Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned.
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...
| Publicado en: | Milbank Quarterly Vol. 103; no. 2; pp. 513 - 528 |
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| Autores principales: | , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
Jun2025
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=186137856&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 186137856 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0887378X MIQ jtl: Milbank Quarterly issn: 0887378X maglogo: Y pubinfo: dt: Jun2025 vid: 103 iid: 2 pid: 480 pub: Wiley-Blackwell artinfo: ui: 186137856 10.1111/1468-0009.70011 ppf: 513 ppct: 15 formats: tig: atl: Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned. aug: au: KNOWLES, MOLLY VASAN, ADITI PAN, ZIWEI LONG, JUDITH A. KANGOVI, SHREYA affil: Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania Penn Center for Community Health Workers, University of Pennsylvania Health System Division of General Pediatrics, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania Leonard Davis Institute of Health Economics, University of Pennsylvania Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center IMPaCT Care su: Community health services Health services accessibility Home care services Supervision of employees Human services programs Social determinants of health Interprofessional relations Evaluation of human services programs Health policy Medical care Hospital care Interviewing Patient-centered care Organizational change Telephones Metropolitan areas Health equity Interpersonal relations Continuing education Critical care medicine Medical protocols Public hospitals Professional practice At-risk people Hospital emergency services Descriptive statistics Workflow Research methodology Eligibility (Social aspects) Evidence-based medicine Health outcome assessment Quality assurance Length of stay in hospitals Medical needs assessment Confidence intervals Regression analysis Brainstorming sug: subj: Community health services Health services accessibility Home care services Supervision of employees Human services programs Social determinants of health Interprofessional relations Evaluation of human services programs Health policy Medical care Hospital care Interviewing Patient-centered care Organizational change Telephones Metropolitan areas Health equity Interpersonal relations Continuing education Critical care medicine Other local, municipal and regional public administration Other Individual and Family Services Community health centres All Other Outpatient Care Centers Residential Mental Health and Substance Abuse Facilities Professional and Management Development Training Home Health Care Services Services for the Elderly and Persons with Disabilities Offices of All Other Miscellaneous Health Practitioners Offices of all other health practitioners Administration of Public Health Programs General Medical and Surgical Hospitals Electronic components, navigational and communications equipment and supplies merchant wholesalers Medical protocols Public hospitals Professional practice At-risk people Hospital emergency services Descriptive statistics Workflow Research methodology Eligibility (Social aspects) Evidence-based medicine Health outcome assessment Quality assurance Length of stay in hospitals Medical needs assessment Confidence intervals Regression analysis Brainstorming keyword: community health workers implementation science social drivers of health community health workers implementation science social drivers of health ab: 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. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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