Reducing readmissions with lay health workers

Trained community or lay health workers (LHW) helped a rural hospital in Kentucky lowered its 30-day readmission rates by almost 48 percent among a high-risk population, according to a study published in Health Education Research.

The single-hospital study was conducted at St. Claire Regional Medical Center in Morehead, Kentucky, led by Roberto Cardarelli, DO, MPH, chief of the community medicine division at the University of Kentucky. The targeted population was patients over 18 years of age admitted to the general medical/surgery floor and identified as high risk for being readmitted based on their medical history. In the end, 107 patients completed all parts of the study.

LHWs aren’t healthcare professionals, but are trained to “promote health or to carry out some health-care services,” according to the World Health Organization, such as assisting during appointments and helping provide access to transportation. In the case of St. Claire Regional, the workers made daily rounds among the identified high-risk patients, including a Wellness Needs Assessment (WNA) in each patient’s chart and coordinating with nurses and case managers during discharge planning meetings on potential problems, like if the patient needed transportation or access to community resources after leaving the hospital. They also obtained all post-discharge instructions, orders and follow-up appointments, contacting patients to review their status and see if they’re following their treatment plan.

Comparing a four-month baseline period to the six months after the LHWs were implemented, 30-day hospital readmission rates fell by 47.7 percent, the odds of being readmitted fell by 56 percent and, after adjusting for education, transportation cost and anxiety symptoms, the odds fell by 77 percent among those who interacted with the LHW.

“Knowledgeable of community-linkages and available local social supports, LHWs help transition patients from the hospital to their home by assuring that patients sustain healthy behaviors and access needed services,” Cardarelli and his coauthors wrote. “Also, because they serve the community in which they live, they often share a similar socioeconomic status and are able to relate to the psychosocial and economic stressors met by their clients.”

The key to the model’s success may lie in relying on the patient’s self-identified social needs. That communication, the authors wrote, not only informs patients about their options but “may also instill a sense of empowerment.”

Despite the limitation of being based on a single hospital’s experience, Cardarelli and his coauthors felt the LHW model shows “special promise” for rural and community hospitals with limited resources trying to shift to value-based care.

“Our dilemma is that our healthcare system does not pay for such services and we continue to see marginalized populations keep coming back to hospitals in an acute crisis,” Cardarelli said in a statement.