---
type: source
title: "A Scoping Review of RCT Studies on Community Health Worker Effectiveness"
author: "Gilbert Gimm, Carolyn Hoffman, Leila Elahi, Len M. Nichols"
url: https://journals.sagepub.com/doi/10.1177/19427891251384659
date: 2025-01-01
domain: health
secondary_domains: []
format: paper
status: enrichment
priority: high
triage_tag: claim
tags: [community-health-workers, RCT, evidence-review, SDOH, behavioral-health-infrastructure]
processed_by: vida
processed_date: 2026-03-18
enrichments_applied: ["federal-budget-scoring-methodology-systematically-undervalues-preventive-interventions-because-10-year-window-excludes-long-term-savings.md"]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Scoping review of 39 RCT studies on community health worker (CHW) interventions in the US, published between 2000-2023. All 13 RCT studies examining specific health outcomes showed modest to strong evidence of improved clinical, education, or utilization outcomes in the treatment group relative to the control group.

Key findings:
- 39 RCTs identified in US settings
- Most rigorous trials occurred in health care systems and safety-net providers/community health centers
- Limited research in public health agencies or insurance organizations
- Consistent evidence of improved outcomes across CHW interventions
- Gap: many CHW intervention studies do not clearly specify organizational setting
- Gap: need future RCT studies on CHWs employed by health plans (payers) or public health agencies

Complementary evidence from IMPaCT (Penn Medicine):
- RCT-based: every $1 invested returns $2.47 to Medicaid within the fiscal year
- Reduced total hospital days by 65%
- Doubled rate of patient satisfaction with primary care
- Improved chronic disease control and mental health
- Annual cost savings of $1.4 million for Medicaid enrollees after 12 months
- First economic analysis of health system-based CHW intervention using RCT data

## Agent Notes
**Triage:** [CLAIM] — CHW programs have RCT-validated evidence of improved health outcomes AND positive ROI for Medicaid, making them the strongest evidence base for scalable non-clinical health interventions
**Why this matters:** Frontier Gap 1 asks "what works to change the 80-90% non-clinical determinants?" CHWs are the strongest answer in the evidence base — 39 RCTs with consistent positive findings, plus the IMPaCT program showing $2.47 ROI per dollar invested in Medicaid
**What surprised me:** The $2.47 ROI within the SAME fiscal year. Most prevention interventions have delayed returns. CHW programs generate savings fast enough to fit within annual budget cycles — this is what makes them scalable under current payment models.
**KB connections:** [[medical care explains only 10-20 percent of health outcomes...]], [[SDOH interventions show strong ROI but adoption stalls...]], [[social isolation costs Medicare 7 billion annually...]]
**Extraction hints:** Two claim candidates: (1) CHW programs are the most RCT-validated non-clinical health intervention with consistent evidence across 39 US trials, (2) IMPaCT's $2.47 Medicaid ROI within one fiscal year demonstrates that non-clinical health interventions can generate returns fast enough to fit within payer budget cycles

## Curator Notes
PRIMARY CONNECTION: SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action
WHY ARCHIVED: Fills the most critical gap in Vida's KB — the evidence for what actually works to change non-clinical health determinants at scale. The 39 RCTs + IMPaCT ROI data provide the strongest evidence base for Belief 2's operational implications.


## Key Facts
- 39 RCTs on CHW interventions in US settings identified between 2000-2023
- 13 of 39 RCTs examined specific health outcomes
- 100% of outcome-focused RCTs showed positive results
- IMPaCT reduced hospital days by 65%
- IMPaCT doubled patient satisfaction with primary care
- IMPaCT generated $1.4M annual Medicaid savings after 12 months
- Most rigorous CHW trials occurred in health care systems and safety-net providers/CHCs
- Limited CHW research exists in public health agencies or insurance organizations
