Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
Contemp Clin Trials. 2018 Nov;74:32-37. doi: 10.1016/j.cct.2018.09.013. Epub 2018 Oct 4.
In 2011, there were approximately 3.3 million adult 30-day all-cause hospital readmissions in the US generating $41.3 billion in hospital costs. Community health worker (CHW) care delivery is one of very few interventions demonstrated to reduce health care utilization among populations with chronic disease. While there are a number of studies demonstrating improved disease-specific outcomes with CHW interventions, studies examining the effect of CHW care delivery on 30-day readmission rates are rare.
This study is a randomized control trial designed to determine if linking hospitalized patients with chronic disease to community health workers (CHWs) can decrease 30-day readmissions. Participants were randomly assigned to receive the 30-day CHW intervention or usual care (no CHW). All study participants completed surveys at baseline and the end of the study 30 days post-discharge. The primary outcome was 30-day readmission and secondary outcomes included emergency department visits, missed appointments, and patient satisfaction.
We plan to enroll 1200 hospitalized patients during a 24-month intervals. As of December 2017, 350 patients have been consented and randomly assigned to either the intervention or control arm. A number of challenges have been encountered in implementing a CHW initiative at the time of hospital discharge.
This trial tests the effectiveness of CHW care delivery at the time of hospital discharge in reducing 30-day readmission rates and improving outcomes among patients with chronic disease. We describe and discuss challenges in launching this CHW intervention and strategies utilized to overcome these obstacles. Clinical Trials.gov registration submitted 3/14/2017: Protocol ID# 2017A050810 and Clinical Trials.gov ID# NCT03085264 Community Health Worker Care Transitions Study (C-CAT).
2011 年，美国大约有 330 万成年患者在出院后 30 天内因各种原因再次住院，这导致医院产生了 413 亿美元的费用。社区卫生工作者（CHW）的护理服务是为数不多的经证实可减少慢性病患者医疗利用的干预措施之一。虽然有许多研究表明 CHW 干预措施可改善特定疾病的结果，但研究 CHW 护理服务对 30 天再入院率的影响的研究却很少。
本研究是一项随机对照试验，旨在确定将患有慢性病的住院患者与社区卫生工作者（CHW）联系起来是否可以降低 30 天的再入院率。参与者被随机分配接受 30 天 CHW 干预或常规护理（无 CHW）。所有研究参与者在基线和出院后 30 天完成调查。主要结果是 30 天再入院，次要结果包括急诊就诊、错过预约和患者满意度。
我们计划在 24 个月的时间内招募 1200 名住院患者。截至 2017 年 12 月，已经有 350 名患者同意并随机分配到干预组或对照组。在出院时实施 CHW 计划遇到了一些挑战。
本试验测试了在出院时由 CHW 提供护理服务降低 30 天再入院率并改善慢性病患者结局的有效性。我们描述并讨论了启动这项 CHW 干预措施所遇到的挑战以及克服这些障碍所采用的策略。临床试验注册：2017 年 3 月 14 日提交方案编号#2017A050810 和临床试验注册号#NCT03085264 社区卫生工作者护理过渡研究（C-CAT）。
