Objective

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

Study Design

Design Element	Description
Design	Mixed-methods program evaluation
Population	418 patients at 3 primary care clinics who had at least 1 meeting with a CRS
Interventions/ Comparators	Before and after adding the CRS to the clinical care team
Outcomes	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.

Results

• 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).

Limitations

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.