Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions
Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions
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DOI：
10.1093/intqhc/mzu046
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发表时间：
2014-08-01
影响因子：
2.6
通讯作者：
Balaban, Richard B.
中科院分区：
文献类型：
--
作者：
Burns, Marguerite E.;Galbraith, Alison A.;Balaban, Richard B.
试点测试社区卫生工作者 (CHW) 干预措施减少再入院的可行性和初步效果。患者层面的随机质量改进干预措施。一个为马萨诸塞州波士顿地区主要低收入人群提供服务的学术医疗中心和 10 个附属初级保健机构。由网络内初级保健医生提供的医疗服务患者出院回家 (n = 423)，并且有 30 天内再入院的五个风险因素之一。住院介绍性访视和每周出院后4 周的电话支持，协助患者协调就诊、获取和使用药物以及自我管理。已完成的社区卫生工作者联系数量；社区卫生工作者报告的帮助患者的障碍和促进因素；初级保健、急诊科和住院护理的使用。大约 70% 的患者在出院后至少接到一次社区卫生工作者的电话；只有 38% 的患者按预期接到至少 4 个电话。与常规护理患者 (17.9%) 相比，社区卫生工作者 (CHW) 患者的再入院率 (15.4%) 较低；差异在统计上并不显着。在基于绩效的支付系统下，确定减少再入院的具有成本效益的解决方案对于所有医院的经济生存至关重要，尤其是安全网系统。这项试点研究表明，通过适当的支持性基础设施，以医院为基础的社区卫生工作者可能是改善弱势群体过渡护理的可行策略。根据该试点的经验教训，正在开展一项社区卫生工作者干预措施的随机对照试验，该试验将进一步深入了解这种方法在减少再入院方面的效用。
To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions.Patient-level randomized quality improvement intervention.An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices.Medical service patients with an in-network primary care physician who were discharged to home (n = 423) and had one of five risk factors for readmission within 30 days.Inpatient introductory visit and weekly post-discharge telephonic support for 4 weeks to assist patient in coordinating medical visits, obtaining and using medications, and in self-management.Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use.Roughly 70% of patients received at least one post-discharge CHW call; only 38% of patients received at least four calls as intended. Hospital readmission rates were lower among CHW patients (15.4%) compared with usual care (17.9%); the difference was not statistically significant.Under performance-based payment systems, identifying cost-effective solutions for reducing hospital readmissions will be crucial to the economic survival of all hospitals, especially safety-net systems. This pilot study suggests that with appropriate supportive infrastructure, hospital-based CHWs may represent a feasible strategy for improving transitional care among vulnerable populations. An ongoing, randomized, controlled trial of a CHW intervention, developed according to the lessons of this pilot, will provide further insight into the utility of this approach to reducing readmissions.