This research project is in progress. PCORI will post its findings here within 90 days after our final review is complete. In the meantime, results have been published in peer-reviewed journals, as listed below.
Background: Chronically ill patients from low socioeconomic status (SES) communities try their best to feel better and gain control of conditions such as 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 has been 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: (1) self-rated physical health (“feeling better” and “not having my health limit what I do”); and (2) 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. We will also explore whether the intervention works differently across various types of primary care settings, whether the effects of the intervention last after it ends, whether achieving health goals makes people feel better, and what patients and CHWs think about the intervention and how it works.
Methods: We will recruit 444 patients who both live in low-income communities and have two or more of the following chronic conditions: diabetes, high blood pressure, obesity, or are smokers with asthma or 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 Outcome (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.
Between Clinicians and Patients, Trained Community Members May Provide a Key Link
A feature story 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.