Boursaw Blake, FitzGerald Courtney A, Taylor Lisa M, Landrau-Cribbs Erica, Caswell Leigh, Cruz Theresa H
Transdisciplinary Research, Equity and Engagement (TREE) Center, College of Population Health, University of New Mexico, Albuquerque, NM, USA.
Prevention Research Center, Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
J Racial Ethn Health Disparities. 2024 Jul 5. doi: 10.1007/s40615-024-02078-x.
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.
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.
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).
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.
关于参与社区慢性病自我管理与预防项目对健康差距的影响，现有证据有限。本研究的目的是确定参与“健康在此健康转诊系统”对西班牙裔/拉丁裔成年人与非西班牙裔白人成年人之间糖化血红蛋白（HbA1c）、收缩压（BP）和舒张压方面现有差距的影响。
我们合并了2018年至2022年新墨西哥州六个重点邮政编码区域成年患者的行政临床和转诊数据，得到了1331名患者的样本，并使用回归模型来检验干预参与的预测因素以及参与对HbA1c和血压结果的倾向调整影响。
被转诊至社区项目但未参与的非西班牙裔白人患者的HbA1c有统计学意义的显著增加。仅转诊的西班牙裔/拉丁裔患者的HbA1c有统计学意义的显著下降，项目参与没有额外益处。两组在HbA1c水平以及收缩压（t(958) = 2.11，p = 0.04）和舒张压结果（t(958) = 2.96，p = 0.003）方面，参与的影响在统计学上有显著差异（t(683) = 3.55，p < 0.001）。
本研究结果支持利用集中转诊系统在社区环境中共同促进健康改善的前景。混合结果凸显了在旨在理解按种族和族裔划分的异质项目影响的评估中，进一步采用理论指导测量的必要性。
