Effects of a Standardized Community Health Worker Intervention on Hospitalization Among Disadvantaged Patients with Multiple Chronic Conditions: A Pooled Analysis of Three Clinical Trials

Authors
Aditi Vasan
John W. Morgan
Nandita Mitra
Chang Xu
Judith A. Long
David A. Asch
Shreya Kangovi
Journal Article
July 2020

IMPaCT is a standardized community health worker (CHW) intervention for high-risk patients that has been previously evaluated in three randomized clinical trials across various clinical settings and diseases. The prior studies showed improvement in outcomes such as access to and quality of care, self-reported mental health, and hospitalization rates, but each trial did not focus solely on hospitalization. This current study combines the data from these trials from 2011 to 2016 to analyze the effects of IMPaCT on hospital utilization.

Compared to the control group, patients enrolled in IMPaCT experienced significant reductions in bed days, hospitalizations, repeat hospitalizations, and length of stay. Additionally, patients experienced decreased fragmentation of care, measured by how many hospitalizations occurred outside the primary health system. This study demonstrates how a longitudinal, tailored, relationship-based social intervention can be successfully implemented in a health system and reduce acute care use, which can support health systems and payers in addressing patients’ social needs while reducing costs. Interestingly, IMPaCT CHWs are explicitly trained not to keep patients out of the hospital, but instead to partner with their patients, who often had unmet social needs to be addressed. The analysis demonstrated that upstream approaches can yield favorable outcomes.

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Population Addressed
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • How can community health workers be used to reduce hospitalizations in high-risk patients?
Level of Evidence
Strong
What does this mean?