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How Community Health Workers Can Affect Health Care

ARTICLE: How Community Health Workers Can Affect Health Care

AUTHORS: Ryan Graddy and Michael Fingerhood

JOURNAL: JAMA Intern Med. 2018 Oct 22. doi:10.1001/jamainternmed.2018.4626.

Interventions that seek to improve patient health among marginalized populations by addressing the social determinants of health have received increasing emphasis in recent years. The expanding understanding that health is deeply affected by nonmedical aspects of life has stimulated the integration of community health workers (CHWs) into health care delivery. These CHWs have been variably shown to help improve patient knowledge regarding disease processes, affect behavioral change, reduce health care system costs, and improve health outcomes, although these outcomes have not been shown consistently across studies and there is great heterogeneity among these interventions.1,2

In this issue of JAMA Internal Medicine, Kangovi et al3 build on their previously published work with the IMPaCT intervention, a standardized program that applies a specific toolbox and strategy across a variety of settings. The consistency of IMPaCT is a strength that is comparable with many other interventions that have differing definitions of CHWs and heterogeneous metrics for success.

Having demonstrated improvements in health-related outcomes among inpatients and outpatients at 2 academic medical centers via IMPaCT,4,5 the current study looks at similar outpatient-focused health improvements in a greater diversity of primary care sites: academic medical center, federally qualified health center, and Veterans Affairs facility. The authors report mixed results. The primary outcome measure of self-rated physical health slightly worsened, although this was not statistically significant and no change in disease-related quality metrics was observed; the secondary outcomes of hospitalizations and patient-reported receipt of high-quality primary care improved favorably in the intervention group.

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Kelsey Bennett