Community health workers -- trusted laypeople from local communities who help high-risk patients to address social issues such as food and housing insecurity -- can help reduce hospital stays by 65 percent and double the rate of patient satisfaction with primary care, a new study says.
Conducted by researchers in the Perelman School of Medicine at the University of Pennsylvania, the research focused on chronically-ill low-income patients and U.S. veterans, finding that costly hospitalizations can be reduced not through expensive drugs or technology, but from simple social support.
The study found that addressing the social determinants of health results in greater patient satisfaction with their primary care, fewer days spent in the hospital and lower rates of repeat hospitalizations.
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Shifts in financing have pushed healthcare organizations toward addressing social issues -- eviction notices, domestic violence and the like -- that make it difficult for millions of people to stay healthy.
Community health workers are well-positioned to address these issues because they've experienced similar challenges themselves. While they are a rapidly growing healthcare workforce, many programs struggle due to insufficient standardization, a lack of rigorous scientific evidence or because they only apply to one disease.
With these issues in mind, the Penn team developed a model called Individualized Management for Patient-Centered Targets, a community health worker model, to be highly standardized and scalable.
In the study, a multi-site trial including a VA medical center, a federally-qualified health center and an academic family practice clinic, nearly 600 patients were randomly assigned to receive standard primary care or six months of support from an IMPaCT community health worker plus standard primary care.
Participants were residents of eight high-poverty zip codes in Philadelphia, Pennsylvania, who had received a diagnosis of two or more targeted chronic diseases (diabetes, obesity, tobacco dependence, and hypertension), at least one of which was in poor control.
Between January 2015 and March 2016, 288 patients were assigned to usual primary care, while 304 patients were assigned to receive community health worker support. The community health worker-supported group received six months of hands-on, tailored support that included coaching, social support, advocacy, and healthcare navigation.
Compared to patients in the typical primary care group, those who received community health worker support were nearly twice as likely to report high-quality primary care, and spent fewer total days in the hospital at six months (155 days vs. 345 days) and at nine months (300 days vs. 471 days).
Such patients also had lower rates of repeat hospitalizations, including 30-day readmissions, which can carry with them reimbursement penalties from the Centers for Medicare and Medicaid Services.
The study's findings are consistent with previous single-center randomized clinical trials measuring the effectiveness of the IMPaCT community health worker model, which showed notable results ranging from improved mental health and better access to quality care, to reduced hospital readmissions and improvements in chronic disease control.
The results are published just weeks after Penn's IMPaCT model was selected among more than 450 applicants to receive "Gold Status" in the Department of Veterans Affairs Shark Tank competition. As a winner of the Shark Tank competition, the IMPaCT model will be replicated in Veterans Affairs medical centers where veterans face social challenges.
Strategies have been proposed to reduce both costs and hospitalizations, though most have been designed around initiatives that target specific conditions, including chronic obstructive pulmonary disease.
For instance, it was discovered earlier this month that patients suffering from COPD with chronic respiratory failure using home non-invasive ventilation live longer, are less likely to be admitted to a hospital and cost Medicare significantly less than patients using other devices.
Meanwhile, Maryland's Health Enterprise Zones, state-funded initiatives designed to improve healthcare outcomes and prevent unnecessary hospitalizations in underserved communities, were associated with large reductions in inpatient stays.