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Controlled Clinical Trial
. 2020 Mar;35(3):815-823.
doi: 10.1007/s11606-019-05530-5. Epub 2019 Nov 20.

Impact of a Low-Intensity Resource Referral Intervention on Patients' Knowledge, Beliefs, and Use of Community Resources: Results from the CommunityRx Trial

Elizabeth L Tung  1   2   3 , Emily M Abramsohn  4 , Kelly Boyd  4 , Jennifer A Makelarski  4 , David G Beiser  5   6 , Chiahung Chou  7   8 , Elbert S Huang  9   10   6 , Jonathan Ozik  11   12 , Chaitanya Kaligotla  11   12 , Stacy Tessler Lindau  4   6   13   14
Affiliations
Controlled Clinical Trial

Impact of a Low-Intensity Resource Referral Intervention on Patients' Knowledge, Beliefs, and Use of Community Resources: Results from the CommunityRx Trial

Elizabeth L Tung et al. J Gen Intern Med. 2020 Mar.

Abstract

Background: Connecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood.

Objective: To evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients' knowledge, beliefs, and use of community resources.

Design: Real-world controlled clinical trial at an urban academic medical center in 2015-2016; participants were assigned by alternating week to receive the CommunityRx intervention or usual care. Surveys were administered at baseline, 1 week, 1 month, and 3 months.

Participants: Publicly insured adults, ages 45-74 years.

Intervention: CommunityRx generated an automated, personalized list of resources, known as HealtheRx, near each participant's home using condition-specific, evidence-based algorithms. Algorithms used patient demographic and health characteristics documented in the electronic health record to identify relevant resources from a comprehensive, regularly updated database of health-related resources in the study area.

Main measures: Using intent-to-treat analysis, we examined the impact of HealtheRx referrals on (1) knowledge of the most commonly referred resource types, including healthy eating classes, individual counseling, mortgage assistance, smoking cessation, stress management, and weight loss classes or groups, and (2) beliefs about having resources in the community to manage health.

Key results: In a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29-3.58) and beliefs (AOR = 1.68; 95% CI, 1.07-2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07-7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05-4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02).

Conclusions: In a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health.

Nih trial registry: NCT02435511.

Keywords: community linkages; community resource referral; disease-management; health information technology; health-related social needs; self-care; self-management; social determinants of health.

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Conflict of interest statement

Dr. Lindau directed a Center for Medicare and Medicaid Innovation Health Care Innovation Award (1C1CMS330997-03) called CommunityRx. This award required development of a sustainable business model to support the model test after award funding ended. To this end, Dr. Lindau is founder and co-owner of NowPow, LLC. Neither entity is supported through CMS funding. Neither the University of Chicago nor the University of Chicago Medicine endorses or promotes any NowPow Entity or its business, products, or services. The remaining authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Sample HealtheRx referral.
Figure 2
Figure 2
Knowledge of resources at baseline and follow-up by intervention status.
See this image and copyright information in PMC

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