Successful health system, congregation collaboration associated with reduced loneliness and fewer emergency department visits
An innovative partnership between a health system and local congregations in neighborhoods with high need are providing individual companionship to older adults found significant reductions in loneliness and a corresponding reduction in emergency department visits.
Social isolation and loneliness are recognized as risk factors for poor health outcomes, especially in older adults, including increased rates of chronic illness, mental health challenges and premature mortality. These issues are more prevalent among individuals living in under-resourced communities, where barriers to transportation, healthcare access and social support are common.
Following participation in the successful relationship building program, the proportion of patients with one or more emergency department visits declined from nearly 25 percent to less than 17 percent. Outpatient visits increased from nearly 64 percent to 71 percent. In addition, participants reported reduced scores on both emotional and social loneliness measures. Patients gained access to calmer settings, the right specialists and more consistent, supportive relationships with regular healthcare providers.
The Congregational Care Network (CCN), developed at Indiana University (IU) Health, connects older adults with trained volunteers from local congregations for weekly phone conversations or in-person visits over a three-month period. In a program evaluation of the CCN, research scientists from IU Health, IU School of Medicine and Regenstrief Institute measured loneliness before and after participation and healthcare utilization in the 90 days before, during and after program involvement.
“The CCN was founded to address the problems of social isolation and loneliness that many of our patients face,” said Regenstrief Research Scientist Alexia Torke, M.D., M.S., who co-led the study. “The goal was to both reduce the loneliness that patients experience and also to improve their overall health and well-being and access to healthcare.” Dr. Torke also is a professor at IU School of Medicine and a physician whose practice addresses many facets of the care of older adults.
“An important effect of the CCN is that we were able to reduce the number of times that patients who participated in the program went to the emergency room and we were able to increase the number of times that our patients went to their outpatient clinics,” said Dr. Torke. “It is better for patients to seek their care in the outpatient setting, where the environment is calm, where they can see the right specialist and where they have time to talk to their clinicians. An important goal of healthcare is to encourage people to attend their outpatient visits and then to avoid the emergency room when possible.”
The CCN operates through collaboration between IU Health staff and partner congregations in Indiana. Each participating congregation identifies community volunteers—referred to as connectors—who receive training and are matched with patients based on neighborhood proximity. Connectors provide weekly telephone-based companionship for 12 weeks. Directed by John (Jay) Foster, DMin, BCC, the vice president of spiritual care for Chaplaincy Services and Congregational Partnerships at IU Health, the program includes support from IU Health-employed social workers and chaplains who assist with referrals and address patient needs that require additional intervention. Dr. Foster notes that for many people, faith is an important part of health, and the CCN program is one means by which persons who are lonely or isolated can speak to issues of meaning and purpose as they cope with illness and hospitalization.
Initially piloted in Indianapolis and Bloomington, Indiana, the CCN has since expanded to four metropolitan areas with participation from 39 congregations representing a range of faith traditions.
“Being open to people of all faiths, belief systems and racial backgrounds was very important,” said Dr. Torke. “Each faith community that partnered with us had to be willing to serve patients from any background. Connectors were trained in the core principles of chaplaincy—caring for individuals without proselytizing and meeting them where they are. That is a vital part of the CCN structure.”
“The Congregational Care Network: Preliminary Data From a Healthcare/Congregational Partnership for At-Risk Older Adults,” is published in The Journal of the American Geriatrics Society.
This work was supported by Indiana University Health, Indiana University Health Community Impact Investment Fund; National Institutes of Health’s National Institute on Aging, K24AG053794.
Authors of the study and their affiliations, as they are listed in the publication, are:
John D Foster1,2, Alexia M Torke1,2,3,4,5, Deanna R Willis1,6, Shadreck W Kamwendo1,2, James E Slaven7, Brownsyne Tucker-Edmonds1,8,9, Erika R Cheng1,9,10, Tricia Behringer1,2, Notoshia Howard1,2, Sherri Session1,2
Affiliations
1Indiana University Health, Indianapolis, Indiana, USA.
2The Evans Center at Indiana University Health, Indianapolis, Indiana, USA.
3Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
4Indiana University Center for Aging Research, Indianapolis, Indiana, USA.
5Regenstrief Institute, Inc, Indianapolis, Indiana, USA.
6Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
7Department of Biostatistics & Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA.
8Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
9Health Equity Advancing Through Learning Health Systems Research (HEALeR) Collaborative, Indianapolis, Indiana, USA.
10Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Alexia Torke, M.D., M.S.
In addition to her appointment as a research scientist with the Indiana University Center for Aging Research at Regenstrief Institute, Alexia Torke, M.D., M.S., is the inaugural chief of the Section of Palliative Medicine within the Division of General Internal Medicine and Geriatrics and a professor of medicine at the Indiana University School of Medicine. She also directs the Daniel F. Evans Center for Spiritual and Religious Values in Healthcare at Indiana University Health.
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