Rural Project Examples: Community health workers
Promising Examples


Updated/reviewed December 2020
- Need: To improve the health of communities in the south central region of New Mexico.
- Intervention: A program was developed to specifically address diabetes prevention and control, behavioral healthcare, and immunization in Luna County.
- Results: During the program, 1,500 immunizations were distributed, baseline measurements of participants improved, and 935 new patients were seen for behavioral health issues.

Updated/reviewed November 2020
- Need: To properly address and treat patients who have concurrent substance use and chronic healthcare issues.
- Intervention: A referral system utilizes community health workers (CHWs) in a drug and alcohol treatment setting. A registered nurse helps with providers' medication-assisted treatment programs.
- Results: This program has reduced hospital emergency visits and hospital readmissions for patients since its inception.

Updated/reviewed October 2020
- Need: To reduce barriers to accessing healthcare for immigrant farmworkers in the rural areas of Vermont.
- Intervention: Bridges to Health uses care coordination and health promoters to reduce barriers to accessing healthcare on an individual level. The program offers targeted technical assistance to address systemic barriers at health access points in areas with high numbers of immigrant farmworkers.
- Results: Some barriers to accessing healthcare have been reduced or removed for immigrant farmworkers in certain counties.

Updated/reviewed May 2020
- Need: To reduce the prevalence of diabetes and cardiovascular disease in rural Colorado.
- Intervention: Community Health Workers are utilized to create a system of coordinated care in Delta, Montrose, Ouray, and San Miguel counties.
- Results: As of 2018, 2,709 people have been screened for diabetes and cardiovascular disease, with many at-risk patients lowering cholesterol, blood pressure, and A1C levels after engaging with a Community Health Worker.

Updated/reviewed December 2019
- Need: To help older patients with chronic conditions learn to manage their illnesses and thereby reduce hospital readmissions in Oconee County, South Carolina.
- Intervention: Community volunteers trained as health coaches mentor discharged patients with certain chronic conditions, to help them transition from home health care to self-care.
- Results: Participants had improved health behaviors and reduced readmissions.

Added March 2019
- Need: Expand healthcare access for the more remote residents of 3 frontier counties in north central Idaho.
- Intervention: Consortium of healthcare providers and community agencies used a hybrid Community Health Worker model to augment traditional healthcare delivery services in order to offer a diverse set of healthcare offerings to frontier area residents.
- Results: Increased healthcare access, especially for cancer and chronic disease screening, along with providing education on a diverse array of health topics.
Other Project Examples
Disabled Adults Oral Health Initiative
Updated/reviewed April 2021
Updated/reviewed April 2021
- Need: To help rural Maryland adults with disabilities learn more about oral health and access care.
- Intervention: Health Right community health workers gave educational presentations at agencies serving those with disabilities.
- Results: From March 2014 to February 2016, educational presentations reached 1,084 adults with disabilities and 344 staff and caregivers, and 256 people received dental treatment.

Updated/reviewed December 2020
- Need: Meeting the health care needs of the uninsured and underinsured population of Sussex County, Delaware.
- Intervention: La Red Health Center was created to offer culturally competent primary and preventative care to children and adults, regardless of ability to pay.
- Results: La Red Health Center (LRHC) serves thousands of residents at four clinical sites, a school-based wellness center and through a collaborative effort with a local senior center.
Super-Utilizer Pilot Project
Updated/reviewed November 2020
Updated/reviewed November 2020
- Need: To address patients' complex physical, behavioral, and social health needs with the goal to reduce unnecessary visits to the emergency department and reduce inpatient admissions.
- Intervention: A registered nurse and community health worker used technology to address patients with high risk and high costs in their home setting through a 90-day intensive intervention.
- Results: The healthcare team in Kalispell saved more than $1.8 million in hospital costs with the project's first 36 patients.

Updated/reviewed July 2020
- Need: Connect individuals to services that address health barriers.
- Intervention: A pay-for-outcomes model utilizing Community Health Workers who help provide community members with tools to address needs associated with improving health.
- Results: Trained Community Health Workers help patients navigate the healthcare and social service systems and provide education about community healthcare resources.
For examples from other sources, see: