Effect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial

Jocelyn Carter, MD, MPH1; Susan Hassan, BA1; Anne Walton, RN1; et al
JAMA Network Open. 2021;4(5):e2110936. doi:10.1001/jamanetworkopen.2021.10936
May 20, 2021
Key Points

Question:  Does community health worker care reduce 30-day hospital readmissions in inpatient adults participating in accountable care organization plans?

Findings:  In this randomized clinical trial including 550 adults, intervention patients were significantly less likely to experience 30-day hospital readmissions than control participants. In post hoc subgroup analysis, the effect remained significant for participants discharged to short-term rehabilitation but not for those discharged home.

Meaning:  In this study, community health workercare improved postdischarge outcomes in clinically complex patients insured by accountable care organizations, particularly for those discharged to short-term rehabilitation.

Importance:  Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients’ unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care.

Conclusions
This randomized clinical trial found that integration of CHWs into clinical care improved preventive care and reduced 30-day readmissions for patients discharged to rehabilitation. Reducing preventable readmissions is a central priority for the Centers for Medicare & Medicaid Services and principal health care stakeholders. As US health care organizations continue to adopt ACO models with the goal of achieving higher quality care at lower costs, policies supporting insurance-based reimbursement for CHW care and investment in comprehensive training and integration of CHWs as valued members of patient care teams will continue to be critical.46 Future research is needed to identify which patients benefit most from certain CHW intervention activities.