Community Health Worker Support for Seriously Ill Older Veterans

(PATH Trial)

Overseen By David Edelman, MD MHS

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

480 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Remote Community Health Worker Support for Seriously Ill Older Veterans?

Research shows that community health workers (CHWs) can effectively provide emotional support and connect older adults to resources, improving their well-being. CHWs have been successful in extending care to vulnerable populations, such as those with multiple chronic diseases, by filling gaps in support left by traditional healthcare systems. ^{1 2 3 4 5}

Is community health worker support generally safe for humans?

Community health worker programs have been implemented in various settings, such as maternal and child health in Tanzania and home visit programs in Ohio, without reported safety concerns. These programs focus on providing education, support, and healthcare referrals, and have been well-accepted in communities, suggesting they are generally safe for human use. ^{6 7 8 9 10}

How is the Remote Community Health Worker Support treatment different from other treatments for seriously ill older veterans?

This treatment is unique because it involves community health workers (CHWs) providing remote support to seriously ill older veterans, focusing on emotional support and connecting them to resources, which is not typically addressed by standard healthcare teams. CHWs help fill gaps in support left by the healthcare system and family, offering a personalized approach that enhances care delivery and well-being. ^{3 4 11 12 13}

What is the purpose of this trial?

The investigators aim to support care partner's well-being and satisfaction with VA care and decrease their work burden by offering extra support from a trained Community Health Worker who will help connect the care partner to helpful resources in their communities and in the VA. The investigators also hope to help Veterans well-being and satisfaction with VA care by supporting their care partner more sufficiently allowing the care partner to focus on caregiving tasks.

Research Team

Nathan A Boucher, DrPH

Principal Investigator

Durham VA Medical Center, Durham, NC

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

Group I: Community Health Worker support Experimental Treatment 1 Intervention

Additional weekly remote support of care partner using a trained/certified community health worker along with regular support from Caregiver Support Program

Group II: Regular support Active Control 1 Intervention

Regular support from Caregiver Support Program ONLY

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

A Qualitative Evaluation of a Home-based Palliative Care Program Utilizing Community Health Workers in India. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

The Role of Community Health Workers in the Health and Well-Being of Vulnerable Older Adults during the COVID Pandemic. [2023]

4. Brazil pubmed.ncbi.nlm.nih.gov

Community health workers caring for dependent elderly people. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

A Community Health Worker Home Visit Program: Facilitators and Barriers of Program Implementation. [2021]

8. England pubmed.ncbi.nlm.nih.gov

Feasibility and evaluation of a pilot community health worker intervention to reduce hospital readmissions. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of asthma self-management support comparing clinic-based nurses and in-home community health workers: the Seattle-King County Healthy Homes II Project. [2021]

10. England 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. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Community health worker interventions for older adults with complex health needs: A systematic review. [2022]

12. England pubmed.ncbi.nlm.nih.gov

The role of community health worker-based care in post-conflict settings: a systematic review. [2023]

13. Netherlands pubmed.ncbi.nlm.nih.gov

The Value of Community Health Workers in Diabetes Management in Low-Income Populations: A Qualitative Study. [2022]