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Moreno G, Mangione CM, Tseng CH, Weir M, Loza R, Desai L, Grotts J, Gelb E. Connecting Provider to home: A home-based social intervention program for older adults. J Am Geriatr Soc 2021; 69:1627-1637. [PMID: 33710616 DOI: 10.1111/jgs.17071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with multiple medical conditions and complex social issues are at risk for high utilization and poor outcomes. The Connecting Provider to Home program deployed teams of a social worker and a community health worker (CHW) to support patients with social issues and access to primary care. Our objectives were to examine the impact of the program on utilization and satisfaction with care among older adults with complex social and medical issues. DESIGN Retrospective quasi-experimental observational study with matched comparator group. SETTING Community-based program in Southern California. PARTICIPANTS Four hundred twenty community dwelling adults. INTERVENTION Community-based healthcare program delivered by a social worker and CHW team for older adults with complex medical and social needs. MEASUREMENTS Acute hospitalization and emergency department (ED) visits in the 12 months preceding and following enrollment in the pilot program. A "difference-in-difference" analysis using a matched comparator group was conducted. Comparator group data of patients receiving usual care were obtained. Surveys were conducted to assess patient satisfaction and experiences with the program. RESULTS The mean age of patients was 74 years, and the program demonstrated statistically significant reductions in acute hospitalizations and ED use compared with 700 comparator patients. Pre/post-acute hospitalizations and ED visits were reduced in the intervention group. The average per patient per year reduction in acute hospitalizations was -0.66, whereas the average per patient reduction in ED use was -0.57. Patients enrolled in the program reported high levels of satisfaction and rated the program favorably. CONCLUSIONS A care model with a social worker and CHW can be linked to primary care to address patient social needs and potentially reduce utilization of healthcare services and enhance patient experiences with care.
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Affiliation(s)
- Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Carol M Mangione
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | | | - Lisa Desai
- SCAN Health Plan, Long Beach, California, USA
| | - Jonathan Grotts
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Eve Gelb
- SCAN Health Plan, Long Beach, California, USA
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Rahman R, Ross A, Pinto R. The critical importance of community health workers as first responders to COVID-19 in USA. Health Promot Int 2021; 36:1498-1507. [PMID: 33569593 PMCID: PMC7928891 DOI: 10.1093/heapro/daab008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts.
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Affiliation(s)
- Rahbel Rahman
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Abigail Ross
- Graduate School of Social Service, Fordham University, New York, NY 10023, USA
| | - Rogério Pinto
- University of Michigan School of Social Work, Ann Arbor, Michigan 48109, USA
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Baughman DJ, Waheed A, Khan MN, Nicholson JM. Enhancing Value-Based Care With a Walk-in Clinic: A Primary Care Provider Intervention to Decrease Low Acuity Emergency Department Overutilization. Cureus 2021; 13:e13284. [PMID: 33728217 PMCID: PMC7955766 DOI: 10.7759/cureus.13284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background Emergency department overutilization is a known contributor to the high per-capita healthcare cost in the United States. There is a knowledge gap regarding the substitution effect of walk-in clinic availability in primary care provider (PCP) offices and emergency department utilization (EDU). This study evaluates associations between PCP availability and EDU and analyzes the potential cost savings for health systems. Methods A retrospective cohort analysis compared low acuity EDU rates in established patients at a family medicine residency's PCP office before and after walk-in clinic implementation. The practice had 12 providers, 12 residents, and a patient panel of approximately 7,000-8,000. Inclusion criteria were met if patients were: (1) established with the PCP office, (2) had a low acuity emergency department (ED) visit (emergency index score level 4 or 5) OR had a walk-in clinic visit at the family practice. ED visits were tracked from January 2018 to January 2020 and encounters were compared numbers to pre and post-implementation of a walk-in clinic. Cost savings for comparable management was estimated with average price differences for low acuity encounters in the ED versus clinic. Results Over the two-year timeframe, there were 10,962 total visits to the ED by family practice patients, 4,250 of these visits were low acuity. Despite gross monthly increases of EDU from 2018-2020, after implementation of a walk-in clinic in 2019, rates of total EDU decreased by 1.5% and low acuity utilization rates also decreased. The average annual patient census nearly doubled from 5,763 to 8,042. T-tests confirmed statistical significance with p-values <0.05. Average low acuity ED visits ($437) cost 4.9 times more than comparable PCP office visits ($91). Managing 2,387 patients in the walk-in clinic resulted in an estimated annual cost savings of $825,902. Conclusion Extended walk-in availability in primary care offices provides non-ED capacity for low acuity management and might mitigate low acuity ED utilization while providing more cost-effective care. This study supports similarly described pre-hospital diversions in reducing ED over-utilization by increasing access to care. Higher levels of evidence are needed to establish causality.
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Affiliation(s)
| | - Abdul Waheed
- Family Medicine, Wellspan Good Samaritan Hospital, Lebanon, USA
- Family and Community Medicine, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA
| | - Muhammad N Khan
- Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, USA
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54
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Sedhom R, Nudotor R, Freund KM, Smith TJ, Cooper LA, Owczarzak JT, Johnston FM. Can Community Health Workers Increase Palliative Care Use for African American Patients? A Pilot Study. JCO Oncol Pract 2021; 17:e158-e167. [PMID: 33476179 DOI: 10.1200/op.20.00574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer. METHODS African American patients diagnosed with an advanced solid organ cancer (stage IV or stage III disease with a palliative performance score < 60%) were enrolled. Patients completed baseline surveys that assessed symptom burden and distress at baseline and 3 months post-CHW intervention. The CHW intervention consisted of a comprehensive assessment of multiple PC domains and social determinants of health. CHWs provided tailored support and education on the basis of iterative assessment of patient needs. Intervention feasibility was determined by patient and caregiver retention rate above 50% at 3 months. RESULTS Over a 12-month period, 24 patients were screened, of which 21 were deemed eligible. Twelve patients participated in the study. Patient retention was high at 3 months (75%) and 6 months (66%). Following the CHW intervention, symptom assessment as measured by Edmonton Symptom Assessment System improved from 33.8 at baseline to 18.8 (P = .03). Psychological distress improved from 5.5 to 4.7 (P = .36), and depressive symptoms from 42.2 to 33.6 (P = .09), although this was not significant. ACP documentation improved from 25% at baseline to 75% at study completion. Sixty-seven percentage of patients were referred to PC, with 100% of three decedents using hospice. CONCLUSION Utilization of CHWs to address PC domains and social determinants of health is feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.
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Affiliation(s)
- Ramy Sedhom
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Richard Nudotor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Thomas J Smith
- Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jill T Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Stiles S, Thomas R, Beck AF, Parsons A, Buzek N, Mansour M, Anderson K. Deploying Community Health Workers to Support Medically and Socially At-Risk Patients in a Pediatric Primary Care Population. Acad Pediatr 2020; 20:1213-1216. [PMID: 32305517 DOI: 10.1016/j.acap.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/27/2020] [Accepted: 04/05/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Susan Stiles
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio
| | - Ronay Thomas
- University of Cincinnati College of Medicine (R Thomas, AF Beck, and M Mansour), Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio; University of Cincinnati College of Medicine (R Thomas, AF Beck, and M Mansour), Cincinnati, Ohio.
| | - Allison Parsons
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio
| | - Nora Buzek
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio
| | - Mona Mansour
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio; University of Cincinnati College of Medicine (R Thomas, AF Beck, and M Mansour), Cincinnati, Ohio
| | - Kristy Anderson
- Cincinnati Children's Hospital Medical Center (S Stiles, AF Beck, A Parsons, N Buzek, M Mansour, and K Anderson), Cincinnati, Ohio
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Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the role, responsibilities, hiring, training, and retention of community health workers (CHWs) on clinical care teams in the United States. RECENT FINDINGS CHWs are unique members of clinical care teams because of their ability to foster a deep trust and understanding with patients by sharing similar life experiences, participating in home visits, and providing constant support and advocacy. By partnering with CHWs, other clinical care members also gain a better understanding of their patients allowing them to deliver more culturally competent, patient/family-centered care. CHWs when incorporated into interdisciplinary teams have shown to lower healthcare costs, reduce hospital stays and admissions, and improve health outcomes and quality of life for children and families. However, the lack of standardization among CHW programs makes it difficult to quantify the overall effect and impact of integrating CHWs into clinical care teams. SUMMARY CHWs are able to improve health outcomes and address social determinants of health when properly integrated into clinical care teams. However, without adequate support, integration, funding, and training, CHWs are not able to reach their full potential. The standardization of CHWs' responsibilities and training, like other clinical care team members, is lacking within the United States, making it a challenge to evaluate programs and maintain sustainable funding for these vital members of the clinical care team.
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Damian AJ, Robinson S, Manzoor F, Lamb M, Rojas A, Porto A, Anderson D. A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs). Pilot Feasibility Stud 2020; 6:132. [PMID: 32963804 PMCID: PMC7499981 DOI: 10.1186/s40814-020-00678-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs' capacity to address health and social issues of vulnerable populations. METHODS An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. RESULTS There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants' self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants' caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. CONCLUSIONS This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.
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Affiliation(s)
- April Joy Damian
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Faaiza Manzoor
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
| | - Mandy Lamb
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
| | - Adriana Rojas
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
| | - Ariel Porto
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
| | - Daren Anderson
- Weitzman Institute, 19 Grand Street, Middletown, CT 06457 USA
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Panahpour Eslami N, Nguyen J, Navarro L, Douglas M, Bann M. Factors associated with low-acuity hospital admissions in a public safety-net setting: a cross-sectional study. BMC Health Serv Res 2020; 20:775. [PMID: 32838764 PMCID: PMC7446119 DOI: 10.1186/s12913-020-05456-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background Given system-level focus on avoidance of unnecessary hospitalizations, better understanding admission decision-making is of utility. Our study sought to identify factors associated with hospital admission versus discharge from the Emergency Department (ED) for a population of patients who were assessed as having low medical acuity at time of decision. Methods Using an institutional database, we identified ED admission requests received from March 1, 2018 to Feb 28, 2019 that were assessed by a physician at the time of request as potentially inappropriate based on lack of medical acuity. Focused chart review was performed to extract data related to patient demographics, socioeconomic information, measures of illness, and system-level factors such as previous healthcare utilization and day/time of presentation. A binary logistic regression model was constructed to correlate patient and system factors with disposition outcome of admission to the hospital versus discharge from the ED. Physician-reported contributors to admission decision-making and chief complaint/reason for admission were summarized. Results A total of 349 (77.2%) of 452 calls resulted in admission to the hospital and 103 (22.8%) resulted in discharge from the ED. Predictors of admission included age over 65 (OR 3.5 [95%CI 1.1–11.6], p = 0.039), homelessness (OR 3.3 [95% CI 1.7–6.4], p=0.001), and night/weekend presentation (OR 2.0 [95%CI 1.1–3.5], p = 0.020). The most common contributing factors to the decision to admit reported by the responding physician included: lack of outpatient social support (35.8% of admissions), homelessness (33.0% of admissions), and substance use disorder (23.5% of admissions). Conclusions Physician medical decision-making regarding the need for hospitalization incorporates consideration of individual patient characteristics, social setting, and system-level barriers. Interventions aimed at reducing unnecessary hospitalizations, especially those involving patients with low medical acuity, should focus on underlying unmet needs and involve a broad set of perspectives.
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Affiliation(s)
| | | | | | | | - Maralyssa Bann
- Division of GIM/Hospital Medicine, Harborview Medical Center, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
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Islam N, Rogers ES, Schoenthaler EDd A, Thorpe LE, Shelley D. A Cross-Cutting Workforce Solution for Implementing Community-Clinical Linkage Models. Am J Public Health 2020; 110:S191-S193. [PMID: 32663090 DOI: 10.2105/ajph.2020.305692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nadia Islam
- Nadia Islam, Erin S. Rogers, Antoinette Schoenthaler, and Lorna E. Thorpe are with the Department of Population Health, NYU Grossman School of Medicine, New York, NY. Donna Shelley is with the NYU School of Global Public Health, New York, NY
| | - Erin S Rogers
- Nadia Islam, Erin S. Rogers, Antoinette Schoenthaler, and Lorna E. Thorpe are with the Department of Population Health, NYU Grossman School of Medicine, New York, NY. Donna Shelley is with the NYU School of Global Public Health, New York, NY
| | - Antoinette Schoenthaler EDd
- Nadia Islam, Erin S. Rogers, Antoinette Schoenthaler, and Lorna E. Thorpe are with the Department of Population Health, NYU Grossman School of Medicine, New York, NY. Donna Shelley is with the NYU School of Global Public Health, New York, NY
| | - Lorna E Thorpe
- Nadia Islam, Erin S. Rogers, Antoinette Schoenthaler, and Lorna E. Thorpe are with the Department of Population Health, NYU Grossman School of Medicine, New York, NY. Donna Shelley is with the NYU School of Global Public Health, New York, NY
| | - Donna Shelley
- Nadia Islam, Erin S. Rogers, Antoinette Schoenthaler, and Lorna E. Thorpe are with the Department of Population Health, NYU Grossman School of Medicine, New York, NY. Donna Shelley is with the NYU School of Global Public Health, New York, NY
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Vasan A, Morgan JW, Mitra N, Xu C, Long JA, Asch DA, Kangovi S. Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: A pooled analysis of three clinical trials. Health Serv Res 2020; 55 Suppl 2:894-901. [PMID: 32643163 PMCID: PMC7518822 DOI: 10.1111/1475-6773.13321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization. DATA SOURCES/STUDY SETTING Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016. STUDY DESIGN The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and were predominantly Medicaid insured. They were randomly assigned to receive usual care versus IMPaCT, an intervention in which CHWs provide tailored social support, health behavior coaching, connection with resources, and health system navigation. Trial one (n = 446) tested two weeks of IMPaCT among hospitalized general medical patients. Trial two (n = 302) tested six months of IMPaCT among outpatients at two academic primary care clinics. Trial three (n = 592) tested six months of IMPaCT among outpatients at academic, Veterans Affairs (VA), and Federally Qualified Health Center primary care practices. DATA COLLECTION/EXTRACTION METHODS The primary outcome for this study was all-cause hospitalization, as measured by total number of hospital days per patient. Hospitalization data were collected from statewide or VA databases at 30 days postenrollment in Trial 1, twelve months postenrollment in Trial 2, and nine months postenrollment in Trial 3. PRINCIPAL FINDINGS Over 9398 observed patient months, the total number of hospital days per patient in the intervention group was 66 percent of the total in the control group (849 days for 674 intervention patients vs 1258 days for 660 control patients, incidence rate ratio (IRR) 0.66, P < .0001). This reduction was driven by fewer hospitalizations per patient (0.27 vs 0.34, P < .0001) and shorter mean length of stay (4.72 vs 5.57 days, P = .03). The intervention also decreased rates of hospitalization outside patients' primary health system (18.8 percent vs 34.8 percent, P = .0023). CONCLUSIONS Data from three randomized clinical trials across multiple settings show that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system. This is the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system-based social intervention.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John W Morgan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chang Xu
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith A Long
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - David A Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Shreya Kangovi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Penn Center for Community Health Workers, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Jack HE, Myers B, Regenauer KS, Magidson JF. Mutual Capacity Building to Reduce the Behavioral Health Treatment Gap Globally. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:497-500. [PMID: 31823100 PMCID: PMC7253395 DOI: 10.1007/s10488-019-00999-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Use of lay health workers for the treatment of common mental disorders is an expanding, yet still underutilized, opportunity for closing the behavioral health treatment gap globally. In this commentary, we describe how "mutual capacity building," an equal exchange of ideas between low and middle-income countries (LMICs) and high-income countries (HICs) to promote shared learning, could promote the development and scale-up of therapies using lay health workers. We propose ways that task sharing models for behavioral health can inform and be supported by bidirectional learning across HICs and LMICs.
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Affiliation(s)
- Helen E. Jack
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow, 7505 South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
| | - Kristen S. Regenauer
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742 USA
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742 USA
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Fiori KP, Rehm CD, Sanderson D, Braganza S, Parsons A, Chodon T, Whiskey R, Bernard P, Rinke ML. Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program. Clin Pediatr (Phila) 2020; 59:547-556. [PMID: 32131620 PMCID: PMC7357198 DOI: 10.1177/0009922820908589] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These findings have implementation implications for programs aiming to address social needs in practice. Less than half of households reported successful referrals, which suggests the need for additional research and an opportunity for further program optimization.
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Affiliation(s)
- Kevin P. Fiori
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA,Integrate Health—Community Health Systems Lab, New York, NY, USA
| | - Colin D. Rehm
- Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Health System, Bronx, NY, USA
| | - Dana Sanderson
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra Braganza
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda Parsons
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Health System, Bronx, NY, USA
| | | | | | | | - Michael L. Rinke
- Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Kennedy K, Allenbrand R, Bowles E. The Role of Home Environments in Allergic Disease. Clin Rev Allergy Immunol 2020; 57:364-390. [PMID: 30684120 DOI: 10.1007/s12016-018-8724-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Allergic diseases are surprisingly common, chronic health conditions. The primary location where the vast majority of people are exposed to allergens and other substances is in their home. This means it is important to understand home environments and how a home's systems function and interact-and that how we occupy these spaces plays a crucial role in both environmental exposure and management of allergic disease. This review provides an overview of what is understood about home environmental exposure and its impact on our health, and proposes a systematic process for using a patient's environmental history to develop individualized, manageable and cost-effective recommendations. Once occupant-related information has been gathered, a home environmental exposure assessment should be performed focused on identifying the relationships between any identified sources of contaminants and the housing systems, and conditions that may be contributing to exposure. The results and recommendations from this assessment can then be used to guide exposure-reduction efforts by patients and/or their caregivers in an effort to improve disease management. In this review, we'll discuss three different types of home interventions-active, which must be routinely performed by the patient and/or caregiver, passive, which are interventions that work without routine, direct interaction from the homeowner, and behavioral changes in how the home environment is cleaned and maintained for long-term reduction of allergens. In this review, and others evaluated for this discussion, a significant number of home environmental assessment and intervention programs were shown to be cost effective, with the majority of programs showing a net positive return on investment. It is important to recognize that to be cost effective, the level and intensity of services offered through home visit programs need be stratified, based on the estimated health risks of the patient, in order to tailor the assessment and target the interventions to a patient's needs while maximizing cost effectiveness.
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Affiliation(s)
- Kevin Kennedy
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA.
| | - Ryan Allenbrand
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA
| | - Eric Bowles
- Section of Toxicology and Environmental Health, Children's Mercy Kansas City, Kansas City, USA
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Where Is the Break-even Point for Community Health Workers? Using National Data and Local Programmatic Costs to Find the Break-even Point for a Metropolitan Community Health Worker Program. Med Care 2020; 58:314-319. [PMID: 32197027 DOI: 10.1097/mlr.0000000000001273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community health worker (CHW) programs take many forms and have been shown to be effective in improving health in several contexts. The extent to which they reduce unnecessary care is not firmly established. OBJECTIVES This study estimates the number of hospitalizations and emergency department (ED) visits that would need to be avoided to recoup program costs for a CHW program that addressed both medical and social needs. RESEARCH DESIGN A programmatic cost analysis is conducted using 6 different categories: personnel, training, transportation, equipment, facilities, and administrative costs. First, baseline costs are established for the current program and then estimate the number of avoided ED visits or hospitalizations needed to recoup program costs using national average health care estimates for different patient populations. MEASURES Data on program costs are taken from administrative program records. Estimates of ED visit and hospitalization costs (or charges in some cases) are taken from the literature. RESULTS To fully offset program costs, each CHW would need to work with their annual caseload of 150 participants to avoid almost 50 ED visits collectively. If CHW participants also avoided 2 hospitalizations, the number of avoided ED visits needed to offset costs reduces to about 34. CONCLUSIONS Estimates of avoided visits needed to reach the break-even point are consistent with the literature. The analysis does not take other outcomes of the program from the clients' or workers' perspectives into account, so it is likely an upper bound on the number of avoided visits needed to be cost-effective.
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Berrett-Abebe J, Donelan K, Berkman B, Auerbach D, Maramaldi P. Physician and nurse practitioner perceptions of social worker and community health worker roles in primary care practices caring for frail elders: Insights for social work. SOCIAL WORK IN HEALTH CARE 2020; 59:46-60. [PMID: 31783722 DOI: 10.1080/00981389.2019.1695703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 11/03/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of SW and CHW in primary care practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Physician and nurse practitioner clinicians were randomly selected within practices, stratifying by practice staffing and presence/absence of geriatric clinicians; our final sample for this analysis included 341 practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession.
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Affiliation(s)
| | - Karen Donelan
- Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Barbara Berkman
- Columbia School of Social Work, Columbia University, New York, NY, USA
| | | | - Peter Maramaldi
- School of Social Work, Simmons University, Boston, MA, USA
- Department of Public Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Magidson JF, Jack HE, Regenauer KS, Myers B. Applying lessons from task sharing in global mental health to the opioid crisis. J Consult Clin Psychol 2019; 87:962-966. [PMID: 31556672 DOI: 10.1037/ccp0000434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current opioid crisis in the United States has been considered an "epidemic of poor access to care." Similar to the shortage of trained providers to prescribe medications to treat opioid use disorder (OUD), there is a severe shortage of trained providers to meet the mental health needs of patients with OUD. These workforce shortages are evident nationwide, yet are particularly salient in rural areas. In this commentary in response to the article "Integrating Addiction Medicine into Rural Primary Care: Strategies and Initial Outcomes (Logan et al., 2019)," we propose that we can apply lessons learned from working in resource-constrained settings globally to improve access to mental health care for patients with OUD in rural areas in the United States. We expand upon Logan et al. (2019) by discussing how non-specialist health workers, including community health workers and peer providers, under the supervision of psychologists and other specialists, can expand access to evidence-based mental health care for patients with OUD, particularly those receiving medications for opioid use disorder (MOUD). We draw from established models in global mental health that rely on "task sharing" mental health care to discuss ways in which lessons learned from scaling up evidence-based interventions with lay health workers in low and middle-income countries can directly inform efforts to increase access to mental health care to address the opioid crisis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Helen E Jack
- Department of Medicine, University of Washington
| | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council
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67
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Humphry J, Kiernan J. Insights in Public Health: Community Health Workers Are the Future of Health Care: How Can We Fund These Positions? HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:371-374. [PMID: 31886469 PMCID: PMC6911776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Jasmin Kiernan
- West Hawai'i Community Health Center, Kailua-Kona, HI (JK)
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson KA, Begay MG, Shin SS. Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation. Int J Equity Health 2019; 18:183. [PMID: 31771603 PMCID: PMC6880375 DOI: 10.1186/s12939-019-1097-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. METHODS We abstracted routine clinical data from the Indian Health Service's information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. RESULTS Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (- 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (- 10.58 mg/dl) compared to the non-COPE group (- 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. CONCLUSION Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. TRIAL REGISTRATION Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Brown
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Katrina A Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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69
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Heisler M, Lapidos A, Henderson J, Guzman RM, Wolfe J, Meyer P, Law D, Kieffer EC, Ernst C, Djelaj V, Khaldun J, Ayanian JZ. Study protocol for a Community Health Worker (CHW)-led comprehensive neighborhood-focused program for medicaid enrollees in detroit. Contemp Clin Trials Commun 2019; 16:100456. [PMID: 31646214 PMCID: PMC6804462 DOI: 10.1016/j.conctc.2019.100456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 01/16/2023] Open
Abstract
Residents of low income neighborhoods disproportionately experience poor health, and many have unmet social needs. Clinical trials have shown the efficacy of Community Health Worker (CHW) programs in improving outcomes for a variety of health conditions. An important next step is developing and evaluating financially sustainable CHW program models in real-life settings. This program evaluation examines health care utilization among participants in a geographically targeted program led by salaried CHWs from three Medicaid health plans. Beneficiaries who reside in the Cody Rouge neighborhood of Detroit and had more than 3 Emergency Department (ED) visits or at least 1 ambulatory care-sensitive hospitalization in the prior 12 months are eligible for the program. Health plan CHWs assigned to the program reach out to eligible beneficiaries to provide an assessment; link them to resources; and provide follow-up. At 12-month follow up, claims data on ED visits, ambulatory care-sensitive hospitalizations, primary care visits, and related costs will be compared between beneficiaries who participated and eligible beneficiaries randomized to receive usual outreach. We hypothesize that patients enrolled in the CHW intervention will experience a reduction in acute care usage resulting in cost savings compared to those receiving usual health plan outreach. This study is among the first to evaluate the impact on health care utilization of augmented services delivered by health plan CHWs for high-utilizing health plan members as part of a health plan-community-academic partnership. This study will provide important information on CHW program sustainability and provide insights into effective implementation of such programs. Trial registration NCT03924713.
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Affiliation(s)
- Michele Heisler
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Adrienne Lapidos
- Department of Psychiatry, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - James Henderson
- Consulting for Statistics Computing & Analytics Research, University of Michigan, 3550 Rackham, 915 E. Washington St, Ann Arbor, MI, 48109, USA
| | - Rebeca M Guzman
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA
| | - Jason Wolfe
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - Patricia Meyer
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - David Law
- Joy-Southfield Community Development Corp, 18917 Joy Road, Detroit, MI, 48228, USA
| | - Edith C Kieffer
- University of Michigan School of Social Work, 1080 South University, Ann Arbor, MI, 48109, USA
| | - Caleb Ernst
- University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA
| | - Valentina Djelaj
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA
| | - Joneigh Khaldun
- Detroit Health Department, 3245 E. Jefferson, Suite 100, Detroit, MI, 48203, USA.,State of Michigan Department of Health and Human Services, USA
| | - John Z Ayanian
- Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA.,University of Michigan Institute for Healthcare Policy & Innovation, 2800 Plymouth Road, North Campus Research Complex, Building 16, Ann Arbor, MI, 48109, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA.,Gerald R. Ford School of Public Policy, University of Michigan, 735 S. State St, Ann Arbor, MI, 48109, USA
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70
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Harding T, Oetzel J. Implementation effectiveness of health interventions for indigenous communities: a systematic review. Implement Sci 2019; 14:76. [PMID: 31382994 PMCID: PMC6683565 DOI: 10.1186/s13012-019-0920-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION Not registered.
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Affiliation(s)
- Truely Harding
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - John Oetzel
- Waikato Management School, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
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Lapidos A, Lapedis J, Heisler M. Realizing the Value of Community Health Workers - New Opportunities for Sustainable Financing. N Engl J Med 2019; 380:1990-1992. [PMID: 31116918 DOI: 10.1056/nejmp1815382] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Adrienne Lapidos
- From the Department of Psychiatry (A.L.), Poverty Solutions at the University of Michigan (A.L., M.H.), the Center for Health and Research Transformation (J.L.), and the Departments of Internal Medicine and Health Behavior and Health Education (M.H.), University of Michigan, and the Veterans Affairs Center for Clinical Management Research (M.H.) - all in Ann Arbor
| | - Jeremy Lapedis
- From the Department of Psychiatry (A.L.), Poverty Solutions at the University of Michigan (A.L., M.H.), the Center for Health and Research Transformation (J.L.), and the Departments of Internal Medicine and Health Behavior and Health Education (M.H.), University of Michigan, and the Veterans Affairs Center for Clinical Management Research (M.H.) - all in Ann Arbor
| | - Michele Heisler
- From the Department of Psychiatry (A.L.), Poverty Solutions at the University of Michigan (A.L., M.H.), the Center for Health and Research Transformation (J.L.), and the Departments of Internal Medicine and Health Behavior and Health Education (M.H.), University of Michigan, and the Veterans Affairs Center for Clinical Management Research (M.H.) - all in Ann Arbor
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Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P, Alberts MJ, Tiner AC, Schwamm LH, Jauch EC. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke 2019; 50:e187-e210. [PMID: 31104615 DOI: 10.1161/str.0000000000000173] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2005, the American Stroke Association published recommendations for the establishment of stroke systems of care and in 2013 expanded on them with a statement on interactions within stroke systems of care. The aim of this policy statement is to provide a comprehensive review of the scientific evidence evaluating stroke systems of care to date and to update the American Stroke Association recommendations on the basis of improvements in stroke systems of care. Over the past decade, stroke systems of care have seen vast improvements in endovascular therapy, neurocritical care, and stroke center certification, in addition to the advent of innovations, such as telestroke and mobile stroke units, in the context of significant changes in the organization of healthcare policy in the United States. This statement provides an update to prior publications to help guide policymakers and public healthcare agencies in continually updating their stroke systems of care in light of these changes. This statement and its recommendations span primordial and primary prevention, acute stroke recognition and activation of emergency medical services, triage to appropriate facilities, designation of and treatment at stroke centers, secondary prevention at hospital discharge, and rehabilitation and recovery.
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73
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Marko-Holguin M, Cordel SL, Van Voorhees BW, Fogel J, Sykes E, Fitzgibbon M, Glassgow AE. A Two-Way Interactive Text Messaging Application for Low-Income Patients with Chronic Medical Conditions: Design-Thinking Development Approach. JMIR Mhealth Uhealth 2019; 7:e11833. [PMID: 31042152 PMCID: PMC6658312 DOI: 10.2196/11833] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/18/2019] [Accepted: 01/30/2019] [Indexed: 12/02/2022] Open
Abstract
Background Two-way interactive text messaging between patient and community health workers (CHWs) through mobile phone SMS (short message service) text messaging is a form of digital health that can potentially enhance patient engagement in young adults and families that have a child with chronic medical conditions such as diabetes mellitus, sickle cell disease, and asthma. These patients have complex needs, and a user-centered way can be useful for designing a tool to address their needs. Objective The aim of this study was to utilize the user-centered approach of design thinking to develop a two-way interactive communication SMS text messaging tool for communication between patients or caregivers and CHWs. Methods We applied a design thinking methodology for development of the SMS text messaging tool. We collected qualitative data from 127 patients/caregivers and 13 CHWs, health care professionals, and experts. In total, 4 iterative phases were used to design the final prototype. Results The design thinking process led to the final SMS text messaging tool that was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic, interactive, and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS text messaging components also include operational factors to support staff such as patient contact lists, SMS text messaging templates, and technology chat support. Conclusions Design thinking can develop a tool to meet the engagement needs of patients with complex health care needs and be user-friendly for health care staff.
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Affiliation(s)
- Monika Marko-Holguin
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Stephanie Luz Cordel
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.,All Voices Consulting, LLC, Phoenix, AZ, United States
| | | | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, United States
| | - Emily Sykes
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Marian Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
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Britt HR, JaKa MM, Fernstrom KM, Bingham PE, Betzner AE, Taghon JR, Shippee ND, Shippee TP, Schellinger SE, Anderson EW. Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience. Am J Hosp Palliat Care 2019; 36:408-416. [PMID: 30541333 PMCID: PMC6442020 DOI: 10.1177/1049909118817740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients' physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .
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Affiliation(s)
| | | | | | | | | | | | - Nathan D. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
| | - Tetyana P. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
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Raviola G, Naslund JA, Smith SL, Patel V. Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap. Curr Psychiatry Rep 2019; 21:44. [PMID: 31041554 DOI: 10.1007/s11920-019-1028-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. RECENT FINDINGS There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.
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Affiliation(s)
- Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephanie L Smith
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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Risica PM, Tovar A, Palomo V, Dionne L, Mena N, Magid K, Ward DS, Gans KM. Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the 'Healthy Start/Comienzos Sanos' cluster randomized trial. BMC Public Health 2019; 19:419. [PMID: 30999881 PMCID: PMC6472069 DOI: 10.1186/s12889-019-6704-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION (# NCT02452645 ) ClinicalTrials.gov Trial registered on May 22, 2015.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Kate Magid
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Diane Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461 USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269 USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269 USA
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77
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Chiu RG, Xia Y, Sharp LK, Gerber BS. Do community health workers affect non-urgent, ambulatory healthcare utilization among low-income, minority patients with diabetes? J Clin Transl Endocrinol 2019; 16:100184. [PMID: 30815365 PMCID: PMC6377405 DOI: 10.1016/j.jcte.2019.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 11/15/2022] Open
Abstract
Community health workers (CHWs) can reduce emergent care among low-income, ethnic minority patients with type 2 diabetes. A secondary analysis of a randomized controlled trial evaluated the effect of CHWs on non-urgent, ambulatory healthcare utilization. Within this trial, no effect on ambulatory care was found.
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Affiliation(s)
- Ryan G. Chiu
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Yinglin Xia
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Lisa K. Sharp
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois College of Pharmacy, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States
| | - Ben S. Gerber
- Department of Medicine, University of Illinois College of Medicine, 1747 W. Roosevelt Rd., Chicago, IL 60608, United States,Corresponding author at: Division of Academic Internal Medicine and Geriatrics, Institute for Health Research and Policy M/C 275, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL 60608, United States.
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78
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Affiliation(s)
- Ryan Graddy
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, Grande D, Long JA. Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:1635-1643. [PMID: 30422224 PMCID: PMC6469661 DOI: 10.1001/jamainternmed.2018.4630] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Addressing the social determinants of health has been difficult for health systems to operationalize. OBJECTIVE To assess a standardized intervention, Individualized Management for Patient-Centered Targets (IMPaCT), delivered by community health workers (CHWs) across 3 health systems. DESIGN, SETTING, AND PARTICIPANTS This 2-armed, single-blind, multicenter randomized clinical trial recruited patients from 3 primary care facilities in Philadelphia, Pennsylvania, between January 28, 2015, and March 28, 2016. Patients who resided in a high-poverty zip code, were uninsured or publicly insured, and who had a diagnosis for 2 or more chronic diseases were recruited, and patients were randomized to either the CHW intervention or the control arm (goal setting only). Follow-up assessments were conducted at 6 and 9 months after enrollment. Data were analyzed using an intention-to-treat approach from June 2017 to March 2018. INTERVENTION Participants set a chronic disease management goal with their primary care physician; those randomized to the CHW intervention received 6 months of tailored support. MAIN OUTCOMES AND MEASURES The primary outcome was change in self-rated physical health. The secondary outcomes were self-rated mental health, chronic disease control, patient activation, patient-reported quality of primary care, and all-cause hospitalization. RESULTS Of the 592 participants, 370 (62.5%) were female, with a mean (SD) age of 52.6 (11.1) years. Participants in both arms had similar improvements in self-rated physical health (mean [SD], 1.8 [11.2] vs 1.6 [9.9]; P = .89). Patients in the intervention group were more likely to report the highest quality of care (odds ratio [OR], 1.8; 95% CI, 1.4-2.4; risk difference [RD], 0.12; P < .001) and spent fewer total days in the hospital at 6 months (155 days vs 345 days; absolute event rate reduction, 69%) and 9 months (300 days vs 471 days; absolute event rate reduction, 65%). This reduction was driven by a shorter average length of stay (difference, -3.1 days; 95% CI, -6.33 to 0.22; P = .06) and a lower mean number of hospitalizations (difference, -0.3; 95% CI, -0.6 to 0.0; P = .07) among patients who were hospitalized. Patients in the intervention group had a lower odds of repeat hospitalizations (OR, 0.4; 95% CI, 0.2-0.9; RD, -0.24; P = .02), including 30-day readmissions (OR, 0.3; 95% CI, 0.1-0.9; RD, -0.17; P = .04). CONCLUSIONS AND RELEVANCE A standardized intervention did not improve self-rated health but did improve the patient-perceived quality of care while reducing hospitalizations, suggesting that health systems may use a standardized intervention to address the social determinants of health. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02347787.
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Affiliation(s)
- Shreya Kangovi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Penn Center for Community Health Workers, Penn Medicine, Philadelphia, Pennsylvania.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lindsey Norton
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rory Harte
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Xinyi Zhao
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tamala Carter
- Penn Center for Community Health Workers, Penn Medicine, Philadelphia, Pennsylvania
| | - David Grande
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Carrasquillo O, Young B, Dang S, Fontan O, Ferras N, Romano JG, Dong C, Kenya S. Hispanic Secondary Stroke Prevention Initiative Design: Study Protocol and Rationale for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e11083. [PMID: 30341050 PMCID: PMC6231896 DOI: 10.2196/11083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/30/2022] Open
Abstract
Background Hispanic-Latino populations face a disproportionate stroke burden and are less likely to have sufficient control over stroke risk factors in comparison with other ethnic populations. A promising approach to improving chronic health outcomes has been the use of community health workers (CHWs). Objective The objective of this randomized controlled trial is to evaluate the effectiveness of a CHW intervention among Latino patients at risk of recurrent stroke. Methods The Hispanic Secondary Stroke Prevention Initiative (HiSSPI) is a randomized clinical trial of 300 Latino participants from South Florida who have experienced a stroke within the last 5 years. Participants randomized into the CHW intervention arm receive health education and assistance with health care navigation and social services through home visits and phone calls. The intervention also includes a mHealth component in which participants also receive daily text messages (short message service). The primary outcome is change in systolic blood pressure at 12 months. Other secondary outcomes include changes in low-density lipoprotein, glycated hemoglobin, and medication adherence. Results Study enrollment began in 2015 and will be completed by the end of 2018. The first results are expected to be submitted for publication in 2020. Conclusions HiSSPI is one of the first randomized controlled trials to examine CHW-facilitated stroke prevention and will provide rigorous evidence on the impact of CHWs on secondary stroke risk factors among Latino individuals who have had a stroke. Trial Registration ClinicalTrials.gov NCT02251834; https://clinicaltrials.gov/ct2/show/NCT02251834 (Archived by WebCite at http://www.webcitation.org/72DgMqftq) International Registered Report Identifier (IRRID) RR1-10.2196/11083
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Affiliation(s)
- Olveen Carrasquillo
- Division of General Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - BreAnne Young
- Division of General Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Stuti Dang
- Division of Geriatrics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Orieta Fontan
- Division of General Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Natalie Ferras
- Division of General Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jose G Romano
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Chuanhui Dong
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Sonjia Kenya
- Division of General Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
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Carter J, Walton A, Donelan K, Thorndike A. Implementing community health worker-patient pairings at the time of hospital discharge: A randomized control trial. Contemp Clin Trials 2018; 74:32-37. [PMID: 30291997 DOI: 10.1016/j.cct.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2011, there were approximately 3.3 million adult 30-day all-cause hospital readmissions in the US generating $41.3 billion in hospital costs. Community health worker (CHW) care delivery is one of very few interventions demonstrated to reduce health care utilization among populations with chronic disease. While there are a number of studies demonstrating improved disease-specific outcomes with CHW interventions, studies examining the effect of CHW care delivery on 30-day readmission rates are rare. METHODS This study is a randomized control trial designed to determine if linking hospitalized patients with chronic disease to community health workers (CHWs) can decrease 30-day readmissions. Participants were randomly assigned to receive the 30-day CHW intervention or usual care (no CHW). All study participants completed surveys at baseline and the end of the study 30 days post-discharge. The primary outcome was 30-day readmission and secondary outcomes included emergency department visits, missed appointments, and patient satisfaction. RESULTS We plan to enroll 1200 hospitalized patients during a 24-month intervals. As of December 2017, 350 patients have been consented and randomly assigned to either the intervention or control arm. A number of challenges have been encountered in implementing a CHW initiative at the time of hospital discharge. CONCLUSION This trial tests the effectiveness of CHW care delivery at the time of hospital discharge in reducing 30-day readmission rates and improving outcomes among patients with chronic disease. We describe and discuss challenges in launching this CHW intervention and strategies utilized to overcome these obstacles. Clinical Trials.gov registration submitted 3/14/2017: Protocol ID# 2017A050810 and Clinical Trials.gov ID# NCT03085264 Community Health Worker Care Transitions Study (C-CAT).
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Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Anne Walton
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Karen Donelan
- Mongan Institute for Health Policy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Anne Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Islam NS, Wyatt LC, Taher M, Riley L, Tandon SD, Tanner M, Mukherji BR, Trinh-Shevrin C. A Culturally Tailored Community Health Worker Intervention Leads to Improvement in Patient-Centered Outcomes for Immigrant Patients With Type 2 Diabetes. Clin Diabetes 2018; 36:100-111. [PMID: 29686448 PMCID: PMC5898170 DOI: 10.2337/cd17-0068] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF This article reports results from a patient-centered intervention to improve management of type 2 diabetes in the New York City Bangladeshi community. The DREAM (Diabetes Research, Education, and Action for Minorities) intervention is a randomized trial among Bangladeshi immigrants with type 2 diabetes comparing those enrolled in a community health worker (CHW) intervention to those in usual care. Participants in the intervention group received five group-based educational sessions and two one-on-one visits delivered by a trained CHW, whereas those in the control group received only the first group educational session. Main outcomes include changes in A1C, systolic and diastolic blood pressure, cholesterol, triglycerides, weight, BMI, and patient-centered outcomes such as knowledge and behavior related to type 2 diabetes management.
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Affiliation(s)
- Nadia S. Islam
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Laura C. Wyatt
- Department of Population Health, New York University School of Medicine, New York, NY
| | - M.D. Taher
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Lindsey Riley
- The Michael J. Fox Foundation for Parkinson’s Research, New York, NY
| | - S. Darius Tandon
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Tanner
- Department of Medicine, New York University School of Medicine, New York, NY
| | - B. Runi Mukherji
- Department of Psychology, State University of New York at Old Westbury, Old Westbury, NY
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University School of Medicine, New York, NY
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83
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Engaging Community Health Workers in the Effort to Prevent Sudden Unexpected Death and Death From Chronic Illness. Med Care 2017; 55:1061. [PMID: 28984706 DOI: 10.1097/mlr.0000000000000817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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