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Impact of a Low-Intensity Resource Referral Intervention on Patients’ Knowledge, Beliefs, and Use of Community Resources: Results from the CommunityRx Trial

  • Elizabeth L. TungEmail author
  • Emily M. Abramsohn
  • Kelly Boyd
  • Jennifer A. Makelarski
  • David G. Beiser
  • Chiahung Chou
  • Elbert S. Huang
  • Jonathan Ozik
  • Chaitanya Kaligotla
  • Stacy Tessler Lindau
Original Research

ABSTRACT

Background

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.

Objective

To evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients’ knowledge, beliefs, and use of community resources.

Design

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.

Participants

Publicly insured adults, ages 45–74 years.

Intervention

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.

Main Measures

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.

Key Results

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).

Conclusions

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

NCT02435511

KEY WORDS

social determinants of health health-related social needs community linkages community resource referral self-management self-care disease-management health information technology 

Notes

Acknowledgments

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.

Author Contributions

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.

Supplementary material

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ESM 1 (DOCX 25 kb)
11606_2019_5530_MOESM2_ESM.pdf (62 kb)
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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Elizabeth L. Tung
    • 1
    • 2
    • 3
    Email author
  • Emily M. Abramsohn
    • 4
  • Kelly Boyd
    • 4
  • Jennifer A. Makelarski
    • 4
  • David G. Beiser
    • 5
    • 6
  • Chiahung Chou
    • 7
    • 8
  • Elbert S. Huang
    • 1
    • 3
    • 6
  • Jonathan Ozik
    • 9
    • 10
  • Chaitanya Kaligotla
    • 9
    • 10
  • Stacy Tessler Lindau
    • 4
    • 6
    • 11
    • 12
  1. 1.Section of General Internal MedicineUniversity of ChicagoChicagoUSA
  2. 2.Center for Health and the Social SciencesUniversity of ChicagoChicagoUSA
  3. 3.Chicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoUSA
  4. 4.Department of Obstetrics and GynecologyUniversity of ChicagoChicagoUSA
  5. 5.Section of Emergency MedicineUniversity of ChicagoChicagoUSA
  6. 6.Center for Healthcare Delivery Science and InnovationUniversity of ChicagoChicagoUSA
  7. 7.Department of Health Outcomes Research and PolicyAuburn UniversityAuburnUSA
  8. 8.Department of Medical ResearchChina Medical University HospitalTaichungTaiwan
  9. 9.Consortium for Advanced Science and EngineeringUniversity of ChicagoChicagoUSA
  10. 10.Decision and Infrastructure Sciences DivisionArgonne National LaboratoryLemontUSA
  11. 11.Department of Medicine-GeriatricsUniversity of ChicagoChicagoUSA
  12. 12.Comprehensive Cancer CenterUniversity of ChicagoChicagoUSA

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