A mixed methods study to inform and evaluate a longitudinal nurse practitioner/community health worker intervention to address social determinants of health and chronic obstructive pulmonary disease self-management

Authors: Lauren Kearney, Renda Soylemez Wiener, Mohsin Dahodwala, Gemmae M Fix, Jacqueline Hicks, Frederic Little, Jinesa Howard, Alexis Gallardo Foreman, Cornelia Wakeman, Charles O'Donnell, Katia Bulekova, Mari-Lynn Drainoni, Hasmeena Kathuria

In this mixed-methods study, researchers created and evaluated a CHW- and nurse practitioner-led intervention for patients with chronic obstructive pulmonary disease. Along with hospital physicians, healthcare leaders, and other stakeholders, researchers reviewed 2018 COPD admissions records at Boston Medical Center in Massachusetts, United States. After review, stakeholders concluded that COPD patients with two or more hospitalizations per year and one or more unmet social determinants of health-related needs should be prioritized for intervention. Researchers collected a convenience sample of 57 COPD patients and, along with nurse practitioners (NPs), CHWs followed patients for one month after discharge. As per the results of the assessment, patients found the program valuable, especially in providing social support, helping with navigating the medical system, and assisting with the management of COPD symptoms. The results of this study suggest that a CHW follow-up intervention may be beneficial to patients with COPD, particularly those with recurrent hospitalizations and unmet social needs.