Introduction
Community health workers (CHWs) serve as frontline members of the public health workforce, bolstered by trust within their community. They bridge critical gaps between community members and healthcare systems by facilitating access to care and enhancing the quality and cultural sensitivity of service delivery. CHWs contribute to enhanced patient health outcomes by addressing social determinants and underlying causes of poor health, reducing hospitalizations and mitigating illness burden. However, evidence remains limited by a lack of standardization spanning CHW training, utilization, integration, funding, and outcome metrics, hindering dissemination and implementation of programs at scale. This three-year randomized controlled trial utilizes mixed-methods to evaluate implementation and patient outcomes associated with scaling a CHW program using the Pathways Community Hub Institute (PCHI) model to identify high-need/high-risk patients at a tertiary care hospital in Phoenix.

Methods
High-need/high-risk patients will be identified during hospitalization via a two-tiered triage system based on insurance status (under or uninsured patients) and social vulnerability index (SVI). Consenting patients will be randomly assigned to receive either CHW services or a referral, the current standard of care. CHW services will be conducted as at-home visits post-discharge in congruence with the PCHI model, ensuring standardized training, assessment, and intervention pathways. The expanded RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance) and Practical, Robust Implementation and Sustainability Model (PRISM) will guide qualitative analysis of implementation through observation, focus groups, and individual interviews. Arizona State University’s Center for Health Information and Research (CHiR) will conduct analysis of patient outcomes at one year utilizing data from patients’ electronic health records and Medicaid claims.

Discussion
This community-centered CHW program utilizes a standardized approach to address Arizona's healthcare worker shortage and health-related social needs of high-risk, underserved populations. The randomized controlled trial design and use of standardization spanning training, assessment, and intervention are important in efforts to better understand mechanisms by which CHWs impact patient outcomes.