Federally qualified health centers as the bridge between health care and community-based trusted messengers for diabetes management

University Of Illinois At Chicago, Chicago IL

Investigators

Abstract

Diabetes is a complex disease that disproportionately affects Black and Hispanic/Latino individuals in historically underserved communities. Treatment often requires interdisciplinary collaboration between multiple professions in healthcare and community-based settings. Social determinants in underserved communities create additional barriers to receiving care. This creates an uneven distribution of diabetes risks, incidence, and control. Challenges to receiving care have been categorized as three C’s: concern (e.g., medical mistrust), convenience (e.g., barriers to access), and complacency (e.g., limited capacity to make lifestyle changes). Federally qualified health centers (FQHCs) play a key role in brokering linkages between healthcare specialists and community-based trusted messengers to address these challenges. FQHCs serve patient populations in communities with high rates of diabetes and work to address barriers to care through beneficial community-clinical linkages. FQHCs are located in community settings and recruit staff that reflect the diversity of their communities. In this study, we plan to evaluate community-based diabetes programs in two FQHCs that serve similar populations, but in different regions of northern Illinois. Both organizations have programs that embed specialists into community settings. The first brings FQHC has an endocrinologist onsite once per week. The second engages pharmacy teams in community-based care. The goal of this study is to evaluate the impact of these FQHC programs, including best practices for engaging Black and Hispanic/Latino patients. Our mixed-method design is grounded in CBPR, which values people’s lived experiences and integrates their expertise into the understanding of community-based phenomena. As part of this study, we will first leverage clinical data and a quasi-experimental setting to measure the impact of these programs on patients’ diabetes control (e.g., A1c values) and care plan adherence. We will use difference-in-differences models to see whether engaging in an FQHC-sponsored diabetes program in a community setting is associated with better A1c control than similar care in a clinical setting. Building on the quantitative findings, we will host a series of interviews with patients to further understand how patients navigate complex diabetes care and the barriers they experience when doing so. In addition, we will plan to distribute a scenario-based survey to develop a scale for assessing potential barriers to diabetes care and the tactics for overcoming those barriers. This survey will ask participants to make tradeoffs between different factors to understand the aspects of different programs that make them more or less successful. Finally, we will conduct focus groups with key stakeholders and community leaders to understand the sustainability of these programs. The successful completion of this study will enhance our understanding of the impact of diabetes treatment location on patient outcomes and provide insight into what aspects of the program contribute to program effectiveness. We will learn how FQHCs create linkages to diabetes care for community members.