One of the first examinations on the clinical impact of community health workers finds their services led to fewer patients being readmitted to the hospital within 30 days following being discharged.
However, the benefit of such interventions was most significant among patients who were transferred from the hospital to short-stay rehabilitation as opposed to those who were sent directly home—an increasingly popular option.
The study, published last week in the journal JAMA Network Open, involved 550 patients hospitalized from April 2017 through March 2019 who were insured within an accountable care organization and had been hospitalized an average of three times in the 12 months prior to taking part in the randomized trial.
The analysis found 12.6% of trial participants who had community health worker interventions were readmitted within 30 days after being discharged compared with 24.5% of patients that did not have those supports. Researchers also found patients with community health worker support had fewer missed follow-up appointments and had a slight decrease in emergency department visits.
"These results indicate that community health worker interventions may help reduce hospital readmissions and improve preventive care among some clinically complex patients within an accountable care organization," lead author Dr. Jocelyn Carter, an investigator in the department of medicine at Massachusetts General Hospital, said in a released statement.
Community health workers provide patients with health coaching, help them to connect to supports to meet their social needs and serve as a bridge to bolster communication and care coordination between patients and their clinicians.
The findings suggest the potential impact community health worker interventions could have toward improving health outcomes among patients discharged to rehabilitation facilities cold be significant.
Patients who are initially sent to rehabilitation rather than home after their inpatient stay in the hospital tend to have more complex medical conditions that lead to them experiencing higher rates of hospital readmissions. The study found community health worker supports led to a 32% reduction in readmissions among patients transferred to rehabilitation compared with just a 5.7% reduction in readmissions among those discharged directly home.
Researchers surmised it was likely the ability of community health workers to address unmet medical and social needs of patients while they were in rehabilitation and coordinate care between rehabilitation staff and their primary-care physicians that played a role in the steep readmission decline. They did note additional research was needed to examine the effect, as well as which patients benefited most from certain community health worker interventions.
But the trial is one of the first to identify a direct link between community health worker interventions and improvement in measurable performance indicators like 30-day readmission rates. Prior research on the potential health benefits of using these workers have focused primarily on the impact such interventions have on improving patient management of certain diseases, like diabetes and hypertension.
Figures from the Bureau of Labor Statistics show there are more than 58,000 community health workers in the nation, but the workforce is projected to grow in the coming years as demand for such services continues to increase among providers seeking to improve engagement with their patients.
"As U.S. healthcare organizations continue to adopt ACO models with the goal of achieving higher-quality care at lower costs, policies supporting insurance-based reimbursement for community health worker care and investment in comprehensive training and integration of CHWs as valued members of patient care teams will continue to be critical," the study concluded.
