Long-Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a Safety-Net System

Health Serv Res. 2017 Dec;52(6):2061-2078. doi: 10.1111/1475-6773.12790.


Objective: Patient navigators (PNs) may represent a cost-effective strategy to improve transitional care and reduce hospital readmissions. We evaluated the impact of a PN intervention on health system costs in the 180 days after discharge for high-risk patients in a safety-net system.

Data source/setting: Primary and secondary data from an academic safety-net health system.

Study design: We compared per-patient utilization and costs, overall and by age, for high-risk, medical service patients randomized to the PN intervention relative to usual care between October 2011 and April 2013. Intervention patients received hospital visits and telephone outreach from PNs for 30 days after every qualifying discharge.

Data collection/extraction methods: We used administrative and electronic encounter data, and a survey of nurses; costs were imputed from the Medicare fee schedule.

Principal findings: Total costs per patient over the 180 days postindex discharge for those aged ≥60 years were significantly lower for PN patients compared to controls ($5,676 vs. $7,640, p = .03); differences for patients aged <60 ($9,942 vs. $9,046, p = .58) or for the entire cohort ($7,092 vs. $7,953, p = .27) were not significant.

Conclusions: Patient navigator interventions may be useful strategies for specific groups of patients in safety-net systems to improve transitional care while containing costs.

Keywords: Hospital readmission; community health worker; cost analysis; patient navigator; safety net.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Continuity of Patient Care / economics*
  • Continuity of Patient Care / organization & administration
  • Female
  • Heart Failure / economics
  • Heart Failure / therapy
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Discharge
  • Patient Navigation / organization & administration
  • Patient Navigation / statistics & numerical data*
  • Patient Readmission / economics*
  • Patient Satisfaction*
  • Pulmonary Disease, Chronic Obstructive / economics
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Risk Factors
  • Safety-net Providers / economics*
  • Safety-net Providers / organization & administration
  • Socioeconomic Factors