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Community Health Worker Intervention Aids Poorer Patients

Improved posthospital outcomes for patients with low socioeconomic status

THURSDAY, Feb. 13, 2014 (HealthDay News) -- A patient-centered tailored community health worker (CHW) intervention improves posthospital outcomes in patients with low socioeconomic status (SES), according to a study published online Feb. 10 in JAMA Internal Medicine.

Shreya Kangovi, M.D., from the University of Pennsylvania Perelman School of Medicine in Philadelphia, and colleagues conducted a randomized clinical trial at two urban, academically affiliated hospitals. The authors sought to examine whether a tailored CHW intervention would improve posthospital outcomes among low SES patients. A total of 446 patients were enrolled and randomized to control or intervention groups. The intervention included CHWs working with patients to create individualized action plans for achieving patients' stated recovery goals. Tailored CHW support was provided to patients for a minimum of two weeks.

The researchers found that, compared with control patients, intervention patients were more likely to obtain timely posthospital primary care (adjusted odds ratio [aOR], 1.52; 95 percent confidence interval [CI], 1.03 to 2.23); to report high-quality discharge communication (aOR, 2.94; 95 percent CI, 1.5 to 5.8); and to show greater improvement in mental health and patient activation (P = 0.02 and 0.05, respectively). No significant between-group differences were seen in physical health, satisfaction with medical care, or medication adherence. The proportions of patients who experienced at least one 30-day readmission were similar in both groups, but multiple 30-day readmissions were less likely among intervention patients (aOR, 0.40; 95 percent CI, 0.14 to 1.06; P = 0.08). Recurrent readmission was reduced from 40.0 to 15.2 percent in the subgroup of 63 readmitted patients (aOR, 0.27; 95 percent CI, 0.08-0.89; P = 0.03).

"Health systems may leverage the CHW workforce to improve posthospital outcomes by addressing behavioral and socioeconomic drivers of disease," the authors write.

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