Original Article Toward A Scalable, Patient-Centered Community Health Worker Model: Adapting the IMPaCT Intervention for Use in the Outpatient Setting Shreya Kangovi, MD, MS, 1 Tamala Carter, CHW, 2 Dorothy Charles, BA, 3 Robyn A. Smith, BA, 1 Karen Glanz, PhD, MPH, 4 Judith A. Long, MD, 1,5 and David Grande, MD, MPA 1 Abstract Community health worker (CHW) programs are an increasingly popular strategy for patient-centered care. Many health care organizations are building CHW programs through trial and error, rather than implementing or adapting evidence-based interventions. This study used a qualitative design-mapping process to adapt an evidence-based CHW intervention, originally developed and tested in the hospital setting, for use among out- patients with multiple chronic conditions. The study involved qualitative in-depth, semi-structured interviews with chronically ill, uninsured, or Medicaid outpatients from low-income zip codes (n = 21) and their primary care practice staff (n = 30). Three key themes informed adaptation of the original intervention for outpatients with multiple conditions. First, outpatients were overwhelmed by their multiple conditions and wished they could focus on 1 at a time. Thus, the first major revision was to design a low-literacy decision aid that patients and providers could use to select a condition to focus on during the intervention. Second, motivation for health behavior change was a more prominent theme than in the original intervention. It was decided that in addition to providing tailored social support as in the original intervention, CHWs would help patients track progress toward their chronic disease management goals to motivate health behavior change. Third, patients were already connected to primary care; yet they still needed additional support to navigate their clinic once the intervention ended. The intervention was revised to include a weekly clinic-based support group. Structured adaptation using qualitative design mapping may allow for rapid adaptation and scale-up of evidence-based CHW interventions across new settings and populations. (Population Health Management 2016;xx:xxx–xxx) Introduction C ommunity health workers (CHWs) are trusted ‘‘nat- ural helpers’’ within their communities and can provide social support, advocacy, and care coordination for high-risk patients. Although CHW interventions are growing in pop- ularity, their widespread use has been limited by absence of an evidence-based intervention (EBI) that is easy to scale. 1 The process of scaling an EBI to new settings creates a tension between fidelity and fit. 2 On one hand, fidelity to an EBI is important for efficiencies of scale and adherence to core components of effectiveness. On the other hand, pro- grams must be adapted to accommodate new settings and patient populations. The literature focuses on adaptations of EBIs to new cultural contexts (eg, adaptation of the Diabetes Prevention Program for a Latino population 3,4 ), but con- siderations are similar when adapting EBIs for new delivery settings (eg, adapting a hospital-based tuberculosis program for use in community settings 5 ) or diseases (eg, adapting a substance abuse behavioral intervention for use among smokers 6 ). Historically, unplanned and often unstructured program adaptation has been widespread. 7 In recent years, the im- plementation science field has explored practical, yet sci- entific ‘‘planned adaptation’’ strategies to guide this process. Numerous published guidelines and frameworks 2,3,8,9,10 1 Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia, Pennsylvania. 2 Perelman School of Medicine, University of Pennsylvania, Penn Center for Community Health Workers, Philadelphia, Pennsylvania. 3 Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 4 Perelman School of Medicine and School of Nursing, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania. 5 Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania. POPULATION HEALTH MANAGEMENT Volume 0, Number 0, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/pop.2015.0157 1