Community Health Workers: A Case Study in Improving Patient Outcomes and Reducing Readmission Rates
A profile of the Penn Center for Community Health Workers' IMPaCT Program
Each day, healthcare providers help chronically ill patients get healthy. Still, patients often struggle to reach health goals because of challenges like trouble paying for medication, access to transportation, and other unaddressed barriers.
Patients with low-socioeconomic status and multiple chronic conditions have been shown to experience disproportionate morbidity and mortality, in part due to limited access to post-hospital primary care and increased risk of hospital readmission (1).
Given that the Affordable Care Act sought to hold health systems responsible for patient outcomes, through measures like tying reimbursement to 30-day hospital readmission rates and patient-reported care outcomes, many hospitals have been compelled to consider ways to address the socioeconomic risk factors in their communities (2). However, the traditional provider workforce lacks both the time and community skills necessary to address these barriers to health. While community health workers, who are trained community members who share socioeconomic backgrounds with their patients, have been shown to improve outcomes for patients with chronic disease and reduce hospital utilization (3-5), they have often failed to be integrated into the health system workforce or studied as a systematic intervention.
The Penn Center for Community Health Workers, through the IMPaCT program, did just that. Over the last five years, the Center has improved access and coordination of care for individuals in poverty within Penn Medicine’s immediate service area through a program that has integrated CHWs into the health system and developed an evidence-based CHW model of care.
The purpose of IMPaCT has been to help low-income General Medicine patients who have been cared for at the Hospital of the University of Pennsylvania or Penn Presbyterian Hospital with the transition from a hospital admission to a primary care clinic over the course of two weeks and up to six months. Community health workers (CHWs) called IMPaCT Partners help discharged patients navigate the health care system and address social, financial, and behavioral determinants of health outcomes. CHWs come from the same communities and share life experiences with the low-income patients they meet in the hospital and continue working with in the community.
In addition to providing social support, CHWs have coordinated insurance and prescription coverage, expedited follow-up appointments with primary care providers, and put in place preventative care measures such as smoking cessation programs and access to diet and exercise for low-income patients. As a 60-year-old patient with COPD in the program wrote, “I had to go to the hospital four times in the first six months of 2011. I had recently lost my job and my purpose in life. During a hospital stay, I met Mary, an IMPaCT CHW. She was so warm and easy to talk to. She turned me on to a community center in our neighborhood and helped me get a quit smoking patch. It has been nearly two years, and I haven’t had a cigarette.”
While the anecdotal evidence was promising, IMPaCT demonstrated its validity in a 2-armed, single-blind, randomized clinical trial published in JAMA Internal Medicine (6). In a study of over 200 patients at 2 urban hospitals, a two-week dose of IMPaCT significantly improved patient activation, access to primary care, mental health, and reduced hospital readmissions. Since the study, published in April 2014, the Penn Center of Community Health Workers has further expanded its CHW workforce, helped other health systems implement similar programs, and continues to conduct quality improvement to understand how to better help Penn patients transition out of the hospital and access preventative care.
Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92(8):1278- 1283.
Hospital Readmissions Reduction Program: Affordable Care Act, section 3025: 2012 Inpatient Prospective Payment System final rule. Centers for Medicare and Medicaid Services. https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772412458. Accessed January 18, 2013.
Heisler M, Vijan S, Makki F, Piette JD. Diabetes control with reciprocal peer support versus nurse care management: a randomized trial. Ann Intern Med. 2010;153(8):507-515.
Levine DM, Bone LR, Hill MN, et al. The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-American population. Ethn Dis. 2003;13(3):354-361.
Brownstein JN, Chowdhury FM, Norris SL, et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007;32(5):435-447.
Kangovi S, Mitra N, Grande D, White ML, McCollum S, Sellman J, Shannon RP, Long JA. Patient-Centered Community Health Worker Intervention to Improve Posthospital Outcomes A Randomized Clinical Trial. JAMA Intern Med. 2014;174(4):535-543. doi:10.1001/jamainternmed.2013.14327