Community Health Worker Home Visits for Adults With Uncontrolled Asthma

Abstract

IMPORTANCE Asthma is often poorly controlled. Home visitation by community health workers (CHWs) to improve control among adults has not been adequately evaluated. OBJECTIVE To test the hypothesis that CHW home visits for adults with uncontrolled asthma improve outcomes relative to usual care. DESIGN, SETTING, AND PARTICIPANTS Randomized parallel group study with 1-year follow-up, conducted 2008 through 2011 at homes of low-income adults aged 18 to 65 years with uncontrolled asthma living in King County, Washington. INTERVENTIONS The CHWs provided a mean of 4.9 home visits during a 1-year period to assess asthma control, self-management, and home environment and to support asthma self-management practices. MAIN OUTCOMES AND MEASURES Primary prespecified outcomes were symptom-free days (number of 24-hour periods in prior 2 weeks without asthma symptoms), asthma-related quality of life (Mini Asthma Quality of Life Questionnaire), and asthma-related unscheduled health care use. RESULTS Of 463 individuals who completed eligibility screening, 443 were eligible, 366 participated (177 in intervention and 189 in control groups), and 333 completed the study (91%). The intervention group had significantly greater increases in mean symptom-free days per 2 weeks (2.02 [95% CI, 0.94-3.09]; P < .001) and quality of life (0.50 [95% CI, 0.28-0.71] points; P < .001) relative to the control group, adjusted for age, sex, race/ethnicity, and education level. The number needed to treat to increase symptom-free days by 2 days per 2 weeks was 7.4 and to improve quality of life by 0.5 points was 2.6. Mean urgent health care use episodes in the past 12 months decreased significantly and similarly in both groups, from a mean of 3.46 to 1.99 episodes in the intervention group (mean change, −1.47 [95% CI, −2.28 to −0.67]; P < .001) and from a mean of 3.30 to 1.96 episodes in the control group (mean change, −1.34 [95% CI, −2.00 to −0.72]; P < .001) (P = .83 comparing groups). CONCLUSIONS AND RELEVANCE The provision of in-home asthma self-management support by CHWs to low-income adults with uncontrolled asthma improves asthma control and quality of life but not unscheduled health care use. Additional studies are needed to confirm these findings and determine the value of wider implementation of this approach. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01783028

The Role of Patient Navigators in Improving Caregiver Management of Childhood Asthma

“…These findings align with previous research on the value of patient navigation for patients with chronic disease, including improved asthma control and quality of life for children and adults (Crocker et al, 2011;Krieger et al, 2015;Krieger et al, 2009), reduced disparities in adult cancer diagnosis and care (Perez-Escamilla et al, 2015), and improved bloodglucose control for Latino adults with type 2 diabetes (Rodday et al, 2015). Apart from these benefits for pediatric asthma care, however, we did not see across-the-board improvements in all trigger and medication-related practices.…”

“…Despite research documenting the benefits of patient navigators for chronic disease management, we know little about how these benefits are actually realized, including assisting caregivers with asthma management in children (Crocker et al, 2011;Krieger, Song, & Philby, 2015;Krieger, Takaro, Song, Beaudet, & Edwards, 2009;Perez-Escamilla et al, 2015;Rodday et al, 2015). In this study we aim to help explore this issue by complementing MCAN evaluation findings with caregivers' perceptions of the factors and conditions by which patient navigators support their effective management of their child's asthma.…”

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

“…Two of four RCTs demonstrated a significant decrease relative to control, 40,53 and two showed no significant decrease relative to control. 54,55 Of the four pre-post studies measuring this outcome, three demonstrated a statistically significant decrease, 41,44,45 and one showed a non-significant increase. 46 …”

“…58 Of the four RCTs measuring preventable use, three found a statistically significant decrease relative to a control. 40,54,59 Three pre-post studies found a decrease in preventable use relative to baseline. 43,45,46 One cohort study found no change in emergency medication use, 49 while another (the only study that measured medication costs) noted a significant decrease in nonnarcotic prescription costs for the control cohort relative to the CHW group.…”

Integrating Community Health Workers Into Medical Homes

“…[3][4][5][6] Interventions by CHWs supporting chronic disease self-management and preventive services show improved health care utilization, knowledge, self-care, adherence, health outcomes, and quality of life, particularly when these workers are integrated into primary care teams. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19][20] Their interventions are most often directed to and studied in underserved communities (racial and ethnic minority and low-income populations, federally qualified health care [FQHC] settings), where the integration of these workers show benefit. 3,4,12,[21][22][23] Health authorities have called for expanding interventions by CHWs among clinics serving these populations, and recent policies create a platform for greater community health worker integration.…”