Community health worker support for disadvantaged patients with multiple chronic diseases: A randomized clinical trial
Am J Public Health
Objectives: To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions.
Methods: We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences.
Results: Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 29.7% (P = .11). There were no differences in patient activation or self-rated physical health.
Conclusions: A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems.
Trial Registration: clinicaltrials.gov identifier: NCT01900470.
This article is included in the PCORI Social Needs Interventions to Improve Health Outcomes Evidence Map. Click here to access evidence map.
Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA. Community health worker support for disadvantaged patients with multiple chronic diseases: A randomized clinical trial. Am J Public Health. 2017;107(10):1660-1667. PMID: 28817334. DOI: 10.2105/AJPH.2017.303985.