Scaling an Evidence-Based Community Health Worker Program With Fidelity: Results and Lessons Learned

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Community health worker (CHW) programs are vital for addressing social determinants of health, improving patient outcomes, and reducing costs.
• Challenges like high turnover and inadequate infrastructure hinder CHW program effectiveness and scalability.
• The Individualized Management for Person-Centered Targets (IMPaCT) model standardizes CHW processes while allowing for adaptation.

Purpose of the Study:

• To evaluate the implementation and impact of the IMPaCT CHW model across five diverse sites.
• To assess model fidelity, sustainability, and effects on acute care utilization.

Main Methods:

• Model fidelity assessed via virtual observations across seven best practice domains.
• Acute care use evaluated using difference-in-differences regression with propensity score matching.
• Measures included total hospital days, hospitalizations, and emergency department visits.

Main Results:

• Core IMPaCT program components were implemented consistently across all sites.
• Three of five sites sustained implementation over three years.
• Significant reductions in acute care use were observed, aligning with prior trials.

Conclusions:

• Evidence-based CHW programs, like IMPaCT, can be effectively implemented to address social drivers of health.
• Fidelity in implementation is key for improving population health, particularly for low-income patients and patients of color.