Community Health Worker Support for Chronically-ill Patients - - PowerPoint PPT Presentation

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Community Health Worker Support for Chronically-ill Patients

Nadirah Rogers and Judith Long

Improving Care in the Community: How to Effectively Deploy Community Health Workers Date November 1, 2018

#PCORI2018

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Nadirah Rogers and Judith Long

Disclosures:

Patient-Centered Outcomes Research Institute (PCORI-1310-07292)

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Objectives

At the conclusion of this activity, the participant should be able to identify:

• Ways a standardized intervention can provide tailored support
• Key elements of a CHW intervention that enable efficacy
• Tools and training to facilitate dissemination and scale of

evidence-based interventions

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Standardized work practices

• Manuals for CHWs, managers and program directors

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Training & Certification

Based on core competencies for each role CHW Manager Director Certification

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Technology

Documentation, reporting and data infrastructure

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Objective

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Determine, in a multi-center randomized controlled trial, whether 6 months of goal setting and CHW support leads to improved outcomes compared to goal setting alone. Sites: VAMC, FQHC, Academic HC

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Methods

Participants:

• Uninsured or publicly insured
• Residents of high-poverty regions in Philadelphia
• ≥2: hypertension, diabetes, obesity, tobacco dependence

Outcomes assessed at 6, 9 months:

• Self-rated physical health, mental health, chronic disease

control, patient activation, quality of care, hospitalizations Analysis:

• Intent-to-treat
• Generalized estimating equations

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Intervention

Adaptations (1-3 months):

• Tailored communication, software and training
• Separate CHWs at each site
• Work privileges

Core intervention:

• 6 months of tailored support
• Weekly contact and monthly face-to-face

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Participants (n=592)

Age, years 52.6 African-American 94% Household Income < 15K 65% Trauma History 98%

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Patient Tailored Support 65 year old socially isolated veteran with PTSD and hypertension CHW (also veteran) organized

• utings with other veterans:

bowling, movies, urban garden 32 year-old single mother with asthma living in moldy shelter basement CHW advocated for patient to move to 1st floor with a window

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Outcomes

Diff-in-Diff P value ∆Self-rated Physical Health

• 0.7

0.30 ∆Self-rated Mental Health 0.8 0.41 ∆Chronic disease control blank 0.21 Systolic blood pressure (mmHg)

• 6.3

blank Obesity (BMI)

• 0.2

blank Diabetes (HbA1c%)

• 0.2

blank Tobacco dependence (Cig per day)

• 0.5

blank ∆Patient Activation 1.9 0.06 Risk Diff P value Highest Quality (Comprehensiveness) 0.12 <0.001 Highest Quality (Supportive of Self-Management) 0.12 <0.001

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blank

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Total Hospital Days

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Hospitalizations

Diff-in-Diff P value Mean Length of Stay

• 3.1

0.06 Risk Diff P value Repeat Admissions 0.4 0.02 30-d Readmission 0.3 0.04 blank blank

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Dissemination

http://chw.upenn.edu/

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Veterans and IMPaCT vimeo.com This is "Veterans and IMPaCT" by Penn Center for CHWs https://vimeo.com/290342176

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Participants (n=592)

Age, years 52.6 African-American 94% Household Income < 15K 65% Trauma History 98% Baseline Chronic Disease Control Systolic Blood Pressure (mmHg) 161.6 Obesity (BMI) 42.5 Diabetes (HbA1c%) 10.5 Tobacco dependence (Cig per day) 9.3

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Limitations

• Geographically limited
• Follow-up period was only 9 months
• Hospitalization data for veterans was limited to the VA network