Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure.
Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure.
复制标题
社区卫生工作者减少了对患有心力衰竭的低社会经济城市患者的重新住院和急诊科的访问。
DOI：
10.1097/hpc.0000000000000220
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发表时间：
2020-09
影响因子：
--
通讯作者：
Tabit CE
中科院分区：
文献类型：
--
作者：
Vohra AS;Chua RFM;Besser SA;Alcain CF;Basnet S;Battle B;Coplan MJ;Liao JK;Tabit CE
低社会经济地位、城市、少数民族心力衰竭（HF）患者通常有独特的护理障碍。社区卫生工作者（CHW）是受过专门培训的外行，他们在服务不足的社区和卫生系统之间担任联络人。目前尚不清楚CHW是否能改善低社会经济水平、城市、少数民族HF患者的结局。社区卫生工作者减少了低社会经济水平城市HF患者的再住院、急诊（艾德）就诊和医疗费用。因急性失代偿性HF入院的患者在出院后被分配接受CHW每周一次的访视。患者的倾向评分与接受常规护理的对照组相匹配。比较指标入院后12个月与入院前同期的HF相关再住院、艾德就诊和住院费用。28例患者出院后12个月内每周接受CHW访视，与28例未接受CHW的对照患者相匹配。接受CHW的患者HF相关艾德就诊减少75%（每例患者0.71 vs. 0.18次，P < 0.001），HF相关再入院减少89%（每例患者0.64 vs. 0.07次，P < 0.005），HF相关就诊的住院费用显著降低。在接受常规治疗的对照组中，住院、艾德就诊或费用没有显著变化。总之，在低社会经济水平的城市少数民族HF患者中，CHW与再住院、艾德就诊和住院费用减少相关。CHW可能是一种具有成本效益的方法，以减少医疗保健利用和改善这一人群的结果。
Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health system. It is not known whether CHWs improve outcomes in low-socioeconomic, urban, minority patients with HF. CHWs reduce rehospitalizations, emergency department (ED) visits, and healthcare costs for low-socioeconomic urban patients with HF. Patients admitted with acute decompensated HF were assigned to receive weekly visits by CHW after discharge. Patients were propensity score matched with controls who received usual care. HF-related rehospitalizations, ED visits, and inpatient costs were compared for 12 months following index admission versus the same period before. Twenty-eight patients who received weekly visits from a CHW for 12 months after discharge were matched with 28 control patients who did not receive CHWs. Patients who received a CHW had a 75% decrease in HF-related ED visits (0.71 vs. 0.18 visits per patient, P < 0.001), an 89% decrease in HF-related readmissions (0.64 vs. 0.07 admissions per patient, P < 0.005), and a significant decrease in inpatient cost for HF-related visits. In controls receiving usual care, there was no significant change in hospitalizations, ED visits, or costs. In conclusion, CHWs are associated with reduced rehospitalizations, ED visits, and inpatient costs in low-socioeconomic, urban, minority patients with HF. CHWs may be a cost-effective method to reduce health care utilization and improve outcomes for this population.