Primary Submission Category: Interventions/Programs
Implementation and impact of an adult Community Health Worker program at a large public hospital system in New York City
Authors: Lorraine Kwok, Renata Howland, Dawn Walter, Rachel Massar, Kayla M. Fennelly, Arya Singh, Michelle Chau, Jennifer Zanowiak, Jenna Lupi, Yuan Jin Tan, Jenifer Clapp, John Billings, Alessandra Calvo-Friedman, Nichola J. Davis, Nadia Islam, Carolyn A. Berry,
Presenting Author: Lorraine Kwok*
Increasingly, primary care clinics are using Community Health Workers (CHWs) as a promising approach to reduce barriers to health, address social needs, and improve engagement in care. New York City Health + Hospitals (NYC H+H), the nation’s largest public hospital system, established a CHW program across 17 adult primary care clinics to support participants with their health goals, social needs, and clinical navigation. We conducted a mixed methods evaluation of the program, including: 1) 59 key informant interviews with healthcare providers, clinic staff, and program leadership to identify implementation facilitators and barriers; 2) 274 pre/post participant surveys to assess domains including self-reported health, healthcare and medication management self-efficacy, social needs, and program satisfaction; 3) 19 interviews with a subset of participants to explore their experience with the program; and 4) pre- and post-enrollment examination of utilization, A1C levels, and blood pressure values using electronic health data for 3568 participants enrolled from 1/2022 to 6/2023. Interviews revealed effective program implementation with some variability due to individual clinic conditions. Participants reported improvement in self-reported health and medication management self-efficacy as well as positive experiences with the clinic and CHW program. Quantitative analysis showed significant post-enrollment decreases in the proportion of participants with any emergency department visit (-6.1%, p<0.01) and any inpatient visit (-4.9%, p<0.01). We also found decreases in the proportion of participants with uncontrolled diabetes (-9.0%, p<0.01) and uncontrolled hypertension (-7.0%, p<0.01). Understanding the implementation and impact of an Adult CHW program at a hospital system such as NYC H+H will inform the development and scale-up of similar interventions.