When One Peer Goes a Long Way

Guidance by peers from communities in Philadelphia helped improve medical outcomes of post-discharged patients from the same low-income neighborhood, according to a recent Penn study.

Executive Director of Penn’s Center for Community Health Workers Shreya Kangovi helped develop Individualized Management for Patient Center Targets , abbreviated IMPaCT, in order to help patients after they are discharged from a hospital.

The recent study on IMPaCT, which was co-authored by Judith Long and David Grande , assistant professors at the Perelman School of Medicine, showed that patients who received even a brief dose of IMPaCT intervention improved in regards to a number of factors. Some improvements patients experienced included being more active in caring for their own health, as well as better access to health care, decreased chances of returning to the hospital and better mental health.

“[Sixty percent] of people who had primary care at 14 days into the intervention ... felt that the discharge communication process had gone well,” Long said. “The 30 day readmission rate was about the same but less people came back multiple times ... [so] we definitely decreased some of the repeat admission.”

Patients given the intervention were interviewed about the process and expressed overall positive views, some of which are available on the Center’s website.

“The program was wonderful. My IMPaCT Partner went out of his way to help with things that were above and beyond. He helped me to get insurance and doctor’s appointments. He became a friend and was very helpful,” one 46-year-old patient who received care through IMPaCT said, according to the Center’s website.

Kangovi said that because the model worked well, Penn’s health system has created the Penn Center for Community Health Workers to employ community health workers - “ people who share life experience with their patients ... [and] come from similar backgrounds” - as paid employees. She added that the model has become a routine part of care at Penn Medicine.

“We’re getting a lot of interest from other organizations across the country like Lancaster Hospital,” Kangovi said. “We want to share what we’ve done and make it an open resource.”

Long explained that hospitals like the Hospital of the University of Pennsylvania care about patient outcomes because they are penalized when patients are rehospitalized within 30 days, and that the health system has really gotten behind the new model.

As part of the model, community health workers connect with patients to talk about barriers they believe are preventing the patients from getting healthy and help to ensure their improvement. The model was developed based on 4,000 surveys and 115 in-depth interviews with patients to assess what they believed was causing the poor health outcomes for those in their neighborhoods and what could be done to improve this situation.

“It’s exciting work - how to use peers effectively in clinical scenarios and make them real partners,” Long said . “It’s about trying to make people culturally competent and I find [that the community health workers are] inherently culturally competent because they are peers, people with the same diseases who live in the same communities.”

Five main issues had to be addressed in designing IMPaCT: improving how to recruit and hire high quality workers, mediating workers’ responsibilities in regards to IMPaCT with their other responsibilities, plugging the community workers into the actual health care system, making the model less disease specific and rigorously testing the model to be implemented.

“We developed clear guidelines for how to recruit high quality workers - like those who listen more than they talk because that’s something patients valued,” Kangovi said. “Now the community health workers are embedded in patient teams and patient care practices so they work closely with the front line.”

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