Effects of a Standardized Community Health Worker Intervention on Health Care Utilization Within an Integrated Delivery System.

Abstract

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. 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. Prospective randomized analysis using adjusted difference-in-differences regression. 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). 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. 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. 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. 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.