Abstract
Background: Internationally, the roles of Community Health Workers, also known as Community Health Navigators (CHNs), have been developed as an intervention to improve the transition of people to their homes following a hospital admission. Generally, CHNs are trusted members of the communities they serve. This trusting relationship enables them to serve as a link between health services, social services and the community to facilitate access and improve the quality and cultural competence of service delivery. Research has found that CHNs can reduce barriers to access for marginalised communities, identify emerging needs, and can make health services more responsive. The CHN’s are employed by the Sydney Local Health District and are embedded within the Planned Care team under the governance of the Aged Health Rehabilitation and Chronic Care Clinical Stream.
This trial aims to evaluate the impact of CHNs who support people with chronic conditions to transition from hospital to their homes. The CHNs are employed by a Local Health District and embedded within the health service. The trial, which is currently underway, will evaluate the impact of a CHN intervention’s on 60-day unplanned hospital readmission, medication adherence, health literacy, quality of life, experience of health care and health service use, compared to usual care. Implementation of the navigator role will also be qualitatively appraised, incorporating data from patients, health professionals and the navigators themselves.
Trial population: Patients aged over 40 years and living with chronic health conditions in a Local Health District in Sydney, Australia.
Engagement: This trial is underpinned and guided by a multi-stakeholder partnership of health planners, primary healthcare providers, and consumers. These stakeholders have joined in co-designing this study to evaluate the effectiveness and cost of CHN follow-up of patients after discharge as a key strategy in preventing re-hospitalisation, and to develop the CHN roles and functions.
What we are doing: This parallel group, pragmatic RCT design will randomly allocate patients after hospital discharge to the CHN intervention or usual care arm. Comparison of outcomes will be made between intervention and control groups.
Results: This RCT is currently underway. Interviews with 27 health staff and a co-design process with 18 participants have informed the development of the CHN roles and the implementation of the trial. Codesign participants were generally enthusiastic about the potential of the CHNs, but there were concerns about how these roles could fit within existing services and supervision arrangements, and the CHNs’ competence to fulfil their roles. A detailed CHN training program was developed with emphases on communication, rapport-building, services that can be referred to, and supervision arrangements. Three CHNs are currently employed.
Lessons: This study includes an intervention embedded in a real-world healthcare setting. The co-design process enabled the CHN roles to be well-described and to have the potential to meet the needs of the study population and to be responsive to service stakeholders. The CHN are integrated into existing health service structures and processes, and are embedded in an established outreach team.
Next steps: Reporting on study.