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The following is a summary of the study titled “Implementing and Monitoring High-Quality Community Health Worker Care in Adult Primary Care at New York City Health + Hospitals,” published in the September 2024 issue of Primary Care by Clapp et al.
Community Health Worker (CHW) programs are increasingly being recognized for their potential to enhance primary care by addressing social determinants of health and improving patient engagement. For a study, researchers analyzed how the New York City Health + Hospitals (NYC H + H) system implemented a large-scale CHW program and established metrics to evaluate its effectiveness.
From January 2022 to December 2023, NYC H + H launched a comprehensive CHW program across its adult primary care clinics. The program’s goals included expanding patient outreach, improving engagement, and addressing specific health and social needs through structured CHW interventions. Metrics were derived from standard data collected through CHW documentation in electronic health records during the program. SQL queries and R scripts were used to clean the data. Metrics were established in several key areas: workforce demographics, team structure and training, enrolled patient demographics, and patient-centered outcomes such as engagement and goal achievement.
By June 2023, the program employed 97 CHWs and 22 CHW supervisors across 17 healthcare sites. The average ratio was 4.6 CHWs per supervisor, with variation ranging from 1:1 to 1:6 depending on the facility. Compared to the overall patient population at NYC H + H, the CHW program served a higher proportion of African American/Black patients (40% vs. 32%) and a notably older patient demographic (35% older than 65 vs. 21% older than 65).
During the study period, CHWs outreached 13,812 patients. Of these, 9,069 (66%) were referred by clinicians, 7,331 (53%) were enrolled in the program, and 5,044 (37%) successfully graduated. The median number of goals identified by patients was four, with a median of three goals completed with the assistance of a CHW. The top goals addressed included increasing engagement with primary care (47%), specialty care (46%), and tackling food insecurity (45%).
The study highlighted that establishing clear implementation and process metrics is crucial for the success of CHW programs. By monitoring these metrics, NYC H + H was able to ensure that CHWs effectively engaged patients, addressed their health goals, and facilitated connections to essential community and government services. The findings highlight the importance of structured program implementation and ongoing evaluation to maximize the impact of CHWs in primary care settings.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02571-6
