Impact of a Low-Intensity Resource Referral Intervention on Patients’ Knowledge, Beliefs, and Use of Community Resources: Results from the CommunityRx Trial
Connecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood.
To evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients’ knowledge, beliefs, and use of community resources.
Real-world controlled clinical trial at an urban academic medical center in 2015–2016; participants were assigned by alternating week to receive the CommunityRx intervention or usual care. Surveys were administered at baseline, 1 week, 1 month, and 3 months.
Publicly insured adults, ages 45–74 years.
CommunityRx generated an automated, personalized list of resources, known as HealtheRx, near each participant’s home using condition-specific, evidence-based algorithms. Algorithms used patient demographic and health characteristics documented in the electronic health record to identify relevant resources from a comprehensive, regularly updated database of health-related resources in the study area.
Using intent-to-treat analysis, we examined the impact of HealtheRx referrals on (1) knowledge of the most commonly referred resource types, including healthy eating classes, individual counseling, mortgage assistance, smoking cessation, stress management, and weight loss classes or groups, and (2) beliefs about having resources in the community to manage health.
In a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29–3.58) and beliefs (AOR = 1.68; 95% CI, 1.07–2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07–7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05–4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02).
In a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health.
NIH Trial Registry
KEY WORDSsocial determinants of health health-related social needs community linkages community resource referral self-management self-care disease-management health information technology
Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health R01AG047869 (S.T. Lindau, PI). The full amount of the project costs were financed with federal money. E. Tung was supported by the Agency for Healthcare Research and Quality (AHRQ) K12 grant in patient-centered outcomes research 5K12HS023007 (E.L. Tung, PI) and the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health 1K23HL145090-01 (E.L. Tung, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors gratefully acknowledge Philip Schumm and Chuanhong Liao from the Department of Public Health Sciences Biostatistics Laboratory for their statistical support. ClinicalTrials.gov number NCT02435511.
Respective author contributions are as follows. Study concept and design: S.T.L., D.G.B., E.L.T., E.A., E.S.H., and J.M. Acquisition of data: S.T.L., E.A., and J.M. Analysis and interpretation of data: S.T.L., E.L.T., E.A, and J.M. Drafting of the manuscript: S.T.L., E.L.T., and E.A. Critical revision of the manuscript for important intellectual content: all authors. Obtaining funding: S.T.L. Administrative, technical, or material support: S.T.L. Final approval of the version to be published: all authors.
Compliance with Ethical Standards
This study was conducted with written informed consent and approved by the University of Chicago Institutional Review Board and registered on clinicaltrials.gov (NCT02435511).
Conflict of Interest
Dr. Lindau directed a Center for Medicare and Medicaid Innovation Health Care Innovation Award (1C1CMS330997-03) called CommunityRx. This award required development of a sustainable business model to support the model test after award funding ended. To this end, Dr. Lindau is founder and co-owner of NowPow, LLC. Neither entity is supported through CMS funding. Neither the University of Chicago nor the University of Chicago Medicine endorses or promotes any NowPow Entity or its business, products, or services. The remaining authors declare no conflicts of interest.
- 7.Lindau ST, Makelarski JA, Abramsohn EM, et al. CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention. Am J Public Health 2019:e1-e7.Google Scholar
- 8.Bandura A. Guide for constructing self-efficacy scales. In: Self-Efficacy Beliefs of Adolescents. Information Age Publishing. 2006:307-337. Available at: https://www.uky.edu/~eushe2/Bandura/BanduraGuide2006.pdf. Accessed 23 Feb 2018.
- 13.National Institutes of Health. Science of Behavior Change Bethesda, MD: U.S. Department of Health and Human Services; 2018 Available from: https://commonfund.nih.gov/behaviorchange. Accessed 15 April 2018.
- 14.U.S. Census Bureau. American Community Survey 5-Year Estimates: American FactFinder; 2014. Available from: http://factfinder.census.gov. Accessed 15 April 2018.
- 16.Lindau ST, Vickery KD, Choi H, et al. A Community-Powered, Asset-Based Approach to Intersectoral Urban Health System Planning in Chicago. Am J Public Health 2016:e1-e7.Google Scholar
- 17.University of Chicago Survey Lab. Methodological Resources Chicago, IL: University of Chicago; 2019. Available from: https://voices.uchicago.edu/surveylab/about-2/. Accessed 15 April 2018.
- 18.American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 9th ed: AAPOR 2016.Google Scholar
- 19.Stead LF, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst Rev 2005(2):Cd001007.Google Scholar
- 27.Tung EL, Peek ME, Makelarski JA, et al. Adult BMI and Access to Built Environment Resources in a High-Poverty, Urban Geography. Am J Prev Med 2016;51(5):e119-e27.Google Scholar
- 28.Bachrach DPH; Wallis, K.; Lipson, M. Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment. The Commonwealth Fund 2014:36.Google Scholar