Care Guides

Abstract

Lay persons ("care guides") without previous clinical experience were hired by a primary care clinic, trained for 2 weeks, and assigned to help 332 patients and their providers manage their diabetes, hypertension, and congestive heart failure. One year later, failure by these patients to meet nationally recommended guidelines was reduced by 28%, P < .001. Improvement was seen in tobacco usage, blood pressure control, pneumonia vaccination, low-density lipoprotein cholesterol levels, annual eye examinations, aspirin use, and microalbuminuria testing. Care guides served an average of 111 patients at an annual per patient cost of $392. Further testing of this model is warranted.

A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol

“…Similar studies have approached this challenge by creating dichotomous variables -such as improved control (yes/no) or achievement of guideline-based control (yes/no)—that can summarize each patient’s disease-specific outcome [17]. This approach is intuitive but loses a significant amount of information and fails to capture incremental improvements.…”

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…[36][37][38][39][40] Of the eight pre-post studies, five showed a significant decrease in ED visits relative to a baseline measurement, [41][42][43][44][45] and one had no significant decrease. 46 Two pre-post studies did not indicate statistical significance; of these, one intervention resulted in a decrease in ED visits 47 and one in an increase in ED visits. 48 There were three cohort studies that examined ED use, two of which showed significant decreases in ED use in the intervention group.…”

“…34,35,37,39,40,51 One showed a significant decrease relative to the control. 36 Of the seven pre-post studies that assessed hospitalization, all showed a decrease in hospitalizations, 41,[43][44][45][46][47][48] but only five indicated statistical significance. 41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations.…”

“…33,56,57 Of four pre-post studies, three found an increase relative to †Indicates significance within groups (pre-post single sample) ‡This cost-effectiveness study also included some outcome results reported relative to a randomized control and is considered an RCT in discussions of those outcomes Fig. 1 Flowchart of inclusion and exclusion of studies baseline, 43,44,47 and one cohort study noted increased adherence relative to an observation cohort. 58 Of the four RCTs measuring preventable use, three found a statistically significant decrease relative to a control.…”

Community Health Workers and the Patient Protection and Affordable Care Act: An Opportunity for a Research, Advocacy, and Policy Agenda

“…Several recent studies demonstrate the value of incorporating CHWs into interdisciplinary health teams. 4–7 For example, the Community Outreach and Cardiovascular Health Program (COACH) was a 12-month nurse practitioner (NP)-CHW comprehensive intervention for patients with cardiovascular disease in Baltimore. In this randomized controlled trial (RCT), participants in the intervention arm received tailored lifestyle and diet coaching, home-based exercise programs, home visits, and telephone reminders of appointments, compared with participants in the control arm who received enhanced usual care consisting of care from their providers, including feedback on their cardiovascular risk also given by the provider.…”