Community Health Workers to address unmet social needs: RCT

Our Upstream Lab journal club focused on this interesting study: Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial (JAMA Intern Med 2018; 178(12): 1635-1643). This is led by Dr. Shreya Kangovi, who is the founding director of the Penn Centre for Community Health Workers.

At the heart of this study is the intervention called IMPaCT, which the Penn Centre website describes as “a standardized, scalable program that leverages community health workers (CHW) –trusted laypeople from local communities– to improve health.” In the paper, the authors note 3 stages:

  1. Goal-setting using a semi-structured interview guide to collect data on social determinants, open-ended questions and asking participants what they need to reach their health goals. Strategies discussed are familiar to those who motivational interviewing (MI) techniques in their clinical care.
  2. Tailored support over 6 months, including weekly contact and meeting face-to-face at least once a month.
  3. Connection with long-term support, which could include neighbours, family or even a weekly CHW facilitated support group.

Getting to the results, in this RCT comparing goal setting alone (n=288) vs goal setting plus CHW (n=304), there was no difference in self-rated health at 6 months (assessed using the SF-12v2 Physical Component). However, those in the intervention group had a substantial reduction in total days in hospital (absolute event reduction of 69% at 6 months), due to shorter average length of stay and lower mean number of hospitalizations.

This is quite striking, and in sharp contrast to our study from last week, which found no impact on health service use. Dr. Kangovi and colleagues recently published a study in Health Affairs finding a positive return on investment of IMPaCT, where every dollar invested in this intervention would return $2.47 to the average payer (e.g. Medicaid) within the fiscal year.

We’ll certainly apply lessons learned to our work, particularly the SPARK Study, but also several other projects where we screen and intervene on social needs at the individual-level.

Published by Andrew Pinto

Dr. Andrew Pinto is the founder and director of The Upstream Lab. He is a Public Health and Preventive Medicine specialist and family physician at St. Michael’s Hospital. Dr. Pinto completed his residency at the University of Toronto and his Master’s in Health Policy, Planning and Financing at the London School of Economics and the London School of Hygiene and Tropical Medicine as a Commonwealth Scholar. Currently, he is a Scientist in the Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital and an Assistant Professor at the University of Toronto.

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