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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.
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]
Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned.
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– Name: Abstract
  Label: Abstract
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  Data: 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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  Label:
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  Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=186137856
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1468-0009.70011
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 513
    Subjects:
      – SubjectFull: Community health services
        Type: general
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Medical protocols
        Type: general
      – SubjectFull: Home care services
        Type: general
      – SubjectFull: Public hospitals
        Type: general
      – SubjectFull: Supervision of employees
        Type: general
      – SubjectFull: Professional practice
        Type: general
      – SubjectFull: Human services programs
        Type: general
      – SubjectFull: Social determinants of health
        Type: general
      – SubjectFull: Interprofessional relations
        Type: general
      – SubjectFull: Evaluation of human services programs
        Type: general
      – SubjectFull: Health policy
        Type: general
      – SubjectFull: Medical care
        Type: general
      – SubjectFull: At-risk people
        Type: general
      – SubjectFull: Hospital care
        Type: general
      – SubjectFull: Interviewing
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Patient-centered care
        Type: general
      – SubjectFull: Workflow
        Type: general
      – SubjectFull: Organizational change
        Type: general
      – SubjectFull: Research methodology
        Type: general
      – SubjectFull: Telephones
        Type: general
      – SubjectFull: Metropolitan areas
        Type: general
      – SubjectFull: Eligibility (Social aspects)
        Type: general
      – SubjectFull: Evidence-based medicine
        Type: general
      – SubjectFull: Health equity
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      – SubjectFull: Health outcome assessment
        Type: general
      – SubjectFull: Quality assurance
        Type: general
      – SubjectFull: Length of stay in hospitals
        Type: general
      – SubjectFull: Interpersonal relations
        Type: general
      – SubjectFull: Continuing education
        Type: general
      – SubjectFull: Medical needs assessment
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Critical care medicine
        Type: general
      – SubjectFull: Regression analysis
        Type: general
      – SubjectFull: Brainstorming
        Type: general
    Titles:
      – TitleFull: Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned.
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              Text: Jun2025
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