Overview

The IMPaCT (Individualized Management of Patient-Centered Targets) model is a standardized, scalable, evidence-based Community Health Worker (CHW) intervention proven to improve chronic disease control, quality of care, mental health, and access to primary care while reducing costly hospitalizations.

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Organization Name

Penn Center for Community Health Workers (PCCHW)

Organization Type

• Academic Medical Center
• Community health center

National/Policy Context

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Local/Organizational Context

• In 2010, the same factors that were playing out on the national stage were occurring at Penn Medicine.
• The Affordable Care Act held health systems accountable for patient outcomes, such as primary care access, patient-reported quality of care, and hospital readmission. Low-income people are at highest risk by these measures.
• Therefore, it was both a patient care and financial imperative for Penn Medicine to improve outcomes for these vulnerable patients.

Patient Population Served and Payor Information

• The Penn Center for CHWs has directly served nearly 10,000 low-income patients in the Philadelphia region across all diagnoses, ages, and care settings.  
• Similarly, healthcare organizations throughout the country that have adopted the IMPaCT model apply it to high-risk patients across a range of demographic criteria.  

Leadership

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Funding

• Initial funding to develop the model came from internal University of Pennsylvania research and health care innovation grants.
• Dr. Kangovi has received over $20 million in funding to support her work in developing and testing this the IMPaCT model of care, including contracts from large academic medical centers, payers and grants from NIH and PCORI.

Research + Planning

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Tools or Products Developed

• Work practice manuals, college-accredited in-person and online training, and software to support this intervention have been developed. These are explained in detail here.

Training

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Team Members Involved

• Administrator
• Community Health Worker
• Social Worker

Workflow Steps

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Budget Details

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Where We Are

• This work began in 2010 and has continued to grow over the years since.

Outcomes

• The IMPaCT model was assessed through three clinical trials published in JAMA and the American Journal of Public Health. These trials consistently demonstrate improvement in outcomes:
  • Mental health: self-rated mental health (12-item Short Form survey)
    • Intervention (IMPaCT) patients compared to controls showed greater improvements in mental health (6.7 vs. 4.5; P = 0.02).
  • Chronic disease control: changes in HbA1c, systolic blood pressure, smoking rates, obesity rates
    • CHW support led to improvements in HbA1c (-0.4 vs. 0.0),  body mass index (-0.3 vs. -0.1), cigarettes per day (-5.5 vs -1.3), systolic blood pressure (-1.8 vs. -11.2; overall P = 0.08).
  • Access to primary care:
    • Intervention (IMPaCT) patients compared to controls were more likely to obtain timely post-hospital primary care (60.0% vs. 47.9%; P = 0.02).
  • Patient-reported quality of care: based on Consumer Assessment of Healthcare Providers and Systems
    • Intervention (IMPaCT) patients compared to controls were more likely to report the highest quality of care (OR 1.8; 95% CI 1.4-2.4; P <0.001).
  • Hospitalizations: number of hospitalizations
    • Intervention (IMPaCT) patients compared to controls were more likely to have less hospitalizations (difference, -0.3; 95% CI -0.6 to 0.0; P = 0.07) and had a lower odds of repeat hospitalizations (OR 0.4; 95% CI 0.2-0.9; P = 0.02).

Future Outcomes

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Benefits

• As shown in three clinical trials, IMPaCT improves critical outcomes including chronic disease control, quality of care, mental health, and access to primary care while reducing costly hospitalizations.

Unique Challenges

• The IMPaCT model gains efficiencies by centralized supervision and infrastructure. However, running a centralized program in a decentralized health system requires strong communication processes with individual clinical entities and health system leadership to ensure connection to both strategic objectives and local priorities.

Glossary

• Community Health Workers (CHWs): trained laypeople who are “natural helpers” hired from the communities they serve to provide health care navigation, resource connection, and social support to patients.

Sources

• Written with significant input from Shreya Kangovi and Jill Feldstein.
• Kangovi, S., Mitra, N., Norton, L., Harte, R., Zhao, X., Carter, T., Grande, D. and Long, J.A., 2018. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Internal Medicine, 178(12), 1635-1643.
• Kangovi S, Asch DA, 2018. The Community Health Worker Boom. NEJM Catalyst. Retrieved from http://catalyst.nejm.org/community-health-workers-boom/.
• Kangovi, S., Mitra, N., Grande, D., Huo, H., Smith, R.A. and Long, J.A., 2017. Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. American Journal of Public Health, 107(10),1660-1667.
• Kangovi, S., Carter, T., Charles, D., Smith, R.A., Glanz, K., Long, J.A. and Grande, D., 2016. Toward a scalable, patient-centered community health worker model: adapting the IMPaCT intervention for use in the outpatient setting. Population Health Management, 19(6), 380-388.
• Kangovi, S., Mitra, N., Grande, D., White, M.L., McCollum, S., Sellman, J., Shannon, R.P. and Long, J.A., 2014. Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Internal Medicine, 174(4) 535-543.
• Kangovi, S., Grande, D., Carter, T., Barg, F.K., Rogers, M., Glanz, K., Shannon, R. and Long, J.A., 2014, July. The use of participatory action research to design a patient-centered community health worker care transitions intervention. Healthcare 2(2); 136-144).