Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project expanded the use of a community health worker, or CHW, program shown to improve quality of care and reduce hospital days for patients facing socioeconomic disadvantage.

About 38 million Americans live in poverty in the United States. People facing socioeconomic disadvantage are more likely to experience life challenges such as unsafe housing and limited access to healthy foods and high-quality health care, which are often made worse by experiences of racism. These challenges also increase the risk of chronic health problems such as heart disease, diabetes, and high blood pressure.

What was the goal of this implementation project?

CHWs are health workers who are trusted members of the communities they serve. CHWs can improve health within their communities by providing social support, advocacy, connections to resources, coaching, and navigation. A PCORI-funded research study found that a standardized CHW program called IMPaCT improved quality of care and reduced hospital days among patients living in low-income neighborhoods. In IMPaCT, CHWs first get to know their patients, including patients’ life stories and priorities. Then, CHWs provide ongoing support based on patients’ needs and preferences.

This project expanded the use of IMPaCT to five healthcare organizations across the United States to support patients with chronic health problems who live in low-income communities.

What did this project do?

The project team adapted IMPaCT for a federally qualified health center, or FQHC, and four health systems. One of the health systems was an integrated delivery network, or IDN. Core parts of IMPaCT, such as guidance for hiring CHWs and protocols for how CHWs work with patients, were the same for all programs. The team adapted other parts of IMPaCT for local patients, caregivers, and clinicians by working with staff at each site. The team also worked with sites to adapt IMPaCT for virtual use during the COVID-19 pandemic.

The project team supported sites while they put IMPaCT in place. The team:

  • Helped recruit and hire CHWs who could build trust with patients
  • Trained CHWs, the people who managed them, and the people who led the CHW program at each site
  • Provided ongoing support and feedback
  • Refined the program as needed for each site, such as by identifying new ways to connect with patients

What was the impact of this project?

IMPaCT programs provided CHW support to 4,695 patients. At all five sites, programs served patients who lived in low-income communities and had chronic health problems. Some programs focused on serving patients of color, immigrants, and patients who spoke a primary language other than English. 

All five sites began serving patients using the IMPaCT program. Four sites also expanded their IMPaCT programs. These four sites used IMPaCT protocols to hire and train 351 CHWs, 66 managers, and other IMPaCT program staff. The other site, the FQHC, ended its IMPaCT program during the early phase of the COVID-19 pandemic due to budget and other concerns. 

In their evaluation, the project team observed IMPaCT teams in the four remaining sites. The team looked at program fidelity, or how closely teams followed each part of the program. For example, the team looked at IMPACT teams’ hiring practices, approach to supervision, and CHW workflows. All four sites followed most parts of the IMPaCT program closely, with global fidelity scores of greater than 4 out of 6. The health systems also looked at the effect of the program on patients’ use of health services. Three of these four sites saw improvements in patients’ use of services. 

The evaluation showed that the IDN had the highest fidelity among the four sites. The global fidelity score was 4.6 out of 6.0. At this site, compared with patients who were eligible for IMPaCT but enrolled later, patients served by IMPaCT:

  • Had a decrease in days spent in the hospital at six months (decrease of 78.8 days versus increase of 92.7 days, p=0.024). This decrease was maintained but no longer statistically significant at 9 and 12 months
  • Were more likely to have had one or more primary care visits at three months (71.3% versus 61.0%, p=0.0002) and at six months (85.7% versus 79.5%, p=0.0054)
  • Were more likely to have had social needs screening at three months (66.1% versus 38.5%, p <0.0001) and six months (67.7% versus 41.7%, p<0.0001) 

At another site, compared with similar patients who didn't receive IMPaCT, patients who did:

  • Had greater decreases in visits to the emergency department, or ED, at three months (-1.35 ED visits versus -0.94 ED visits, p=0.003) and six months (-1.05 ED visits versus -0.70 ED visits, p=0.034). 
  • Were 52% less likely to return to the hospital at six months (odds ratio [OR]=0.48, p=0.041). 
  • Were 97% more likely to have attended a primary care visit at three months (OR=1.97, p=0.014). This effect was maintained but no longer statistically significant at six months. 

At the third site, compared with similar patients who didn't receive IMPaCT, those who did had 29% fewer hospital stays at nine months (incidence rate ratio [IRR]=0.71, p=0.005). 

The fourth site delivered IMPaCT with high fidelity. The global fidelity score was 4.2. But this health system decided to discontinue IMPaCT at the end of the project. This site didn’t see improvements in patients’ use of healthcare services. 

The three sites that kept using IMPaCT after the project ended are expanding its use to new care delivery areas.

More about this implementation project:

Stakeholders Involved in This Project

  • Penn Center for Community Health Workers 

  • IMPaCT Care

Publicly Accessible Project Materials

For more information about these materials, please contact the project team at skangovi@impactcarehq.com.

The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

Project Achievements

  • Implemented IMPaCT CHW program in five diverse health settings. 

  • Reached 4,965 patients who live in low-income communities and have chronic health problems. 

  • Demonstrated a standardized approach to implementing a CHW program that diverse sites could implement and sustain.

Implementation Strategies

  • Adapted the program based on sites’ clinical needs and to work with sites’ existing resources and workflows.

  • Provided sites with tools to support implementation, including hiring strategies, protocols for supervision, and best practices for patient outreach and engagement.

  • Trained CHWs, supervisors, and directors in person and online.

  • Conducted cyclical small tests of change at sites.

  • Provided technical assistance to sites, including consultation.

Evaluation Outcomes

To document implementation:

  • Number of patients enrolled in CHW programs

  • Number of CHWs hired to deliver the program

  • Additional measures of acceptability, fidelity of program delivery, expansion, and sustainability

  • Implementation barriers and facilitators

To assess healthcare and health outcomes:

  • Hospitalizations

  • Total hospital days or inpatient length of stay

  • Hospital readmissions

  • ED utilization

  • Primary care utilization

Project Information

Shreya Kangovi, MD, MS
University of Pennsylvania Perelman School of Medicine
$1,339,575
Implementation of the IMPaCT Community Health Worker Intervention

Key Dates

February 2019
June 2023
2019
2024

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Collaborative Goal Setting with or without Community Health Worker Support for Patients with Multiple Chronic Conditions


Note: Aditi Vasan, MD, MSHP served as Interim Principal Investigator of this project while Principal Investigator Shreya Kangovi, MD, MS was on sabbatical in 2021.

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Last updated: April 23, 2024