Related Experiment Video
Updated: May 14, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Effects of a Standardized Community Health Worker Intervention on Health Care Utilization Within an Integrated
Aditi Vasan1,2,3, Molly Knowles4,5, Shaun Flerchinger6,7
1Division of General Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. vasana@chop.edu.
Background:
Community health worker (CHW) interventions can improve health outcomes and reduce acute care utilization. Few prior studies have examined the association of CHW interventions with health care utilization among patients within an integrated health system.
Objective:
To evaluate the effects of Individualized Management for Patient Centered Targets (IMPaCT), a standardized CHW intervention originally developed within a single health system in Philadelphia, PA, on acute care utilization and primary care engagement among low-income patients at two clinics within an integrated health system in Portland, Oregon.
Design:
Prospective randomized analysis using adjusted difference-in-differences regression.
Participants:
In total, 1230 adults living in low-income zip codes were randomized using a 2:1 allocation sequence to receive either IMPaCT (n = 820) or usual care (n = 410).
Interventions:
IMPaCT is a standardized intervention in which CHWs use an in-depth interview to understand patients' strengths, social needs, and health-related goals and then collaboratively develop tailored action plans. Over 3 months, CHWs communicated with patients at least once weekly to provide coaching, social support, and navigation tailored to their goals. Due to the COVID- 19 pandemic, the intervention was predominantly delivered remotely.
Main Measures:
Primary outcome measures were hospital and emergency department (ED) utilization, both measured per 1000 members per month, and proportion of patients with 1+ primary care visits. Implementation fidelity and maintenance were also assessed.
Key Results:
Compared to usual care, patients who received IMPaCT had a relative reduction in total hospital days at 6 months (- 172.3 days per 1000 members per month, 95% CI - 320.05 to - 24.53, p= 0.022), and a greater proportion attended 1+ primary care visits (85.7% vs. 79.5%, p= 0.006). There were no differences in ED utilization.
Conclusions:
A standardized CHW intervention delivered remotely within an integrated health system during the COVID- 19 pandemic was associated with decreased hospital utilization and improved primary care engagement.
Related Concept Videos
01:20Integrated Healthcare System
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...