{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:44:25Z","timestamp":1780980265674,"version":"3.54.1"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["DI\u20102018C2\u201013000"],"award-info":[{"award-number":["DI\u20102018C2\u201013000"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Effectively implemented community health worker (CHW) programs improve patient health outcomes and quality of care, reduce health care costs, and are a key strategy for addressing social and structural drivers of health.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>As policymakers consider funding mechanisms for CHW programs, it is crucial to tie funding to evidence\u2010based best practices while also allowing for innovation and context\u2010specific adaptations.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Community health worker (CHW) programs represent a key strategy for addressing social and structural drivers of health and have the potential to improve patient health outcomes and enhance quality of care while reducing health care costs. However, challenges such as high staff turnover, lack of program infrastructure, and inadequate CHW support and supervision can hinder implementation and sustainment of effective CHW programs. Furthermore, few CHW programs have been successfully scaled across multiple organizations and communities. Individualized Management for Person\u2010Centered Targets (IMPaCT) is an evidence\u2010based CHW model designed to address these challenges by standardizing processes for CHW hiring, training, support, and supervision while still allowing for context\u2010specific adaptation and tailoring. In this dissemination and implementation project, we evaluated implementation of IMPaCT across five geographically and structurally distinct sites serving diverse and varied patient populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Model fidelity was assessed across seven best practice domains via structured virtual observations with CHWs, supervisors, and program directors at each implementation site. Acute care use was evaluated using difference\u2010in\u2010differences regression modeling for patients enrolled in IMPaCT compared with a propensity score\u2010matched control group. All implementation sites examined total hospital days per patient, and several sites chose to incorporate additional measures of acute care use such as the number of hospitalizations and emergency department visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>We found that core program components were implemented consistently across sites, and three of five sites were able to both sustain implementation over a three\u2010year period and demonstrate significant reductions in acute care use, consistent with previous randomized controlled trials of this program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Health systems may be able to address social drivers of health and improve population health for patients who are low\u2010income and patients of color by implementing evidence\u2010based CHW programs with fidelity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70011","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T13:52:08Z","timestamp":1744811528000},"page":"513-527","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Scaling an Evidence\u2010Based Community Health Worker Program With Fidelity: Results and Lessons Learned"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6521-5326","authenticated-orcid":false,"given":"MOLLY","family":"KNOWLES","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine University of Pennsylvania"},{"name":"Penn Center for Community Health Workers University of Pennsylvania Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ADITI","family":"VASAN","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics University of Pennsylvania Perelman School of Medicine University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZIWEI","family":"PAN","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JUDITH A.","family":"LONG","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine University of Pennsylvania"},{"name":"Leonard Davis Institute of Health Economics University of Pennsylvania"},{"name":"Center for Health Equity Research and Promotion Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SHREYA","family":"KANGOVI","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine University of Pennsylvania Perelman School of Medicine University of Pennsylvania"},{"name":"IMPaCT Care"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Support for community health workers to increase health access and to reduce health inequities.American Public Health Association. November 10 2009. Accessed September 2 2022.apha.org\/policies\u2010and\u2010advocacy\/public\u2010health\u2010policy\u2010statements\/policy\u2010database\/2014\/07\/09\/14\/19\/support\u2010for\u2010community\u2010health\u2010workers\u2010to\u2010increase\u2010health\u2010access\u2010and\u2010to\u2010reduce\u2010health\u2010inequities"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-56375-2_2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.303985"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302987"},{"key":"e_1_2_9_7_1","unstructured":"Heart disease and stroke prevention: interventions engaging community health workers.The Community Preventive Services Task Force (CPSTF). Updated December 22 2021. 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An overview of current evidence with recommendations for strengthening community health worker programs to accelerate progress in achieving the health\u2010related millennium development goals.Baltimore Johns Hopkins Bloomberg School of Public Health. September 2012. Accessed September 2 2022.chwcentral.org\/wp\u2010content\/uploads\/2013\/07\/How\u2010effective\u2010are\u2010community\u2010health\u2010workers\u2010Johns\u2010Hopkins\u2010University_0.pdf"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2014.02.001"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2015.0157"},{"key":"e_1_2_9_25_1","unstructured":"Centers for Medicare & Medicaid Services.Medicare and Medicaid programs; CY 2024 payment policies under the physician fee schedule and other changes to part B payment and coverage policies; Medicare Shared Savings Program requirements; Medicare Advantage; Medicare and Medicaid provider and supplier enrollment policies; and basic health program.Fed Regist. November 16 2023. Accessed January 2 2024.federalregister.gov\/d\/2023\u201024184"},{"key":"e_1_2_9_26_1","unstructured":"GyurinaC VictorianoL.Environmental scan on community health workers: a 50\u2010state scan of Medicaid reimbursement approaches for the CHW workforce.UMass Chan Medical School. January 2024. 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