. Sedgwick oversaw specifics on the college's end such as course registration logistics while Davis developed the course's clinical components.
Loraine Frank-Lightfoot, RN, DNP
Students, usually sophomores at the liberal arts college, start with a general overview of the program including a description of the role and responsibilities of a health coach. Davis then covers the clinical aspects, including pathophysiology, of the various diseases students may encounter out in the field like diabetes, COPD, heart failure, and hypertension.
Students review disease-specific discharge booklets which all Wooster patients receive upon discharge. They help patients set goals, ensure patients have the proper resources to maintain or improve their health, and report any issues to the patients' primary healthcare providers.
Each student is assigned two patients who they visit once a week. The program awards students 0.5 credit hours toward fulfilment of the college's volunteer service requirement.
The two-year-old program has had success. Currently, 35 students and 80 patients are enrolled, says Davis, and by January 2016 she expects over 100 patients to be part of the program. As enrollment, which is always voluntary, has gone up, hospital use has gone down. According to data collected a year ago, patients enrolled in the program had a 26% reduction of ED use and 51% reduction in hospital readmissions, Frank-Lightfoot says.
As the program has grown, it has also undergone some changes.
At first it was about readmissions and hospital utilization, but as time passed, "we found that most of the patients we were getting into the program were not coming through the hospital," Frank-Lightfoot says. "These were, in many cases, patients that physicians had in their office practices that were very fragile and needed more care and attention than they could provide."
Another recent change Davis has made to the program is focusing on patients with frequent readmissions to keep them out of the hospital for at least 31 days.
"We're reviewing patients that have been admitted to the hospital for CHF, COPD, and pneumonia," says Davis. "We're working with those case managers and those patients and finding out if they're appropriate for our network or not."
Frank-Lightfoot says that while the program is definitely of value, those wishing to start a similar program should consider a few factors. First, consider funding. Wooster's program is free to patients, but interestingly, the program has never been supported by any grant money.
"The grants either pigeon-hole you too much, or the grant is over and you don't have any money to fund it," she explains. "We made the commitment when we started… that we were going to do the funding through the hospital. That way we had control, we could partner with who we needed to partner with, and we knew the money wasn't going to dry up after a year."
Davis says one way to keep costs in check, is to be savvy about staffing. Volunteers aside, the program's staff consists of Davis, one full-time LPN and one part-time LPN. "You don't need to have a whole bunch of RNs out there," she says.
Understanding the community's needs and resources is also key to developing a productive program, says Frank-Lightfoot. "Be open to doing this in a non-traditional way," she says. "You have to find what works in your community and tailor it with the resources you have available. You may not be able to find a college or university that's willing to partner. You may have to pay people to do it."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.