Outcomes of Interest

The Center is interested in CHW models that fulfill the Institute for Healthcare Improvement's (IHI's) "Triple Aim" for health delivery innovations:

  1. Improving the health of the population
  2. Enhancing the patient experience of care (including quality, access, and reliability)
  3. Reducing, or at least controlling, the per capita cost of care.

IMPaCT Results table

Results

IMPaCT™ was designed with the "Triple Aim" in mind. We wanted to improve the health and quality of experience for high-risk patients and do this in a way that reduced their dependence on hospital care.

A randomized controlled trial of 446 hospitalized patients showed that a two-week 'dose' of the IMPaCT; model significantly improved access to primary care, HCAHPS scores, patient activation, mental health and recurrent hospital readmission.

Ongoing Studies

It takes more than one experiment to build a body of evidence supporting any given model. The Center is interested in continuing to test IMPaCT's effectiveness in a variety of settings and patient groups.

  1. IMPaCT Primary Care: We are currently conducting a randomized controlled trial testing the effectiveness of a 6-month dose of IMPaCT in improving chronic disease outcomes among primary care patients with multiple chronic conditions.
  2. IMPaCT Teaching Service: Medical education currently emphasizes the treatment of illness through health care delivery in clinics or hospitals. Because of this narrow focus, medical students are inadequately trained to understand social and systemic determinants that shape the health of populations. To address this gap, the Center partnered with the Perelman School of Medicine to create a medical student course called the IMPaCT Teaching Service.

    We are currently conducting a formative evaluation that will also explore the effect of the IMPaCT teaching service on medical students' social psychology constructs --attribution error, cultural awareness and empowerment— that are fundamental to a population health education for medical students.

Publications

  1. Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA.Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial. Am J Public Health. 2017 Aug. DOI: 10.2105/AJPH.2017.303985. Pubmed PMID: 28817334.
  2. Kangovi S, Mitra N, Smith RA, Kulkarni R, Turr L, Huo H, Glanz K, Grande D, Long JA. Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial. Patient Educ Couns. 2016 Sep 25. pii: S0738-3991(16)30447-5. doi: 10.1016/j.pec.2016.09.019. [Epub ahead of print] PubMed PMID: 27717532.
  3. Morgan AU, Grande DT, Carter T, Long JA, Kangovi S. Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center. Am J Public Health. 2016 Nov;106(11):1958-1960. PubMed PMID: 27631747.
  4. Kangovi S, Carter T, Charles D, Smith RA, Glanz K, Long JA, Grande D. Toward A Scalable, Patient-Centered Community Health Worker Model: Adapting the IMPaCT Intervention for Use in the Outpatient Setting. Popul Health Manag. 2016 Mar 23. [Epub ahead of print] PubMed PMID: 27007164.
  5. Kangovi S, Grande D, Carter T, Barg FK, Rogers M, Glanz K, Shannon R, Long JA. The use of participatory action research to design a patient-centered community health worker care transitions intervention. Healthc (Amst). 2014 Jul;2(2):136-44. doi: 10.1016/j.hjdsi.2014.02.001. PubMed PMID: 26250382.
  6. Brown EJ, Kangovi S, Sha C, Johnson S, Chanton C, Carter T, Grande DT. Exploring the Patient and Staff Experience With the Process of Primary Care. Ann Fam Med. 2015 Jul-Aug;13(4):347-53. doi: 10.1370/afm.1808. PubMed PMID: 26195680; PubMed Central PMCID: PMC4508176.
  7. Kangovi S, Grande D, Trinh-Shevrin C. From rhetoric to reality--community health workers in post-reform U.S. health care. N Engl J Med. 2015 Jun 11;372(24):2277-9. doi: 10.1056/NEJMp1502569. PubMed PMID: 26061832; PubMed Central PMCID: PMC4689134.
  8. Kangovi S, Kellom K, Sha C, Johnson S, Chanton C, Carter T, Long JA, Grande D. Perceptions of high-risk patients and their providers on the patient-centered medical home. J Ambul Care Manage. 2015 Apr-Jun;38(2):134-43. doi: 10.1097/JAC.0000000000000060. PubMed PMID: 25748262.
  9. Reilly JB, Bennett N, Fosnocht K, Williams K, Kangovi S, Jackson R, Ende J. Redesigning rounds: towards a more purposeful approach to inpatient teaching and learning. Acad Med. 2015 Apr;90(4):450-3. doi: 10.1097/ACM.0000000000000579. PubMed PMID: 25426739.
  10. Kangovi S, Levy K, Barg FK, Carter T, Long JA, Grande D. Perspectives of older adults of low socioeconomic status on the post-hospital transition. J Health Care Poor Underserved. 2014 May;25(2):746-56. doi: 10.1353/hpu.2014.0111. PubMed PMID: 24858883.
  11. Kangovi,S., Mitra, N.; Grande, D.; White, M.; McCollum, S.; Sellman, J.; Shannon, R.; Long, J.A. A randomized controlled trial of a patient-centered community health worker intervention to improve post-hospital outcomes. JAMA Internal Medicine. February 10th, 2014.
  12. Kangovi, S. Grande,D., Carter, T., Barg F., Rogers M. Glanz, K. Shannon, R. Long, J.A. The use of participatory action research to design a patient-centered community health worker care transitions intervention. Healthcare. 26 February 2014.
  13. Kangovi S., Mukherjee J., Bohmer R., Fitzmaurice G.: A classification and meta-analysis of community-based directly observed therapy programs for tuberculosis treatment in developing countries. Journal of Community Health 34(6): 506-13, Dec 2009.
  14. Kangovi S., Grande D.: Hospital readmissions--not just a measure of quality. JAMA : The Journal of the American Medical Association 306(16): 1796-7, Oct 2011.
  15. Long JA, Jahnle EC, Richardson DM, Loewenstein G, Volpp KG: Peer mentoring and financial incentive to improve glucose control in African American Veterans: A randomized controlled trial. Annals of Internal Medicine 156(6): 416-424, March 2012.
  16. Kangovi S., Grande D., Meehan P., Mitra N., Shannon R., Long J.A.: Perceptions of readmitted patients on the transition from hospital to home. Journal of Hospital Medicine August 2012.
  17. Kangovi S., Long J.A., Emanuel, E.: Community health workers combat readmission. Archives of Internal Medicine Page: 1-2, Nov 5 2012.
  18. Yehia B., Kangovi S., Frank I.: Patients in transition: avoiding detours on the road to HIV treatment success. AIDS Feb 21 2013
  19. Kangovi S, Barg FK, Carter T, Long JA, Shannon R, Grande D. Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff (Millwood). Jul 2013;32(7):1196-1203.
  20. Kangovi S, Barg FK, Carter T, et al. Challenges Faced by Patients with Low Socioeconomic Status During the Post-Hospital Transition. J Gen Intern Med. Aug 6 2013
  21. Kangovi, S.; Grande, D.: Transitional Care Management Reimbursement To Reduce Chronic Obstructive Pulmonary Disease Readmission. Chest 2013.
  22. Yano EM, Green LW, Glanz K, Ayanian JZ, Mittman BS, Chollette V, Rubenstein LV. Implementation and spread of interventions into the multilevel context of routine practice and policy: Implications for the cancer care continuum. Journal of the National Cancer Institute Monographs, 44: 86-99, 2012.
  23. Dunlop AL, Leroy ZC, Logue KM, Glanz K, Dunlop BW. Preconsent education about research processes improved African Americans’ willingness to participate in clinical research. Journal of Clinical Epidemiology, 2011, 64: 872-877.
  24. Oldenburg B, Glanz K, Ffrench M. The application of staging models to the understanding of health behavior change and the promotion of health. Psychology and Health, 14:503-516, 1999.
  25. Glanz, K. Rimer, B., Viswanath, K. Health Behavior and Health Education: Theory, Research, and Practice. 4th Ed. September 2, 2008 | ISBN-10: 0787996149.
  26. Rashid JR, Spengler RF, Wagner RM, Melanson C, Skillen EL, Mays RA Jr, Heurtin-Roberts S, Long JA. Eliminating health disparities through transdisciplinary research, cross-agency collaboration, and publicparticipation. Am J Public Health. 2009 Nov;99(11):1955-61. doi: 10.2105/AJPH.2009.167932.
  27. Hutchinson RN, Putt MA, Dean LT, Long JA, Montagnet CA, Armstrong K. Neighborhood racial composition, social capital and black all-cause mortality in Philadelphia. Soc Sci Med. 2009 May;68(10):1859-65. doi: 10.1016/j.socscimed.2009.02.005. Epub 2009 Mar 25.
  28. Grande D, Barg FK, Johnson S, Cannuscio CC. Life disruptions for midlife and older adults with high out-of-pocket health expenditures. Ann Fam Med. 2013 Jan-Feb;11(1):37-42.
  29. Armstrong K, Putt M, Halbert CH, Grande D, Schwartz JS, Liao K, Marcus N, Demeter MB, Shea JA. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care. 2013 Feb;51(2):144-50. doi: 10.1097/MLR.0b013e31827310a1.
  30. Polsky D, Grande D. The burden of health care costs for working families--implications for reform. N Engl J Med. 2009 Jul 30;361(5):437-9. doi: 10.1056/NEJMp0905297
Image of newspapers

Press

The key to transforming healthcare lies in part in establishing a systematic program like the one at the University of Pennsylvania, one that clearly delineates the functions of the workers and has a structured way of deploying and supervising them. The program needs this structure and focus in order to produce both financial and health returns for the medical side of the equation—the practice and health system—as well as health and psychosocial improvements for the patient side.
  1. "Hospitals reach out to keep patients from returning." Christina Hernandez Sherwood, The Philadelphia Inquirer, December 28, 2011
  2. "This week: Health care reform in 2012." Interview with Gregory Warner, Marketplace Money, Friday, January 6, 2012
  3. "Rethinking hospital readmissions." Gregory Warner, Marketplace for Tuesday, February 7, 2012
  4. Video: Investing in People - The RWJF Scholars, Fellows and Leadership Programs http://rwjcsp.unc.edu/
  5. "Sick and mired." Samantha Melamed, City Paper, August 30, 2012
  6. NBC 10 Philadelphia Video Featurette: "Home Care Teams Help Hospital Patients." Jacqueline London , NBC10.com, April 12, 2013
  7. Penn Medicine News Release "Penn Medicine Study Sheds Light on Why Low-Income Patients Prefer Hospital Care to a Doctor's Office: Health Reform Initiatives Need to Improve Perceived Quality, Cost and Accessibility of Primary Care to Reduce Low Value Care." July 8, 2013
  8. Washington Post article via Kaiser Health News "Researchers Look at Why Poor Patients Prefer Hospital Care." Ankita Rao, July 8, 2013
  9. U.S. News & World Report article via HealthDay "Cost, Quality, Accessibility Spur Poor to Choose ER Care." Robert Preidt, July, 8, 2013 [also appeared in: Health Magazine, Intramed, Medline Plus]
  10. WHYY Radio Article "Why Some Philly Patients Prefer the ER." Elana Gordon, July 9, 2013
  11. WHYY Radio Audio Segment
  12. Courier-Journal "Running to the ER: Study sheds light on why poorer people head to hospitals." Robert Preidt, July 10, 2013
  13. Modern Healthcare article #1 (registration required) "Reform Update: Low-income patients prefer hospitals for primary care."
  14. Modern Healthcare article #2 (registration required) "Reform Update: HHS rule allows hospitals to bill state for some presumed-eligible Medicaid patients."
  15. Health Affairs Blog, "New Health Affairs Issue Examines The States And Medicaid Expansion." Chris Fleming, July 8, 2013
  16. Medicaldaily.com article #1 "Low-Income Patients Opt For Emergency Care, Perceiving It As More Affordable And Accessible, But Are They Right?" Anoopa Singh, July 8, 2013
  17. Medicaldaily.com article #2 "Poor Americans Explain Why They Prefer 'One-Stop Shop' ERs Instead Of Doctors' Offices When They Fall Ill." Anthony Rivas, July 9, 2013
  18. KPCC-FM Article Southern California Public Radio, "Study delves into why low-income patients prefer the emergency room to primary care." José Martinez, July 9th, 2013
  19. Fierce Healthcare "Why poorer patients prefer hospital care." Ashley Gold, July 9, 2013
  20. The Advisory Board Company "Why Low-Income Patients Prefer The Hospital." July 10, 2013
  21. Everyday Health, "All Helmets Provide Equal Concussion Protection." July 15, 2013
  22. The Institute for Policy Innovation, "IPI Policy Bytes: Another ObamaCare Assumption Bites The Dust.." Dr. Merrill Matthews, July 23, 2013
  23. The Doctor's Lounge, "Low-Income Patients Prefer Hospital To Outpatient Care." [also appeared in: Health Day]
  24. IPolitics, "Health Week: Command And Control." Wayne Kondro, July 18, 2013
  25. Kaiser Health News, "One Woman Fails To Get Hospital Estimate Of Baby Delivery Bill." July 9, 2013
  26. MedPage Today, "Poor See ED Care As Better." David Pittman, July 11, 2013 [also appeared in: Everyday Health]
  27. Medscape News Today, "Why Low-Income Patients Prefer EDs To Physicians' Offices." Leigh Page, July 11, 2013
  28. Modern Healthcare, "Reform Update: Low-Income Patients Prefer Hospitals For Primary Care." Andis Robeznieks, July 8, 2013
  29. News Medical, " Study Reveals That Low-Income Patients Use Hospital Care More Often Than Primary Care." July 9, 2013
  30. Philly.Com, "New Answers On ER And The Poor." Curtis Skinner, July 18, 2013
  31. The Post And Courier, "The Allure Of Emergency Rooms." July 15, 2013
  32. USA Today, "Low-Income Patients Turn To Hospitals Because They Think Treatment Is Better." Fatimah Waseem, July 17, 2013. [also appeared in: Delaware Online]
Leonard Davis Institute


CHIPS

Funding Sources

  • University of Pennsylvania Health System
  • Penn Medicine Center for Health Care Innovation
  • Penn Center for Health Improvement and Patient Safety
  • Leonard Davis Institute of Health Economics
  • Penn Clinical and Translational Science Community-Based Research Grant
  • Penn Center for Therapeutic Effectiveness Research
  • Eisenberg Scholar Research Award
  • Penn Department of Medicine
  • Penn Presbyterian Department of Medicine
  • Penn Armstrong Founders Award
  • Bach Fund