Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, Washington, United States of America.
US Department of Health and Human Services, Washington, DC, United States of America.
PLoS One. 2023 Feb 27;18(2):e0279230. doi: 10.1371/journal.pone.0279230. eCollection 2023.
Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota.
HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9-12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8-44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4-2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability.
HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.
社区为基础的健康干预措施正日益被视为一种护理模式，可以弥合美国（美国）服务不足社区所经历的医疗保健差距。通过这项研究，我们试图评估通过美国 HealthRise 计划实施的此类干预措施对明尼苏达州亨内平县、拉姆齐县和赖斯县服务不足社区的高血压和糖尿病的影响。
使用差异分析评估了 2016 年 6 月至 2018 年 10 月期间 HealthRise 患者的数据，与常规护理相比，量化了该计划在降低收缩压（SBP）和血红蛋白 A1c 以及达到临床目标（高血压<140mmHg，糖尿病<8%Al1c）方面的效果。对于高血压，参与 HealthRise 计划与赖斯县的 SBP 降低相关（6.9mmHg [95%置信区间：0.9-12.9]），而亨内平县和赖斯县的临床目标达标率更高（27.3 个百分点 [9.8-44.9]）和赖斯县（17.1 个百分点 [0.9 到 33.3]）。对于糖尿病，HealthRise 与 Ramsey 县的 A1c 降低相关（1.3 [0.4-2.2]）。定性数据表明，家庭访视与诊所服务相结合具有价值；然而，仍然存在挑战，包括社区卫生工作者的留用和计划的可持续性。
HealthRise 计划的参与对一些地点改善高血压和糖尿病的结果有积极影响。虽然社区为基础的健康计划可以帮助弥合医疗保健差距，但它们本身并不能完全解决许多服务不足社区所经历的结构性不平等问题。
