Experts have long held that improvements to community health worker (CHW) programs could significantly enhance care delivery, and now new research from University of Pennsylvania's Perelman School of Medicine has modified the model for outpatient settings.
Researchers, led by Shreya Kangovi, M.D., of the Penn Center for Community Health Workers, interviewed 21 outpatients from low-income areas, all of whom were either chronically ill, uninsured or Medicaid beneficiaries, along with 30 primary practice staffers. Based on the responses, they created a manual adapting the Individualized Management for Patient Centered Targets (IMPaCT) model to outpatient settings.
Under the model, CHWs visit patients with multiple chronic morbidities to help them navigate both their daily routines and the healthcare system. They also offer support for social factors that can interfere with care delivery, such as lack of transportation or food insecurity.
Researchers said there were three major takeaways from the survey:
- Comorbidities overwhelm patients, who prefer to address one at a time. As a result, researchers created a "Goal Card" that patients with low health literacy can use to focus on one chronic condition.
- Improved healthcare behavior was more prominent among respondents than it was for patients in inpatient settings. Based on this finding, researchers amended the model to include CHWs helping patients monitor their progress on chronic disease management goals.
- While patients are already connected with primary care providers, they need more help navigating the clinic post-intervention. This finding led researchers to add weekly clinic-based support groups to the model.
"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," said senior author David Grande, M.D. "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."