Community Health Workers Making a Difference in Philadelphia, PA
Innovative IMPaCT program improves health outcomes for high-risk patients from low-income communities.
A hospital stay is a stressful, challenging experience. But for many patients – especially those with limited resources – the greatest challenge is staying healthy after being discharged. Predictably, it can be difficult to maintain one’s health in the face of housing or food insecurity, or lack of medical insurance, to name but a few problems common in poverty-stricken neighborhoods.
But at the Hospital of the University of Pennsylvania, patients of low socioeconomic status (SES) are offered assistance by a team of Community Health Workers (CHWs), trained laypeople from surrounding communities who work with patients – in and out of the hospital – to help set and achieve goals for recovery. Unlike physicians and nurses, CHWs don’t provide medical advice or deliver treatment; instead, they offer emotional support and act as a liaison between the patient and traditional health-care personnel, who, despite their best intentions, may not have the time, skills or connections to address the root causes of illness in the same way as someone from within the community.
The Role of a Community Health Worker
Senior Community Health Worker Sharon McCollum has those skills and contacts in spades. A resident of southwest Philadelphia for more than two decades, McCollum is recognized as a leader in her community, and revered among co-workers for her ability to connect with people.
“Anyone who comes into the hospital with physical or mental issues is going to have a wall up. But we [CHWs] are not judgmental. We treat people with the utmost respect – like they are family,” McCollum says, before noting that she has “a lot of family and friends who have gone through life issues similar to those of the patients I see.”
Emotional support aside, one of a CHW’s primary goals is to connect patients with a primary care physician. “Sometimes you say ‘PCP’ and they say, ‘Huh?’ I tell them: ‘The ER is not your doctor. You need a regular physician,’” she continues, mindful of the need to keep patients out of the hospital. McCollum assists with everything from dropping off prescriptions to filling out insurance forms, then follows up with patients after they are discharged, typically visiting them at home or accompanying them to a doctor’s appointment.
One recent week McCollum counseled Nathana Simpkins, 30, who was going through withdrawal and also suffering from depression in the wake of a recent job loss, necessitating a week-long hospital stay. “I would call or text Sharon anytime I felt down or just wanted to talk,” says Simpkins, who also answers to ‘Butter,’ a high-school nickname born of a silky smooth three-point shot. Meanwhile, McCollum assisted Simpkins with her résumé, job applications and housing concerns – the kind of issues that can seem overwhelming to a recovering patient.
Making an IMPaCT
Penn’s CHW program (named IMPaCT, for Individualized Management for Patient-Centered Targets) got its start four years ago in a randomized clinical trial that sought to determine whether CHW intervention would improve post-hospital outcomes among low-SES patients. Results indicated that intervention patients were more likely to obtain post-hospital primary care and less likely to have multiple readmissions to the hospital, among other benefits.
The evidence-based outcomes prompted the University of Pennsylvania Health System “to adopt IMPaCT as routine care for its high-risk patients and create the Penn Center for Community Health Workers, not only to support IMPaCT within Penn, but to help disseminate the model to other health-care systems around the country,” says the trial’s lead author Dr. Shreya Kangovi, assistant professor of Medicine at the Perelman School of Medicine and director of the center. As a result, Penn plans to hire 17 additional CHWs by January 2015, bringing the total to 24.
The people in the served communities certainly appreciate the assistance that CHWs provide. “I see my patients at the market, at the Laundromat or at the movies, and afterwards they are so happy. No matter what their struggle, we helped them in some way,” reports McCollum, adding that Simpkins’ mother was especially “thankful that assistance was available, because she was drained from trying to get help for her daughter.”
Hospital staffers have noticed the positive impact as well, thanks in part to the fact that CHWs round with the inpatient team and provide updates on previously discharged individuals. “The residents, physicians and nurses are thrilled to be able to reach beyond the hospital walls and make sure their patients are doing okay,” Dr. Kangovi adds.
The updates are particularly relevant in light of the decline in multiple hospital readmissions. “It feels good when [a doctor or nurse] stops me in the hallway and asks about a patient they used to see once a month but haven’t seen in a year. They say, ‘Ever since she hooked up with Sharon, we don’t see her no more,’” McCollum says with a laugh.
Simpkins can attest to McCollum’s influence. “If Sharon wasn’t involved, I probably would have got up and left the hospital,” she admits. “I don’t think I would have been able to stick it out.”