About

Shreya Kangovi, MD, MSHP, is an Adjunct Professor of Medicine (General Internal Medicine) at the University of Pennsylvania Perelman School of Medicine. She is also a Senior Fellow at the Leonard Davis Institute, the Center for Public Health Initiatives, and the Veterans Affairs Center for Health Equity Research & Promotion at the University of Pennsylvania. Dr. Kangovi is the Founding Executive Director of the Penn Center for Community Health Workers (CHW). Her research focuses on perspectives of low-income patients regarding socioeconomic determinants of health and healthcare utilization, as well as evaluating the effectiveness of community health workers in modifying behavioral, socioeconomic, and health system barriers to improve patient-centered outcomes. She has contributed to advancing community health interventions and health equity through her work and leadership in these areas.

Research topics

• Medicine
• Political Science
• Environmental health
• Nursing
• Internal medicine
• Gerontology
• Public economics
• Economics
• Family medicine
• Economic growth
• Actuarial science
• Business
• Physical therapy
• Finance

Selected publications

• Training to understand and navigate emotions and interactions (TUNE In): A novel program to support social functioning in adults on the autism spectrum

  Research in Autism · 2026-01-12

  articleOpen access
  PublisherDOI

• Effects of a Standardized Community Health Worker Intervention on Health Care Utilization Within an Integrated Delivery System

  Journal of General Internal Medicine · 2025-04-11 · 2 citations

  articleOpen accessSenior author

  BACKGROUND: Community health worker (CHW) interventions can improve health outcomes and reduce acute care utilization. Few prior studies have examined the association of CHW interventions with health care utilization among patients within an integrated health system. OBJECTIVE: To evaluate the effects of Individualized Management for Patient Centered Targets (IMPaCT), a standardized CHW intervention originally developed within a single health system in Philadelphia, PA, on acute care utilization and primary care engagement among low-income patients at two clinics within an integrated health system in Portland, Oregon. DESIGN: Prospective randomized analysis using adjusted difference-in-differences regression. PARTICIPANTS: In total, 1230 adults living in low-income zip codes were randomized using a 2:1 allocation sequence to receive either IMPaCT (n = 820) or usual care (n = 410). INTERVENTIONS: IMPaCT is a standardized intervention in which CHWs use an in-depth interview to understand patients' strengths, social needs, and health-related goals and then collaboratively develop tailored action plans. Over 3 months, CHWs communicated with patients at least once weekly to provide coaching, social support, and navigation tailored to their goals. Due to the COVID- 19 pandemic, the intervention was predominantly delivered remotely. MAIN MEASURES: Primary outcome measures were hospital and emergency department (ED) utilization, both measured per 1000 members per month, and proportion of patients with 1+ primary care visits. Implementation fidelity and maintenance were also assessed. KEY RESULTS: Compared to usual care, patients who received IMPaCT had a relative reduction in total hospital days at 6 months (- 172.3 days per 1000 members per month, 95% CI - 320.05 to - 24.53, p= 0.022), and a greater proportion attended 1+ primary care visits (85.7% vs. 79.5%, p= 0.006). There were no differences in ED utilization. CONCLUSIONS: A standardized CHW intervention delivered remotely within an integrated health system during the COVID- 19 pandemic was associated with decreased hospital utilization and improved primary care engagement.

  PublisherOA PDFDOI

• Scaling an Evidence‐Based Community Health Worker Program With Fidelity: Results and Lessons Learned

  Milbank Quarterly · 2025-04-16 · 2 citations

  articleOpen accessSenior author

  Policy Points Effectively implemented community health worker (CHW) programs improve patient health outcomes and quality of care, reduce health care costs, and are a key strategy for addressing social and structural drivers of health. As policymakers consider funding mechanisms for CHW programs, it is crucial to tie funding to evidence-based best practices while also allowing for innovation and context-specific adaptations. CONTEXT: Community health worker (CHW) programs represent a key strategy for addressing social and structural drivers of health and have the potential to improve patient health outcomes and enhance quality of care while reducing health care costs. However, challenges such as high staff turnover, lack of program infrastructure, and inadequate CHW support and supervision can hinder implementation and sustainment of effective CHW programs. Furthermore, few CHW programs have been successfully scaled across multiple organizations and communities. Individualized Management for Person-Centered Targets (IMPaCT) is an evidence-based CHW model designed to address these challenges by standardizing processes for CHW hiring, training, support, and supervision while still allowing for context-specific adaptation and tailoring. In this dissemination and implementation project, we evaluated implementation of IMPaCT across five geographically and structurally distinct sites serving diverse and varied patient populations. METHODS: Model fidelity was assessed across seven best practice domains via structured virtual observations with CHWs, supervisors, and program directors at each implementation site. Acute care use was evaluated using difference-in-differences regression modeling for patients enrolled in IMPaCT compared with a propensity score-matched control group. All implementation sites examined total hospital days per patient, and several sites chose to incorporate additional measures of acute care use such as the number of hospitalizations and emergency department visits. FINDINGS: We found that core program components were implemented consistently across sites, and three of five sites were able to both sustain implementation over a three-year period and demonstrate significant reductions in acute care use, consistent with previous randomized controlled trials of this program. CONCLUSIONS: Health systems may be able to address social drivers of health and improve population health for patients who are low-income and patients of color by implementing evidence-based CHW programs with fidelity.

  PublisherOA PDFDOI

• Training to Understand and Navigate Emotions and Interactions (Tune in): A Novel Program to Support Social Functioning in Adults on the Autism Spectrum

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

  JAMA Health Forum · 2024-03-08 · 30 citations

  articleOpen access

  Importance: Community health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes. Objective: To identify barriers and facilitators to implementing an evidence-based CHW model. Design, Setting, and Participants: This qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling. Intervention: The disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans. Main Outcomes and Measures: Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains. Results: Of a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs' interpersonal skills and life experiences. Program-specific facilitators included the model's strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity. Conclusions and Relevance: These findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.

  PublisherOA PDFDOI

• A Qualitative Study Identifying the Potential Risk Mechanisms Leading to Hospitalization for Patients With Chronic Lung Disease

  CHEST Pulmonary · 2024-05-03 · 2 citations

  articleOpen access

  BACKGROUND: Care management programs for chronic lung disease attempt to reduce hospitalizations, yet have not reliably achieved this goal. A key limitation of many programs is that they target patients with characteristics associated with hospitalization risk, but do not specifically modify the mechanisms that lead to hospitalization. RESEARCH QUESTION: What are the common mechanisms underlying known patient-level risk characteristics leading to hospitalizations for acute exacerbations of chronic lung disease? STUDY DESIGN AND METHODS: We conducted a qualitative study of patients admitted to the University of Pennsylvania Health System with acute exacerbations of chronic lung disease between January and September 2019. We interviewed patients, their family caregivers, and their inpatient and outpatient clinicians about experiences leading up to the hospitalization. We analyzed the interview transcripts using triangulation and abductive analytic methods. RESULTS: We conducted 69 interviews focused on the admission of 22 patients with a median age of 66 years (interquartile range, 60-70 years), of whom 16 patients (73%) were female and 14 patients (64%) were Black. We interviewed 22 patients, 14 caregivers, 19 inpatient clinicians, and 14 outpatient clinicians. We triangulated the available interview data for each patient admission and identified the underlying mechanisms of how several known patient characteristics associated with risk actually led to hospitalization. These mechanisms included limited capacity for home management of acute symptom changes, barriers to accessing care, chronic functional limitations, and comorbid behavioral health disorders. Importantly, many of the clinical, social, and behavioral mechanisms underlying hospitalizations were present for months or years before the symptoms that prompted inpatient care. INTERPRETATION: Care management programs should be built to target specific clinical, social, and behavioral mechanisms that directly lead to hospitalization. Upstream interventions that reduce hospitalization risk are possible given that many contributory mechanisms are present for months or years before the onset of acute exacerbations.

  PublisherDOI

• Community Health Workers: A Key Workforce to Promote Health Equity for Children in Immigrant Families

  Academic Pediatrics · 2024-07-01 · 3 citations

  articleOpen access
  PublisherOA PDFDOI

• Community Health Worker Integration with and Effectiveness in Health Care and Public Health in the United States

  Annual Review of Public Health · 2023-04-03 · 127 citations

  reviewOpen accessSenior author

  Community health workers (CHWs) have worked in a variety of settings in the United States for more than 70 years and are increasingly recognized as an essential health workforce. CHWs share life experience with the people they serve and have firsthand knowledge of the causes and impacts of health inequity. They provide a critical link between marginalized communities and health care and public health services. Several studies have demonstrated that CHWs can improve the management of chronic conditions, increase access to preventive care, improve patients' experience of care, and reduce health care costs. CHWs can also advance health equity by addressing social needs and advocating for systems and policy change. This review provides a history of CHW integration with health care in the United States; describes evidence of the impact of CHW programs on population health, experience, costs of care, and health equity; and identifies considerations for CHW program expansion.

  PublisherOA PDFDOI

• Digital Health and Community Health Worker Support for Diabetes Management: a Randomized Controlled Trial

  Journal of General Internal Medicine · 2022-05-17 · 15 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Design of a randomized controlled trial of digital health and community health worker support for diabetes management among low-income patients

  Contemporary Clinical Trials Communications · 2021-12-08 · 5 citations

  articleOpen accessSenior author

  BACKGROUND: Insulin-dependent diabetes is a challenging disease to manage and involves complex behaviors, such as self-monitoring of blood glucose. This can be especially challenging in the face of socioeconomic barriers and in the wake of the COVID-19 pandemic. Digital health self-monitoring interventions and community health worker support are promising and complementary best practices for improving diabetes-related health behaviors and outcomes. Yet, these strategies have not been tested in combination. This protocol paper describes the rationale and design of a trial that measures the combined effect of digital health and community health worker support on glucose self-monitoring and glycosylated hemoglobin. METHODS: The study population was uninsured or publicly insured; lived in high-poverty, urban neighborhoods; and had poorly controlled diabetes mellitus with insulin dependence. The study consisted of three arms: usual diabetes care; digital health self-monitoring; or combined digital health and community health worker support. The primary outcome was adherence to blood glucose self-monitoring. The exploratory outcome was change in glycosylated hemoglobin. CONCLUSION: The design of this trial was grounded in social justice and community engagement. The study protocols were designed in collaboration with frontline community health workers, the study aim was explicit about furthering knowledge useful for advancing health equity, and the population was focused on low-income people. This trial will advance knowledge of whether combining digital health and community health worker interventions can improve glucose self-monitoring and diabetes-related outcomes in a high-risk population.

  PublisherDOI

Recent grants

• Modifying Behavioral Response to Failure among Patients with Cardiovascular Disease Risk Factors

  NIH · $695k · 2016–2021

Frequent coauthors

• Judith A. Long

  57 shared

• David Grande

  University of Pennsylvania

  44 shared

• Tamala Carter

  Penn Center for AIDS Research

  40 shared

• Nandita Mitra

  University of Pennsylvania

  29 shared

• Kevin Fosnocht

  16 shared

• Kendal Williams

  University of Pennsylvania

  16 shared

• R I Jackson

  University of North Texas

  16 shared

• Jack Ende

  University of Pennsylvania

  16 shared

Labs

• Shreya Kangovi LabPI

Awards & honors

• Senior Fellow, Leonard Davis Institute, University of Pennsy…
• Founding Executive Director, Penn Center for Community Healt…
• Investigator, Veterans Affairs Center for Health Equity Rese…
• Senior Fellow, Center for Public Health Initiatives, Univers…