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Managing Multiple Chronic Conditions with a Community Health Worker Intervention

An Evidence-Based Practice

Description

Patients who resided in high-poverty zip codes, were uninsured or publicly insured, and who had a diagnosis for 2 or more chronic diseases were recruited to join a randomized control trial from 3 primary care facilities in Philadelphia, PA. Participants were randomized to either the Community Health Worker (CHW) intervention or the control arm (goal setting only). Follow-up assessments were conducted at 6 and 9 months after enrollment.

Goal / Mission

To assess whether an Individualized Management for Patient-Centered Targets (IMPaCT), delivered by community health workers improved patients' chronic disease management and self-rated physical and mental health.

Impact

Individuals with multiple chronic conditions when paired with a community health worker will perceive that their care is higher quality and may have fewer hospitalizations.

Results / Accomplishments

Patients in the CHW group were more likely to report the higher quality of care and spent fewer total days in the hospital at 6 months and 9 months. Among patients who were hospitalized, individuals experienced lower number of hospitalizations and shorter lengths of stay. Lastly, patients who were paired with a CHW had a lower odds of repeat hospitalizations, including 30-day readmissions.

About this Promising Practice

Organization(s)
Penn Center for Community Health Workers
Primary Contact
Penn Center for Community Health Workers, Penn Medicine, Philadelphia, Pennsylvania
215-662-8624
Vera.Jahnle@PennMedicine.upenn.edu
https://chw.upenn.edu/contact/
Topics
Health / Health Care Access & Quality
Organization(s)
Penn Center for Community Health Workers
Date of implementation
2015
Location
Philadelphia, PA
For more details
Target Audience
Older Adults
Nevada Tomorrow