Nav: Home

Penn study adapts proven community health worker model for outpatient setting

March 24, 2016

PHILADELPHIA -- Penn's Innovative Community Health Worker (CHW) model, shown to reduce admissions and lead to better health outcomes for hospitalized patients, can now be used in outpatient settings, according to a study from researchers at the Perelman School of Medicine in the journal Population Health Management.

In the Individualized Management for Patient-Centered Targets, or IMPaCT™ model, CHWs visit patients facing multiple chronic conditions and help in navigating the health care system and carrying out daily activities. CHWs come from low-income communities and provide social support to address the real-life issues - hunger, homelessness, transportation barriers, etc. - that make it hard to stay healthy.

In the current study, lead author Shreya Kangovi, MD, MS, an assistant professor of Medicine and executive director of the Penn Center for Community Health Workers, and senior author David Grande, MD, MPA, an assistant professor of Medicine, and Penn colleagues, including IMPaCT community health workers, conducted qualitative in-depth interviews with 21 chronically ill, uninsured, or Medicaid outpatients from low-income zip codes as well as 30 members of their primary care practice staff. Using the responses to these interviews, the researchers created an outpatient manual to administer IMPaCT outside of the hospital setting, hired additional staff, and are working with seven primary care facilities in Philadelphia to implement IMPaCT on their premises, including the Corporal Michael J. Crescenz VA Medical Center and a federally qualified health center.

IMPaCT has been adopted by the University of Pennsylvania Health System as part of routine care for over 5,000 patients. Recruitment, training, care, and integration systems within the program were established with input from hundreds of patient interviews to address challenges routinely faced.

"IMPaCT has been successfully used for several years throughout the Penn health system," said Kangovi. "We've seen several positive results, including reduced readmission rates and better health outcomes. We wanted to introduce new patients who had not yet been hospitalized to the model, so our study is helping us adapt it to the outpatient setting."

Under the IMPaCT approach, neighborhood residents are recruited and trained as community health workers. The workers join patients and their providers to set achievable health goals. They next help patients to create tailored plans and support patients in achieving those goals. Activities could include exercising with patients at the local YMCA, helping to coordinate doctor's appointments, and providing emotional support through a difficult time. The community health workers then link patients with a long-term source of support -like stable primary care or a support group that the CHWs facilitate--in order to maintain their health gains and prevent future problems.

The Penn researchers identified three themes that helped them adapt the original IMPaCT model for the outpatient setting.

First, outpatients were overwhelmed by their multiple health conditions and wanted to concentrate on one at a time. To address this finding, design mapping was used to create a low-literacy decision aid called the Goal Card, which allows patients to select one of their chronic conditions to focus on. Second, motivation for health behavior change was a more prominent theme than in the hospital-based version. It was therefore decided that in addition to providing tailored social support as in the original approach, community health workers would help patients track progress toward their chronic disease management goals to motivate health behavior change. Third, patients were already connected to primary care; yet they still needed additional support to navigate their clinic once the intervention ended. The intervention was revised to include a weekly clinic-based support group.

"Our findings are relevant to the growing interest in community health worker programs across the United States," said Grande, who is also a senior fellow in the Leonard Davis Institute of Health Economics at Penn. "But many payers and provider organizations are tempted to use a trial-and-error approach. This results in a lot of reinventing the wheel, which is costly, time-consuming, and leaves programs open to making common mistakes. And many of these efforts lack formal evaluation. On the other hand, we know that one size doesn't always fit all, so we didn't want to be too rigid about fidelity without allowing for adaptation and tailoring. Our study describes a way to balance fidelity and fit."

The center is using the methodology described in this paper to adapt the IMPaCT model for use in new health systems and geographic settings as part of its new Partnership Program. This program helps partner organizations to adapt IMPaCT manuals to suit the needs of local populations, and then provides turn-key support for program launch, including hiring, training, documentation, clinical integration and evaluation.

In addition to Kangovi and Grande, other Penn co-authors are Tamala Carter, CHW; Dorothy Charles, BA; Robyn A. Smith, BA; Karen Glanz PhD, MPH; and Judith A. Long, MD.
-end-


University of Pennsylvania School of Medicine

Related Primary Care Articles:

The need to reinvent primary care
Primary care is 'first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease, or organ system.' High-quality primary care has been associated with improved population health, lower costs, and greater equity.
Affordable Care Act boosted primary care access for Medicaid patients
Since the introduction of the Affordable Care Act, which provided access to health insurance to millions of previously uninsured adults in the United States, the availability of appointments with primary care physicians has improved for patients with Medicaid and remains unchanged for patients with private coverage, according to new research.
Gauging ACA's effect on primary care access
A new research letter published online by JAMA Internal Medicine assessed the Affordable Care Act's effect on primary care access because millions of uninsured adults have gotten health insurance since major coverage provisions were implemented.
What primary care providers should know about diabetic neuropathy
Researchers at Michigan Medicine led a group of internationally recognized endocrinologists and neurologists from both sides of the Atlantic and teamed up with the American Diabetes Association to craft a new position statement on the prevention, treatment and management of diabetic neuropathy.
Most primary care doctors 'strongly endorse' key elements of the Affordable Care Act
Proponents of repealing the Affordable Care Act, including President Donald Trump's nominee for Secretary of Health and Human Services, Tom Price, have argued that the law places an undue burden on physicians.
Primary care physician involvement at end of life associated with less costly, less intensive care
A new study published in the January/February issue of Annals of Family Medicine finds that primary care physician involvement at the end of life is associated with less costly and less intensive end-of-life care.
Patients not attached to new primary care practices receive lower quality care
One in six patients in Ontario does not belong to an organized primary care practice, new research suggests.
Having primary care physician may not be enough to reduce ED visits by vulnerable groups
Having a regular family physician may not be enough to reduce emergency department visits among patients with disabilities, a small study published in Canadian Family Physician suggests.
Primary care physicians primed to help patients be more active
Exercise plays a crucial role in being healthy and preventing disease.
Primary care is point of entry for many kids with concussions
Many children with concussion initially sought care through primary care and not the emergency department, although younger children and those insured by Medicaid were more likely to go to the ED, according to an article published online by JAMA Pediatrics.

Related Primary Care Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...