Community Health Workers: From Rhetoric to Reality Shreya Kangovi, MD, MS Division of General Internal Medicine, Perelman School of Medicine Penn Center for Community Health Workers University of Pennsylvania MN CHW Alliance Workshop December 1st, 2015

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

Penn Center for CHWs Research: Design, test and refine CHW programs Direct Care: IMPaCT for 1,500 pts annually Dissemination: Tools, training, technical assistance for > 450 organizations.

Design

Lessons from History Kangovi, Grande, Trinh-Shevrin NEJM 2015 Photo Credit: Quora.com

Lessons from History Hiring Work practice Integrated Patient-centered Evidence-based Kangovi, Grande, Trinh-Shevrin NEJM 2015 Photo Credit: Quora.com

Design Map Barrier Intervention Trait Skill Patients want to be heard and do not want to feel judged CHW conducts open-ended, strengths-based interview -Nonjudgmental -Listens > talks  Qualitative Interviewing 

Recruitment

Patient-centered Set goals Support Connect

Standardized program

Integration with clinicians -CHWs communicate through EMR, telephone, huddles - IMPaCT Teaching Service

Integration with clinicians “[CHW] is symbolic of the highest standards of patient advocacy and the best our health system offers its patients.” -Nurse “I was just so grateful that people did this work. I was glad to learn how to do it better, to establish this patient dynamic.” -Student

Randomized Controlled Trial (n=446) Kangovi et al, JAMA Internal Medicine 2014.

Ongoing RCTs Single-center randomized controlled trial of 6- month IMPaCT among patients with multiple chronic conditions (n=212) Multi-center randomized controlled trial at VA, academic, community sites (n=444)

Outcomes  Sustainability Funding Status Access to primary care Provider Preventable hospitalizations Payer/Provider Patient satisfaction Student education Medical School Cost-effective workforce Practices Chronic disease control

Future directions

Penn Center for CHWs Improve health in high-risk populations through the effective use of CHWs

What does success look like

Income differences in health A Guide to Measuring the Triple Aim, IHI 2012

No income differences in health A Guide to Measuring the Triple Aim, IHI 2012

Key Questions Is this working? For whom? How can we make it better? Quality often suffers with growth: can we prevent this? How can we bring a non-medical intervention firmly into healthcare without breaking it? Can we capture an opportunity moment for CHW programs? Or will history repeat itself? How do we fix underlying problems, not just Band-Aid? What will keep our organization happy and stable?

5- year plan Mission Strategic Priorities To improve health in high- risk populations through the effective use of Community Health Workers   Understand and improve outcomes Expand high-quality care Drive clinical integration Support CHW programs across the country Advocate at local, state and national levels Build a stable organization that promotes human capital

Conclusion

Collaboration http://chw.upenn.edu/

Acknowledgements Judith A. Long, MD Tamala Carter, CHW David Grande, MD, MPA Karen Glanz, PhD, MPH Richard Shannon, MD Natalie Levkovich Sharon McCollum, CHW Joan Doyle, RN, MSN, MBA Mary White, CHW Garry Scheib, MBA Casey Chanton, MSW Phyllis Cater, BA Robyn Smith, BS Horace DeLisser, MD Raina Kulkarni, BS David Asch, MD, MBA Nandita Mitra, PhD Roy Rosin, MBA Jill Feldstein, MPA Susan Day, MD Marisa Rogers, MD Liyuan Ma, MS Josh Metlay, MD Ralph W. Muller, MA Katrina Armstrong, MD