Proven Community Health Worker Model Adapted for Use in Primary Care

Community health workers are trusted, knowledgeable, frontline healthcare personnel who help bridge cultural and linguistic barriers, expand access to coverage and care, and improve health outcomes within their communities. Their service can be invaluable.

The Penn Center for Community Health Workers Individualized Management for Patient-Centered Targets, or IMPaCT model, which has already shown to reduce re-admissions and lead to better health outcomes for hospitalized patients, is now being used for chronically ill patients in the primary care setting.

Small Steps

In 2014, the Penn Center for Community Health Workers completed a randomized control trial involving 446 patients in its two- to four-week inpatient program. The goal was to evaluate the effectiveness of a community health worker intervention that kept people from falling through the cracks while transitioning from the hospital to home.

“That’s really an important time for a lot of people, particularly for high-risk patients,” explained Jill Feldstein, director of the center.

That two-week dose of IMPaCT had a significant effect. Patients who worked with a community health worker increased access to primary care by 12%; improved HCAHPS scores for quality of communication between patients and providers by 13%; reduced likelihood of recurrent 30-day hospital readmissions among readmitted patients by 25%; and improved patients’ mental health and level of engagement with their healthcare providers.

That led to the creation of an outpatient intervention to administer IMPaCT outside the hospital setting, the hiring of additional staff, and integrating with seven primary care facilities to implement IMPaCT on their premises.

Primary Care Benefits

Feldstein says the center has received a great deal of positive feedback from its primary care provider partners about the additional insight they’re able to obtain into their patients’ lives thanks to information shared by community health workers.

“It’s really about two-way communication,” she explained. “The patient is talking to the community health worker in a different way than they’re talking to their doctor. And the community health worker can really help solve problems the patient may be hesitant to bring up with their provider.”

For example, one patient who was managing diabetes as well as other chronic health conditions told a community health worker that she wasn’t going to her doctor appointments because there were too many of them. The community health worker can speak with the physician, look at the patient’s appointment list, and work to combine some of them — such as meeting with the pharmacist while at her doctor’s appointment.

“That additional information, when applied in a problem-solving mindset—which is the function of the community health worker—really makes a difference for both patient care and the efficiencies of the practice,” Feldstein said.

Echoes Scott Tornek, chief strategy officer for the center, “You’re getting to the root cause of [the patient’s] issue, which a lot of times is not clinical, but it creates health issues.”

Training and Integration

Feldstein detailed the training program for the newly hired community health workers. It starts with a 140-hour college accredited community health worker-training program covering everything from using your own life experience to help others to navigating the healthcare and social services systems. The new community health workers then shadow senior community health workers with several years of experience, followed by working under the close supervision of their manager before they’re certified to work independently with patients.

“We’ve worked hard to integrate our community health workers into the existing work practices of the care team,” Feldstein said. “It’s less that [the clinic staff] has had to adjust to us, and more that we’ve had to figure out the best and most seamless way to integrate the community health worker into primary care practices.”

Community health workers communicate with providers in a variety of ways, sending electronic medical messages, attending huddles, and participating in monthly case conferences.

Adapting IMPaCT from the inpatient to the outpatient setting also required some modification to the original IMPaCT model — specifically, the duration. For example, the goal of the hospital program is the safe transition from hospital to home. But in primary care, the goal is improving the patients’ chronic health conditions, which often involves changing their habits.

“And habit change takes longer than two to four weeks,” Feldstein continued. “So the goal drives the duration. That’s how we ended up with a primary care program where patients are connected to a community health worker for six months.”

The next stage, Tornek explained, is not only expansion within the University of Pennsylvania Health System, but also working in partnership with other health systems to implement IMPaCT. That includes an in-house developed application called Homebase to ensure everyone uses the same workflow and reporting measures.

The effects of the IMPaCT model in the outpatient setting are being tested by an ongoing randomized controlled trial.

“It’s a continuous improvement mindset, where we’re always learning and evolving.”