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A mixed methods study to inform and evaluate a longitudinal nurse practitioner/community health worker intervention to address social determinants of health and chronic obstructive pulmonary disease self-management

L. Kearney, R.S. Wiener, M. Dahodwala, G.M. Fix, J. Hicks, F. Little, J. Howard, A.G. Foreman, C. Wakeman, C. O'Donnell, K. Bulekova, M.L. Drainoni, H. Kathuria
BMC Pulm Med

Background: Individuals with low socioeconomic status experience higher prevalence and worse outcomes of chronic obstructive pulmonary disease (COPD). We undertook a quality improvement initiative at our safety net hospital in which a nurse practitioner (NP)/community health worker (CHW) team followed patients with COPD, frequent admissions, and unmet SDOH needs from hospitalization through one month post-discharge. We report our mixed methods approach to inform development and preliminary evaluation of this intervention.

Methods: We first assessed characteristics of patients admitted with COPD in 2018 (n = 1811), performing multivariable logistic regression to identify factors associated with ≥ 2 admissions per year. We then tested a standardized tool to screen for unmet SDOH needs in a convenience sample of 51 frequently hospitalized patients with COPD. From January–July 2019, we pilot tested the NP/CHW intervention with 57 patients, reviewed NP/CHW logs, and conducted qualitative interviews with 16 patient participants to explore impressions of the intervention.

Results: Patients with Medicaid insurance, mental health disorders, cardiac disease, and substance use disorder had increased odds of having ≥ 2 admissions. COPD severity, comorbidities, and unmet SDOH needs made COPD self-management challenging. Seventy-four percent of frequently admitted patients with COPD completing SDOH screening had unmet SDOH needs. Patients perceived that the NP/CHW intervention addressed these barriers by connecting them to resources and providing emotional support.

Conclusions: Many patients with COPD admitted at our safety-net hospital experience unmet SDOH needs that impede COPD self-management. A longitudinal NP/CHW intervention to address unmet SDOH needs following discharge appears feasible and acceptable.

Kearney L, Wiener RS, Dahodwala M, et al. A mixed methods study to inform and evaluate a longitudinal nurse practitioner/community health worker intervention to address social determinants of health and chronic obstructive pulmonary disease self-management. BMC Pulm Med. 2022;22(1):74. Published 2022 Mar 1. doi:10.1186/s12890-022-01863-w PMID: 35232414 PMCID: PMC8889692

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Social Needs/ SDH
Patient Experience of Care
Social Determinant of Health
Childcare
Education/Literacy
Employment
Food/Hunger
Housing Stability
Transportation
Utilities
Study design
Other Study Design