Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned.
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| Title: | Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned. |
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| Authors: | KNOWLES, MOLLY, VASAN, ADITI, PAN, ZIWEI, LONG, JUDITH A., KANGOVI, SHREYA |
| Source: | Milbank Quarterly. Jun2025, Vol. 103 Issue 2, p513-527. 15p. |
| Subjects: | Community health services, Health services accessibility, Medical protocols, Home care services, Public hospitals, Supervision of employees, Professional practice, Human services programs, Social determinants of health, Interprofessional relations, Evaluation of human services programs, Health policy, Medical care, At-risk people, Hospital care, Interviewing, Hospital emergency services, Descriptive statistics, Patient-centered care, Workflow, Organizational change, Research methodology, Telephones, Metropolitan areas, Eligibility (Social aspects), Evidence-based medicine, Health equity, Health outcome assessment, Quality assurance, Length of stay in hospitals, Interpersonal relations, Continuing education, Medical needs assessment, Confidence intervals, Critical care medicine, Regression analysis, Brainstorming |
| Abstract: | Policy PointsEffectively implemented community health worker (CHW) programs improve patient health outcomes and quality of care, reduce health care costs, and are a key strategy for addressing social and structural drivers of health.As policymakers consider funding mechanisms for CHW programs, it is crucial to tie funding to evidence‐based best practices while also allowing for innovation and context‐specific adaptations. Context: Community health worker (CHW) programs represent a key strategy for addressing social and structural drivers of health and have the potential to improve patient health outcomes and enhance quality of care while reducing health care costs. However, challenges such as high staff turnover, lack of program infrastructure, and inadequate CHW support and supervision can hinder implementation and sustainment of effective CHW programs. Furthermore, few CHW programs have been successfully scaled across multiple organizations and communities. Individualized Management for Person‐Centered Targets (IMPaCT) is an evidence‐based CHW model designed to address these challenges by standardizing processes for CHW hiring, training, support, and supervision while still allowing for context‐specific adaptation and tailoring. In this dissemination and implementation project, we evaluated implementation of IMPaCT across five geographically and structurally distinct sites serving diverse and varied patient populations. Methods: Model fidelity was assessed across seven best practice domains via structured virtual observations with CHWs, supervisors, and program directors at each implementation site. Acute care use was evaluated using difference‐in‐differences regression modeling for patients enrolled in IMPaCT compared with a propensity score‐matched control group. All implementation sites examined total hospital days per patient, and several sites chose to incorporate additional measures of acute care use such as the number of hospitalizations and emergency department visits. Findings: We found that core program components were implemented consistently across sites, and three of five sites were able to both sustain implementation over a three‐year period and demonstrate significant reductions in acute care use, consistent with previous randomized controlled trials of this program. Conclusions: Health systems may be able to address social drivers of health and improve population health for patients who are low‐income and patients of color by implementing evidence‐based CHW programs with fidelity. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Policy PointsEffectively implemented community health worker (CHW) programs improve patient health outcomes and quality of care, reduce health care costs, and are a key strategy for addressing social and structural drivers of health.As policymakers consider funding mechanisms for CHW programs, it is crucial to tie funding to evidence‐based best practices while also allowing for innovation and context‐specific adaptations. Context: Community health worker (CHW) programs represent a key strategy for addressing social and structural drivers of health and have the potential to improve patient health outcomes and enhance quality of care while reducing health care costs. However, challenges such as high staff turnover, lack of program infrastructure, and inadequate CHW support and supervision can hinder implementation and sustainment of effective CHW programs. Furthermore, few CHW programs have been successfully scaled across multiple organizations and communities. Individualized Management for Person‐Centered Targets (IMPaCT) is an evidence‐based CHW model designed to address these challenges by standardizing processes for CHW hiring, training, support, and supervision while still allowing for context‐specific adaptation and tailoring. In this dissemination and implementation project, we evaluated implementation of IMPaCT across five geographically and structurally distinct sites serving diverse and varied patient populations. Methods: Model fidelity was assessed across seven best practice domains via structured virtual observations with CHWs, supervisors, and program directors at each implementation site. Acute care use was evaluated using difference‐in‐differences regression modeling for patients enrolled in IMPaCT compared with a propensity score‐matched control group. All implementation sites examined total hospital days per patient, and several sites chose to incorporate additional measures of acute care use such as the number of hospitalizations and emergency department visits. Findings: We found that core program components were implemented consistently across sites, and three of five sites were able to both sustain implementation over a three‐year period and demonstrate significant reductions in acute care use, consistent with previous randomized controlled trials of this program. Conclusions: Health systems may be able to address social drivers of health and improve population health for patients who are low‐income and patients of color by implementing evidence‐based CHW programs with fidelity. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 0887378X |
| DOI: | 10.1111/1468-0009.70011 |
