ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Even though they face a higher risk of COVID-19-related morbidity and mortality, racial and ethnic minorities in the Greater Boston area have had less access to COVID-19 testing and vaccinations. DESCRIPTION OF PROGRAM/INTERVENTION: We implemented a novel, community-based mobile health unit program by repurposing transportation vans with COVID-19 testing equipment, preventive hygiene kits, and mRNA vaccines. Our goal was to expand testing and vaccine availability in highly affected communities in the Greater Boston area. We used a “double equity” model by hiring workers from a local transportation company whose staff were at risk of unemployment. The vans were staffed with racially/ ethnically diverse and multilingual staff, including members of the target communities themselves. We incorporated a system of “trusted messengers” to answer questions about COVID-19 and in particular, vaccination from the community. We implemented this program with crucial input from community-based organizations and municipal public health departments. Van location sites were guided by community partners, in some cases incorporating SARS-CoV-2 wastewater surveillance data to meet rapidly changing community needs. MEASURES OF SUCCESS: Our goals were to (1) demonstrate the feasibility of a COVID-19 testing program guided by community partnerships and SARS-CoV-2 wastewater surveillance data;(2) improve access to COVID-19 testing in underserved communities;and (3) improve access to COVID-19 vaccination among racial/ethnic minorities. We collected ongoing feedback (e.g. through the local community advisory groups etc) on the mobile health program from community partners, patients, and staff. We compared sociodemographic characteristics of mobile health participants with the general population of the state of Massachusetts and the population of the target communities. FINDINGS TO DATE: From January 2021 - January 2022, our mobile health units have tested greater than 4500 persons in predominantly low socioeconomic communities that have been highly impacted by the pandemic. From May 2021 - January 2022, we vaccinated 5480 persons in these communities. An analysis of our program from January 2021 - January 2022 demonstrated that mobile health unit participants receiving COVID-19 vaccines were significantly more likely to be non-White and Hispanic compared with the general vaccinated population of the state of Massachusetts and of the target communities, and these findings were statistically significant. We also found that the mobile health units vaccinated more youth and adolescents in the target community compared with the general state vaccination data. KEY LESSONS FOR DISSEMINATION: Delivery of preventive COVID19 care via mobile health units is feasible and associated with high usage from affected communities when implemented with high stakeholder engagement and expertise from local public health departments. Employing diverse, multilingual, and well-trained healthcare staff as trusted messengers likely improved COVID-19 vaccine uptake in this population.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Will a telehealth initiative improve poorly controlled type 2 diabetes mellitus (DM) and unmet social determinants of health (SDOH) needs exacerbated by the COVID-19 pandemic? DESCRIPTION OF PROGRAM/INTERVENTION: Due to COVID-19, many patients with DM faced challenges accessing healthcare, as well as exacerbations of socioeconomic disparities regarding access to food, affordable housing, and safe places to exercise. To address these challenges, we adapted an existing student-faculty collaborative practice at Beth Israel Deaconess Medical Center, Boston, MA, to a telehealth platform to provide targeted DM management, and referrals to dietitians and community resource specialists. MEASURES OF SUCCESS: We assessed clinical outcomes, such as changes in hemoglobin A1c (HbA1c), LDL, and number of medication adjustments. Measured quality indicators included frequency of HbA1c, LDL, and microalbuminuria measurements, as well as prescription of cardiovascular/diabetic medications such as ACE inhibitors, statins, and aspirin within the year prior to enrollment and within 6 months after the final visit. To measure the role and intervenability of SDOH needs, we tracked the results of SDOH screens to identify key needs, as well as the number of dietitian and community resource specialist (CRS) referrals placed. FINDINGS TO DATE: Of 998 patients with non-insulin-dependent type 2 DM, 60 were enrolled in the program, of whom 42% were white and had a median BMI of 32.0 kg/m2 (IQR 28.3-36.1). Patients endorsed high motivation (8/10) and confidence (7/10) in managing their diabetes, but reported inadequate nutrition education (56.7% of cohort), as well as difficulty maintaining a healthy diet (76.7%) and exercising (78.3%). Analysis of baseline data and for those who completed the program thus far (n = 22, >6 months since last clinic visit), showed a significant decrease in mean HbA1c (mean ±SEM) from 8.72±0.15 to 8.09±0.22 (p = 0.03). LDL levels were not significantly different before and after the program, 90.3±5.4 vs 100.9±10.6 (p = 0.42). Lab draw frequency (HbA1c, LDL) and medication prescription (ACE inhibitors, statin, aspirin) and were not significantly different. Of patients who completed the program, 8 (36.4%) had their diabetes medications adjusted. 2 (9.1%) were referred to a CRS, and 2 (9.1%) were referred to a dietitian. KEY LESSONS FOR DISSEMINATION: Our ongoing study showed that the implementation of a telehealth diabetes program with SDOH screening can be an effective way to assist patients with uncontrolled diabetes. We identified significant patient needs for additional support and clinical care. Assessing socioeconomic burdens faced by patients and understanding the impact and key features of such a collaborative telehealth program can pave the way for the implementation of a similar model of care for other chronic conditions.