Improving Health and Reducing Chronic Disease Disparities with Latinx Communities: Evaluating the Role of Documented Community-Based Intervention Participation.

PURPOSE: Limited evidence exists on the impact of participation in community-based chronic disease self-management and prevention programs on health disparities. The purpose of this research was to determine the effects of participation in the Healthy Here Wellness Referral System on existing disparities in glycated hemoglobin (HbA1c), systolic blood pressure (BP), and diastolic BP among Hispanic/Latinx adults compared with non-Hispanic White adults. METHODS: We merged administrative clinical and referral data from 2018 through 2022 for adult patients in six focus ZIP codes in New Mexico resulting in a sample of 1331 patients and used regression models to examine predictors of intervention participation as well as propensity-adjusted impacts of participation on HbA1c and BP outcomes. RESULTS: Non-Hispanic White patients who were referred to community-based programming but did not participate saw statistically significant increases in HbA1c. Hispanic/Latinx patients saw statistically significant decreases in HbA1c with referral alone, with no added benefit from program participation. The impact of participation differed statistically significantly (t(683) = 3.55, p < .001) between these two groups for HbA1c levels, as well as for systolic (t(958) = 2.11, p = .04) and diastolic BP outcomes (t(958) = 2.96, p = .003). CONCLUSIONS: Results of this study support the promise of using centralized referral systems to co-produce health improvement in community settings. Mixed findings highlight the need for further uptake of theory-informed measurement in evaluations seeking to understand heterogeneous program impacts by race and ethnicity.

Healthy Here: A Promising Referral System Model for Community-Clinical Linkages to Prevent Chronic Disease.

Linking clinical services to community-based resources is a promising strategy for assisting patients with chronic disease prevention and management. However, there remains a gap in understanding how to effectively develop and implement community-clinical linkages (CCLs), especially in communities of color. The Healthy Here initiative used Stage Theory of organizational change to implement a centralized wellness referral system, linking primary care clinics to community organizations in majority Hispanic/Latinx and Native American communities. Data were collected using a standardized referral form. Facilitators and challenges were identified through semi-structured discussions with partner organizations. Between 2016 and 2021, 43 clinics and 497 health care providers made 7,465 referrals, the majority of which were from the focus populations. The average proportion of patients referred by clinic champions decreased significantly over time, reflecting diffusion of the intervention within clinics. Facilitators to system success included building on existing networked partnerships, utilizing a centralized referral center, leveraging funding, sharing data, addressing challenges collectively, incorporating multilevel leadership, and co-developing and testing a standardized referral form and process with a single clinic and provider before scaling up. Challenges included funding restrictions, decreasing referrals within clinics over time, changing availability of resources and programs, and the COVID-19 pandemic. This innovative initiative demonstrates that CCLs can be developed and implemented to successfully reach Hispanic/Latinx and Native American communities and provides strategies for overcoming challenges.

Community-Clinical Linkages: The Effects of the Healthy Here Wellness Referral Center on Chronic Disease Indicators Among Underserved Populations in New Mexico.

The majority of U.S. adults are living with at least one chronic condition, and people of color bear a disproportionate burden of chronic disease. Prior research identifies community-clinical linkages (CCLs) as a strategy for improving health. CCLs traditionally use health care providers to connect patients to community-based self-management programs. The purpose of this study was to examine the effectiveness of a centralized CCL system on health indicators and health disparities. Administrative health data were merged with referral system data to conduct a quasi-experimental comparative time series study with a comparison group of nonreferred patients. Interrupted time-series comparisons within referred patients were also conducted. Of the 2,920 patients meeting inclusion criteria, 972 (33.3%) received a referral during the study period (January 2019-September 2021). Hemoglobin A1c levels, used to diagnose diabetes, declined significantly among referred patients, as did disparities among Hispanic/Latinx participants compared with non-Hispanic White participants. No changes were observed in body mass index (BMI). Blood pressure increased among both referred and nonreferred patients. CCLs with a centralized referral system can effectively reduce markers of diabetes and may contribute to the maintenance of BMI. The observed increase in blood pressure may have been affected by the COVID-19 pandemic and warrants further study. Practitioners can work with community partners to implement a centralized CCL model, either on its own or to enhance existing clinician or community health worker-based models.