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. 

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.

Publication Year: 
2017
Resource Type: 
Peer Reviewed Research
Study Design: 
Randomized Controlled Trial (RCT)
Social Determinant of Health: 
Not Specified
Population: 
Complex Patients
Outcomes: 
Health & Health Behaviors
Patient Experience of Care
Utilization
Screening Research: 
No