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Effectiveness of collaborative goal-setting versus IMPaCT community health worker support for improving chronic disease outcomes
Investigator (PI): Long, Judith
Performing Organization (PO): (Current): University of Pennsylvania, Penn Medicine, Department of Medicine, Division of General Internal Medicine / (215) 573-5111
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2019
Record Source/Award ID: PCORI/AD-1310-07292
Funding: Total Award Amount: $1,989,120
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Chronically ill patients from low-socioeconomic status (SES) communities try their best to feel better and gain control of conditions like diabetes or high blood pressure. However, they are at high risk for poor outcomes because they often struggle with real-life challenges: How can I afford the medications my doctor ordered? How can I cut down on salt when I get my food from a pantry? There is some evidence that community health workers (CHWs) can help these patients. Yet many CHW programs have not been proven to be effective or sustainable. Our community-academic-health system team used participatory action research with high-risk patients to design IMPaCT (Individualized Management for Patient Centered Targets). IMPaCT is a standardized, comprehensive CHW model that was proven to work in a large clinical trial of hospitalized patients. The study team used further participatory action research with chronically ill primary care patients to adapt IMPaCT for primary care. We propose this study to test the newly adapted IMPaCT primary care model. Upon enrollment in the trial, patients will collaborate with their primary care provider to set a chronic disease management goal. Collaborative goal-setting has been shown to improve outcomes, but may not be sufficient for low-SES patients with multiple chronic conditions. Objectives: We will evaluate whether collaborative goal-setting plus IMPaCT is more effective than goal-setting alone at improving outcomes suggested to us by low-SES, chronically ill patients in focus groups: A. self-rated physical health ("feeling better and not having my health limit what I do"); B. chronic disease control ("improving my numbers"), mental health ("being happier"), quality of primary care ("having a good experience with my doctor's office"), patient activation ("feeling in control of my health") and reducing hospitalizations; and C. we will also explore 1) whether the intervention works differently across various types of primary care settings, 2) whether the effects of the intervention last after it ends, 3) whether achieving health goals makes people feel better, and 4) what patients and CHWs think about the intervention and how it works. Methods: We will recruit 444 patients who 1) live in low-income communities, AND 2) have two or more of the following chronic conditions: diabetes, high blood pressure, obesity, or are smokers with asthma/emphysema. Half of these patients will be assigned to goal-setting alone and the other half will also receive six months of support from an IMPaCT CHW. Patient outcomes (projected): At the end of the six months, we will see which group had better outcomes. We expect that the patients who received IMPaCT will do better as measured by feeling physically healthier, achieving better chronic disease control, improving their mental health, having better quality of care, being more activated and requiring fewer hospitalizations. Brown EJ, Kangovi S, Sha C, Johnson S, Chanton C, Carter T, Grande DT. Exploring the Patient and Staff Experience With the Process of Primary Care [1]. Ann Fam Med. 2015 Jul-Aug;13(4):347-53. doi: 10.1370/afm.1808. PubMed PMID: 26195680; PubMed Central PMCID: PMC4508176. S. Kangovi, K. Kellom, C. Sha et al., Perceptions of High-Risk Patients and their Providers on the Patient-Centered Medical Home [2], Journal of Ambulatory Care Management 38(2) (April-June 2015): 134-143. (Abstract only available) Shreya Kangovi, David Grande, Chau Trinh-Shevrin, From Rhetoric to Reality--Community Health Workers in Post-reform U.S. Health Care [3], New England Journal of Medicine 372(24) (June 2015): 2277-2279. Between Clinicians and Patients, Trained Community Members May Provide a Key Link [4]: A narrative on this project, which highlights PCORI-funded studies that are testing whether lay people on clinical teams make a measurable difference to lower barriers patients may face in receiving care and following treatment plans. [1] http://www.annfammed.org/content/13/4/347.full.pdf+html [2] http://www.ncbi.nlm.nih.gov/pubmed/25748262 [3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4689134/ [4] http://www.pcori.org/research-in-action/between-clinicians-and-patients-trained-community-members-may-provide-key-link
MeSH Terms:
  • Asthma /therapy
  • Blood Pressure
  • Chronic Disease
  • Community Health Services /*organization & administration
  • * Community Health Workers
  • Community-Institutional Relations
  • Comparative Effectiveness Research
  • Diabetes Mellitus /therapy
  • Emphysema /therapy
  • Hospitalization
  • Humans
  • Hypertension /therapy
  • Obesity /therapy
  • Outcome Assessment, Health Care
  • Primary Health Care
  • Quality of Health Care
  • Smoking
  • Social Class
  • Treatment Outcome
Country: United States
State: Pennsylvania
Zip Code: 19104
UI: 20152039
CTgovId: NCT02347787
Project Status: Completed
Record History: ('2019: Project extended to 2019 ',) ('2018: Added publication information to record. 2017: Project extended to 2018.',)