Community health workers help reduce hospitalizations

Doctors and nurses have been struggling for years with how to best improve the health of low-income patients, who on virtually every measure are sicker than the more affluent.

It doesn’t necessarily take a lot of medical knowledge to have a big impact on patient health, according to results of a clinical trial published Monday in JAMA Internal Medicine.

Dr. Shreya Kangovi, an assistant professor of medicine at the University of Pennsylvania and director of the Penn Center for Community Health Workers, said the project began by asking low-income patients what would help.

“They felt a sense of disconnect from traditional health care personnel — people like doctors, nurses, and social workers,” said Kangovi. “They just wished for support from someone to whom they could relate.”

That led them to use community health workers — laypeople who are not so different from the patients themselves, but have been trained to create action plans and help solve the basic problems getting in the way of healthy living.

For example, one man with emphysema needed to quit smoking, but anxiety over an inability to make rent kept him up, chain smoking at night. His community health worker helped him quit by organizing his finances.

In another case, a man with heart failure couldn’t afford regular transportation to a doctor, so he waited until he needed an ambulance.

“The community health worker helped him to apply for van services through his insurance company,” said Kangovi, “and actually rode the van with him, and made sure that it happened, and got him to his primary care appointment.”

Kangovi said the idea of enlisting community health workers isn’t new, but careful implementation and rigorous evaluation of the programs are.

The researchers, for example, found that it’s important to hire workers who share life experience with their patients — and are good, nonjudgmental listeners.

In Kangovi’s study, 450 low-income patients participated; half received regular medical care and the other half got the same care as well as being partnered with a community health worker.

Patients in both groups were equally likely to return to the hospital for treatment in the month after their initial discharge. But patients meeting with community health workers were more likely to follow up with primary care physicians and less likely to be readmitted multiple times.

“We think that’s potentially because the community health workers were getting to the root of the problem,” said Kangovi.

It’s not yet clear if the reduced hospitalizations, for example, will cover the added cost of the health workers, but at $14 per hour, it’s a relatively economic intervention. Kangovi said it will be important for researchers to continue to make decisions based on evidence, and make sure any growth in the community health worker sector is productive.

The University of Pennsylvania has already started using community health workers in its own health system, and the Penn Center has consciously planned to make their successes easy to replicate in other places.