What was the research about?
Chronic, or long-term, health problems such as diabetes or high blood pressure are on the rise in the United States. Doctors can help patients manage chronic health problems like these. Community programs may also help people manage their health. For example, community programs may give people free rides to the doctor or teach people how to make healthy meals.
In this study, the research team created a new job within the health care teams at primary care clinics called a community resource specialist, or CRS. CRSs were non-medical professionals who had expertise in community resources. The CRS helped patients find programs and resources in their communities that supported their health goals. The CRS also worked with patients to make a plan for using those resources. After three months, the team wanted to see how the CRS affected both patients and clinic staff.
What were the results?
- On surveys, patients reported that they were very satisfied with the services they received from the CRS.
- In interviews, patients who saw the CRS reported improved health and health habits. But the research team didn’t find any changes in these patients’ health or health habits on survey responses.
- Patients who saw the CRS used some types of healthcare services, such as going to the doctor or hospital, slightly more than patients who didn’t see the CRS.
- In interviews, clinic staff who worked with a CRS reported that their workload got easier and they could provide better care to patients with a CRS on the team.
Who was in the study?
Patients in the study were from three Kaiser Permanente clinics in Washington State. Of the 622 patients referred to the CRS, 418 patients had at least one complete visit with the CRS. Common health problems for these patients were diabetes, high blood pressure, or depression. Of these 418 patients, 73 percent were over the age of 35, and 75 percent were female. Patients in the study were racially diverse.
What did the research team do?
Before the study, the research team met with 12 patients, 11 providers, and clinic staff at a four-day workshop to create the CRS job. Then, three clinics in a large healthcare system tested the role. Doctors in these clinics referred patients to the CRS.
The research team gave a survey to patients during their referral and again three months later. Next, the team had a group discussion with patients and talked with clinic staff about the CRS role. Finally, using electronic health records, the research team looked at patients’ use of healthcare services three and six months after they saw a CRS. The team compared these health records to health records of similar patients that did not see a CRS.
What were the limits of the study?
There were several problems that affected the study, including staff turnover. These problems required the research team to change the study design and made it difficult to evaluate the CRS role as planned.
How can people use the results?
Clinics serving patients with chronic illnesses may look at whether patients have adequate access to community resources and figure out how best to support them.
To create and evaluate a new primary care role, called the community resource specialist (CRS), to connect patients to clinic and community resources to support chronic disease management
|Design||Mixed-methods program evaluation|
|Population||418 patients at 3 primary care clinics who had at least 1 meeting with a CRS|
Before and after adding the CRS to the clinical care team
Patient satisfaction with CRS services, self-reported health and health behaviors, healthcare utilization, clinician perceptions of workload and quality of care
|Timeframe||Up to 6-month follow-up for study outcomes|
This mixed-methods study evaluated the CRS role, a position added to the care teams at primary care clinics to help connect patients with community-based resources supporting their overall health management needs. Researchers worked with 12 patients, 11 providers, and clinic staff to design the CRS role. The CRS provided services ranging from referring patients to community resources to developing action plans for patients. CRSs received one month of training and had previous experience working in community settings or service industries.
All participating patients were from three Kaiser Permanente Washington clinics. The most common chronic health problems among patients referred to the CRS were hypertension, depression, and diabetes. Of the 622 patients referred to the CRS, 418 patients completed at least one visit. Of these 418 patients, 73% were age 35 or older and 75% were female. The patients were racially diverse and reflected the overall clinic population.
Researchers collected data from patients and staff at the three clinics. To assess patients’ satisfaction with CRS services and changes in patients’ health and health behaviors, researchers conducted focus groups and administered a patient survey at baseline and again at three months follow‐up. Researchers also compared the electronic health records of each patient who met with the CRS to the health records of three matched controls from a neighboring clinic who did not meet with a CRS to determine patients’ healthcare utilization at three and six months after using CRS services. Finally, researchers asked staff at the three clinics about their perceptions of having the CRS role in the clinic including how it affected clinic staff workload and quality of care.
- On the three-month follow-up survey, most patients (63%) who met with the CRS reported that they were “very satisfied” with CRS services. In the focus groups, patients reported satisfaction with the resources that the CRS provided to them.
- In the focus groups, patients who met with the CRS reported that they had improved health behaviors, such as eating healthier or exercising more, and that they had improved health overall. However, researchers did not detect such changes from patient survey data between baseline and the three-month follow-up.
- In interviews, clinic staff members reported that including a CRS on the care team eased workload and helped clinical staff provide better quality care.
- At the three- and six-month review of patients’ electronic health records, patients who met with the CRS used slightly more of some types of healthcare services, such as face-to-face clinician visits, than matched control patients who did not meet with the CRS (p<0.05 or below).
The study encountered several challenges, including staff turnover, which affected the selected intervention sites. These challenges required the researchers to modify the study design and limited the team’s ability to assess outcomes and make comparisons as planned. The heterogeneous nature of patients’ health issues and resource needs resulted in small subgroup populations, limiting the ability to conduct subgroup analyses.
Conclusions and Relevance
Qualitative findings indicated that the CRS position had benefits for patients and clinic staff. Aside from satisfaction with CRS services, the quantitative assessments from surveys, EHRs, and administration data did not reflect these findings. However, problems with study implementation limited the ability to fully assess the CRS position as planned.
Future Research Needs
Future research could continue to explore the effectiveness of the CRS role, focusing on specific patient populations who could benefit from community support.
Final Research Report
View this project's final research report.
More to Explore...
The Community Resource Specialist Role
Produced by GroupHealth Research Institute
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.
In response to peer review, the PI made changes including
- Making major revisions in the structure and language of the report to make sure that the report clearly conveyed what happened in the study. The researchers revised much of the language of the report so that it would be understandable for the general scientist audience, with appropriate specificity around methods used and study outcomes.
- Providing detailed descriptions, in a newly created section on patient and stakeholder engagement, of how patients and other stakeholders affected the development of this study.
- Explaining the reasons why the researchers changed the approach for collecting patient surveys. Because of difficulties in sampling patients from intervention and control clinics as intended, the researchers used mailed surveys to all patients who had access to the intervention, regardless of whether they used it. The reviewers expressed concern that this type of data collection could lead to a biased sample of respondents.
- Acknowledging the limitations of the intervention and the study, specifically that the intervention required considerable resources and was underutilized by patients.
Conflict of Interest Disclosures
Study Registration Information
^Group Health Cooperative was purchased by Kaiser Foundation Health Plan of Washington.
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