Community Health Worker Support for Seriously Ill Older Veterans

(PATH Trial)

Overseen By Jennifer B Zervakis, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Caregiver abuse, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to support caregivers of seriously ill older veterans by providing extra assistance from a trained Community Health Worker. The goal is to enhance the well-being of both caregivers and veterans by connecting caregivers to helpful resources, enabling them to focus more on caregiving tasks. The trial will compare regular support with additional weekly remote support from the Community Health Worker. It suits caregivers of veterans living in rural areas who assist with daily tasks like shopping or managing medications. Veterans should receive care at specific VA Health Systems and require help with daily activities due to conditions such as heart failure or dementia. As an unphased trial, this study offers caregivers a unique opportunity to access additional support and resources, enriching their caregiving experience.

Do I need to stop my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this method is safe for supporting care partners of seriously ill older veterans?

Research has shown that community health worker (CHW) programs are generally safe and well-received. Studies of similar programs have found that these workers improve healthcare for patients needing extra support by connecting them to important resources. No major reports have indicated problems caused by CHW support.

In this trial, participants will receive extra weekly remote support from a trained community health worker. This method has previously helped patients and their caregivers manage the healthcare system. The goal is to reduce caregiver stress and improve the well-being of both patients and caregivers. Overall, evidence suggests that this type of support is safe and beneficial for everyone involved. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the use of remote community health worker support for seriously ill older veterans because it provides personalized, consistent care without the need for frequent hospital visits. Unlike the usual care that involves irregular or in-person support, this approach leverages trained community health workers to offer additional weekly guidance remotely. This method not only aims to improve the quality of life for veterans by reducing the burden of travel and healthcare facility visits but also enhances care by giving dedicated support to both the patients and their care partners.

What evidence suggests that Remote Community Health Worker Support is effective for supporting care partners of seriously ill older veterans?

This trial will compare the effects of regular support with additional Community Health Worker (CHW) support for seriously ill older Veterans. Research has shown that a CHW can greatly assist both caregivers and Veterans. Studies have found that CHWs ease the burden on caregivers, enabling them to better care for their loved ones. This support also increases satisfaction with the care provided by the VA. Additionally, CHWs assist older adults with complex health needs by connecting them to useful resources. These findings suggest that including a CHW in the care team can significantly benefit everyone involved. ^{1 2 3 5 6}

Who Is on the Research Team?

Nathan A Boucher, DrPH

Principal Investigator

Durham VA Medical Center, Durham, NC

Are You a Good Fit for This Trial?

This trial is for care partners of older veterans who are seriously ill with conditions like kidney disease, obstructive airway diseases including COPD, cancer, or dementia. These care partners should be living in rural areas and need support managing their caregiving responsibilities.

Inclusion Criteria

Care Partner must reside in a rural area based on RUCC or Rural-Urban Continuum Codes

Care Partner must be enrolled in CSP Program of General Caregiver Support Services

Veteran must receive care at Durham, Asheville, and Richmond VA Health Systems and reside in a rural area

Exclusion Criteria

Veteran must not have a flag or social work note indicating suspected Caregiver abuse

I can communicate in English by phone.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive additional weekly remote support from a trained Community Health Worker for 6 months

6 months

Weekly remote support

Follow-up

Participants are monitored for outcomes such as caregiver burden and satisfaction with VA care

6 months

Evaluation and Planning

Conduct semi-structured interviews and Delphi Method sessions to evaluate intervention effectiveness and plan for implementation

3-6 months

What Are the Treatments Tested in This Trial?

Interventions

• Remote Community Health Worker Support

Trial Overview The study is testing whether extra support from a trained Community Health Worker can improve the well-being and satisfaction of both the care partner and the veteran. The worker will help connect them to resources within their community and the VA system.

How Is the Trial Designed?

Group I: Community Health Worker support Experimental Treatment 1 Intervention

Additional weekly remote support of care partner using a trained/certified community health worker

Group II: Regular support Active Control 1 Intervention

Regular care

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Durham VA Medical Center

Collaborator

Trials

40

Recruited

9,300+

Published Research Related to This Trial

Community health workers (CHWs) played a crucial role in a diabetes self-management intervention for low-income individuals, addressing barriers such as lack of diabetes knowledge, socioeconomic challenges, and healthcare system complexity through personalized education and support.

The study analyzed 634 encounter reports from 145 participants, highlighting that CHWs provided essential resources and guidance, demonstrating their effectiveness in improving diabetes management beyond what typical primary care can offer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study. Silverman, J., Krieger, J., Sayre, G., et al.[2022]

The pilot navigation program using community health workers (CHWs) aims to reduce delays in cancer treatment by providing tailored support to patients and caregivers, potentially improving healthcare utilization and reducing patient distress.

The study will assess the program's effectiveness by measuring the time to initial oncology treatment and patient satisfaction, with evaluations conducted at 3 and 6 months post-intervention, ensuring a systematic approach to implementation and feedback.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving cancer care for underserved populations in an academic and community practice setting: protocol for a community health worker pilot navigation programme. Suen, JJ., Parrillo, E., Hassoon, A., et al.[2022]

The pilot study involved 423 patients at an academic medical center and tested a community health worker (CHW) intervention that provided post-discharge support, with about 70% of patients receiving at least one call from a CHW.

While the intervention showed a trend towards lower hospital readmission rates (15.4% for CHW patients vs. 17.9% for usual care), the difference was not statistically significant, indicating the need for further research to confirm its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions. Burns, ME., Galbraith, AA., Ross-Degnan, D., et al.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06963970

Using Community Health Workers to Support Rural Care ... Aim 1: Determine CSNAV effectiveness in increasing rural Veterans' well-being, reducing rural care partner burden, and increasing rural care partner/Veteran ...

2. reporter.nih.gov reporter.nih.gov/project-details/11108609

Using Community Health Workers to Support Rural Care ... Using Community Health Workers to Support Rural Care Partners of Seriously Ill Older Veterans ... Determine CHW effectiveness in reducing care partner ...

3. centerwatch.com centerwatch.com/clinical-trials/listings/NCT06963970/using-community-health-workers-to-support-rural-care-partners-of-seriously-ill-older-veterans

Using Community Health Workers to Support Rural Care ... Aim 1: Determine CSNAV effectiveness in increasing rural Veterans' well-being, reducing rural care partner burden, and increasing rural care ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8263299/

Community Health Worker Interventions for Older Adults with ... We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs.

5. hsrd.research.va.gov hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141706848

CDA 17-007 – HSR Study - VA Health Systems Research This CDA proposes to develop a novel, effective navigator intervention targeting caregivers of older, community-dwelling Veterans with advanced illness. In ...

6. hsrd.research.va.gov hsrd.research.va.gov/publications/vets_perspectives/0219-Community-Health-Workers-Improve-Healthcare-for-High-Risk-Veterans.cfm

Community Health Workers Improve Healthcare for High-Risk ... In the IMPaCT model, Community Health Workers (CHW) join care teams and help patients navigate the healthcare system and connect to resources.