Journal
INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE
Volume 26, Issue 4, Pages 358-365Publisher
OXFORD UNIV PRESS
DOI: 10.1093/intqhc/mzu046
Keywords
inpatient readmissions; community health worker; quality improvement; safety net
Funding
- Partners Community Healthcare, Inc
- Department of Population Medicine, Harvard Medical School
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Inc.
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To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions. Patient-level randomized quality improvement intervention. An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices. 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. 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. Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use. 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. 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.
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