title: Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions.
abstract: OBJECTIVE
  To pilot-test the feasibility and preliminary effect of a community health worker (CHW) intervention to reduce hospital readmissions.
  
  
  METHODS
  Patient-level randomized quality improvement intervention.
  
  
  METHODS
  An academic medical center serving a predominantly low-income population in the Boston, Massachusetts area and 10 affiliated primary care practices.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Number of completed CHW contacts; CHW-reported barriers and facilitators to assisting patients; primary care, emergency department and inpatient care use.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin-Madison, 610 North Walnut Street, Madison WI 53726, USA.
authors.forename: Marguerite E
authors.initials: ME
authors.lastname: Burns
authors.affiliation: Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston,MA 02115, USA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Galbraith
authors.affiliation: Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston,MA 02115, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.affiliation: Department of Internal Medicine, Cambridge Health Alliance, Cambridge, MA 02139, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Balaban
mesh_terms: D003150:Community Health Workers / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D058007:Physicians, Primary Care; D010865:Pilot Projects; D011203:Poverty; D012307:Risk Factors; D012648:Self Care; D013689:Telephone
keywords: community health worker; inpatient readmissions; quality improvement; safety net
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