Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure

Abstract

Background: Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health system. It is not known whether CHWs improve outcomes in low-socioeconomic, urban, minority patients with HF. Hypothesis: CHWs reduce rehospitalizations, emergency department (ED) visits, and healthcare costs for low-socioeconomic urban patients with HF. Methods: Patients admitted with acute decompensated HF were assigned to receive weekly visits by CHW after discharge. Patients were propensity score matched with controls who received usual care. HF-related rehospitalizations, ED visits, and inpatient costs were compared for 12 months following index admission versus the same period before. Results: Twenty-eight patients who received weekly visits from a CHW for 12 months after discharge were matched with 28 control patients who did not receive CHWs. Patients who received a CHW had a 75% decrease in HF-related ED visits (0.71 vs. 0.18 visits per patient, P < 0.001), an 89% decrease in HF-related readmissions (0.64 vs. 0.07 admissions per patient, P < 0.005), and a significant decrease in inpatient cost for HF-related visits. In controls receiving usual care, there was no significant change in hospitalizations, ED visits, or costs. Conclusions: In conclusion, CHWs are associated with reduced rehospitalizations, ED visits, and inpatient costs in low-socioeconomic, urban, minority patients with HF. CHWs may be a cost-effective method to reduce health care utilization and improve outcomes for this population.

Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial

“…Some smaller studies have also supported these outcomes. In a study with 28 patients with HF paired with CHWs at the time of hospital discharge, participants paired with a CHW for 12 months saw a decrease in HF-related ED visits (0.71 vs 0.18; P <.001), and an 89% decrease in HF readmission (0.64 vs 0.07; P <.005) [ 51 ]. No significant difference in 30-day readmissions or ED visits was seen compared to matched controls.…”

Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers

“…Extensive research in multiple countries has provided evidence for the efficacy of CHWs working in primary care settings to improve health and healthcare outcomes. 18 - 24 A number of systematic reviews have established that CHW-mediated interventions are effective (compared to usual care) at increasing adherence to cancer screening, improving chronic disease self-management, 18 , 19 promoting smoking cessation, 20 encouraging immunization and breastfeeding, aiding in the diagnosis and treatment of selected infectious diseases, 21 and reducing hospitalizations, 22 and emergency department visits. 23 Educational interventions by CHWs can improve patient behaviors, whereas navigational interventions can improve access to services.…”

Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial

“…The American Public Health Association describes CHWs as ‘frontline public health workers who are trusted members of and /or have an unusually close understanding of the community served’ 13. Particularly within the USA, CHWs have been successfully engaged to improve chronic disease management, particularly hypertension, diabetes and asthma 14. Internationally, CHWs undertake a variety of roles including helping to navigate health services 15.…”

“…13 Particularly within the USA, CHWs have been successfully engaged to improve chronic disease management, particularly hypertension, diabetes and asthma. 14 Internationally, CHWs undertake a variety of roles including helping to navigate health services. 15 Navigation has been shown to reduce admission and readmission rates and improve access to health and social care for disadvantaged groups, especially indigenous and CALD populations.…”