Community Health Workers Help to Drop Hospital Readmission Rates

The Community Care Transitions (C-CAT) clinical trial, recently published in JAMA Network Open, matched Massachusetts General Hospital (MGH) patients insured by accountable care organizations with community health workers (CHWs) who provided health coaching and support. Results revealed that 30-day hospital readmission rates for the intervention group were significantly lower than those of the control group.

"These results indicate that CHW interventions may help reduce hospital readmissions and improve preventive care among some clinically complex patients within an accountable care organization," explained lead author and the trial’s principal investigator Jocelyn Carter, MD, MPH, a physician-scientist in the MGH Division of General Internal Medicine, in a recent press release.

The trial included 550 adult patients, split into an intervention group and a control group. CHWs kept in contact with patients for 30 days after they were discharged. They helped patients by directing them to health resources and provided support using various behavioral strategies such as goal-setting and motivational interviewing, the trial results stated. The CHWs connected with patients over telephone, text, and in-person visits. Meanwhile, the control group received routine care including outpatient referrals and primary care visits.

Researchers hypothesized that “community health worker interventions may address patients’ unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care.”

Results revealed that 30-day hospital readmission rates were particularly impactful for patients who were discharged to short-term rehabilitation centers, but significantly less so for those who went straight home. Of the trial participants, 432 were discharged home and 127 went to a short-term rehabilitation center. Intervention group participants were additionally less likely to miss clinic appointments within 30 days of discharge.

“Hospitalizations account for one-third of US health care costs. Readmissions in the first 30 days after hospital discharge are common, and approximately 27 [percent] of adult 30-day readmissions are estimated to be preventable,” the trial results explained.

“Increasing movement toward value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable readmissions.”

CHWs can provide patients with psychosocial support, as well as assisting patients with gaining access to food, transportation, and housing. Trial participants were deemed eligible because they were considered to have at least a 16 percent chance of being readmitted to the hospital, as determined by an MGH risk algorithm.

Of the intervention group participants, 12.6 percent were readmitted within 30 days, while 24.5 percent of control group participants were readmitted within 30 days. Meanwhile, only five percent of intervention group participants who were discharged to rehabilitation were readmitted within 30 days, compared to 37.3 percent for control group participants who were discharged to rehabilitation.

Researchers explained that trial results show promise for using CHWs to reduce overall ACO spending.

“In this randomized clinical trial at [one] academic medical center, a CHW intervention reduced 30-day hospital readmissions in adult general medicine inpatients by nearly 50 [percent]. However, subgroup analyses revealed that most of the effect occurred for participants initially discharged to short-term rehabilitation,” trial results stated.

“Intervention participants also were less likely to miss clinic appointments, but no significant reductions in ED visits were noted. These results indicate that CHW interventions may help reduce hospital readmissions and improve preventive care among some clinically complex patients within an ACO.”

Recently, CMS announced that its Next Generation Accountable Care Organization Model will come to end by the end of 2021, to the industry’s surprise. Despite industry calls for an extension of the Next Generation ACO Model past 2021, CMS stated that it produced no net savings, contrasting with other industry analyses that show that the Model has saved millions.