Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions

Abstract

Objective: To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions.

Design: Patient-level randomized quality improvement intervention.

Setting: An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices.

Participants: Medical service patients with an in-network primary care physician who were discharged to home (n = 423) and had one of five risk factors for readmission within 30 days.

Intervention: Inpatient introductory visit and weekly post-discharge telephonic support for 4 weeks to assist patient in coordinating medical visits, obtaining and using medications, and in self-management.

Main outcome measures: Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use.

Results: Roughly 70% of patients received at least one post-discharge CHW call; only 38% of patients received at least four calls as intended. Hospital readmission rates were lower among CHW patients (15.4%) compared with usual care (17.9%); the difference was not statistically significant.

Conclusion: Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.

Keywords: community health worker; inpatient readmissions; quality improvement; safety net.

Figure 1

Role of community health worker in post-discharge care process.

Figure 2

Study enrollment.

Figure 3

Percentage of patients in CHW group with direct CHW contact.