When patients leave Cedars-Sinai Medical Center, their recovery often depends on more than just medical follow-up. Factors such as housing, food access, transportation, and the ability to follow discharge instructions can play a significant role in health outcomes.
Cedars-Sinai’s community health workers (CHWs) are designed to address these needs. “Our team meets patients where they are—literally and figuratively—and helps them navigate care as whole people, not just patients,” said Katie Hren, LCSW, MPH, director of the Community Connect Program at Cedars-Sinai. “Many of the patients we work with need more than medicine. They also may need assistance finding safe housing, accessing healthy food, arranging transportation to appointments or applying for benefits that support their daily lives.”
Research from the National Association of Community Health Workers shows that programs led by CHWs can reduce emergency department visits by up to 38% and hospitalizations by 30%, highlighting their impact on both patient outcomes and healthcare costs.
A community health worker is a frontline public health professional who helps patients navigate healthcare and community resources. They often come from the same neighborhoods they serve, which gives them insight into the cultural and practical challenges faced by patients.
Unlike other hospital staff members, CHWs continue supporting patients after discharge. Their work includes connecting individuals to services like meal delivery or transportation and ensuring that referrals and treatment plans are followed through.
CHWs focus on helping those most at risk of falling through gaps in care—such as people without stable housing after discharge or older adults who cannot drive. Their role complements nurses, social workers, and case managers by addressing social barriers like housing or food insecurity that affect overall health.
Their daily tasks vary but often include meeting with clinical teams before discharge or following up with patients in person or by phone. Much of their work takes place outside the hospital—visiting homes or attending appointments with patients—and they collaborate with organizations such as Healthcare in Action to provide broader support.
At Cedars-Sinai, referrals to CHWs usually come from physicians, nurses, or social workers. The CHW then reaches out directly to build trust and offer assistance.
According to Hren, Cedars-Sinai’s program has produced measurable results: “Patients who work with CHWs are more likely to attend follow-up and primary care visits, less likely to use the emergency department unnecessarily, and they report higher satisfaction with their overall care.” Providers have also noted that CHWs allow them to focus on complex medical issues while giving patients confidence navigating the healthcare system.
To further expand access to resources, Cedars-Sinai has launched CS Community Resource—an online portal connecting users with free or low-cost health and social service programs.
Looking ahead, Hren sees an increasing role for CHWs both at Cedars-Sinai and nationally: “The role of CHWs is more essential than ever. I see their integration into healthcare continuing to expand, not just at Cedars-Sinai but across the country. As healthcare shifts toward whole-person care, CHWs bring skills and connections that can’t be replicated by other providers.”
Cedars-Sinai Medical Center is located in Los Angeles and was founded in 1902. The hospital admitted over 50,000 patients for treatment during 2022 according to its annual report. Thomas M. Priselac serves as its current president (https://www.cedars-sinai.org/about.html).
For additional information about how Cedars-Sinai’s community health workers support patient recovery beyond hospital walls, visit the Cedars-Sinai Blog.
