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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Study protocol

Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border

Authors: Abby M. Lohr, Maia Ingram, Scott C. Carvajal, Kevin Doubleday, Benjamin Aceves, Cynthia Espinoza, Floribella Redondo, Gloria Coronado, Cassalyn David, Melanie L. Bell

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities.

Methods

The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice.

Discussion

The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection.

Trial registration

This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018.
Appendix
Available only for authorised users
Literature
1.
Bureau of C. Projections of the Size and Composition of the U.S. Population: 2014–60: current population reports. Series P−25: population estimates and projections; 2015 ASI 2546–3.194;census P-25, no. 1143. 2015. Contract No.: Report.
2.
3.
American Diabetes Association. Improving care and promoting health in populations: standards of medical Care in Diabetes. Diabetes Care. 2018;41(Supplement 1):S7–S12.CrossRef
4.
O'Brien MJ, Alos VA, Davey A, Bueno A, Whitaker RC. Acculturation and the prevalence of diabetes in US Latino adults, National Health and nutrition examination survey 2007–2010. Preventing chronic disease, vol. 11; 2014. p. E176.
5.
Daviglus ML, Talavera GA, Aviles-Santa ML, Allison M, Cai J, Criqui MH, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. Jama. 2012;308(17):1775–84.CrossRef
6.
Strine TW, Chapman DP, Balluz LS, Moriarty DG, Mokdad AH. The associations between life satisfaction and health-related quality of life, chronic illness, and health behaviors among U.S. community-dwelling adults. J Community Health. 2008;33(1):40–50.CrossRef
7.
8.
Stewart AL, Greenfield S, Hays RD, Wells K, Rogers WH, Berry SD, et al. Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. Jama. 1989;262(7):907–13.CrossRef
9.
10.
Ruggiero L, Castillo A, Quinn L, Hochwert M. Translation of the diabetes prevention program's lifestyle intervention: role of community health workers. Current Diabetes Report. 2012;12(2):127–37.CrossRef
11.
Meister J, Giuliano A, Saltzman S, Abrahamsen M, Hunter J, de la Ossa E. Community health Workers at the U.S.-Mexico border – effectiveness of a Cancer prevention/education intervention. Women & Cancer. 1999;1(5):25–34.
12.
Warrick L, Wood A, Meister J, et al. Evaluation of a peer health worker prenatal outreach and education program for Hispanic farmworker families. J Community Health. 1992;17(1):13–26.CrossRef
13.
Margolis K, Lurie N, McGovern P, Tyrrell M, Slater J. Increasing breast and cervical Cancer screening in low-income women. J Intern Med. 1998;13(8):515–21.
14.
Hunter J, Guernsey de Zapien J, Papenfuss M, Fernandez M, Meister J, Giuliano A. The impact of a Promotora on increasing routine chronic disease prevention among women 40 years of age and older at the U.S.-Mexico border. Health Educ Behav. 2004;31(4):18S–28S.CrossRef
15.
Larkey LK, Herman PM, Roe DJ, Garcia F, Lopez AM, Gonzalez J, et al. A cancer screening intervention for underserved Latina women by lay educators. Journal of women's health (2002). 2012;21(5):557–66.CrossRef
16.
Staten LK, Scheu LL, Bronson D, Peña V, Elenes J. Pasos Adelante: the effectiveness of a community-based chronic disease prevention program. Prev Chronic Dis. 2005;2(1):A18.PubMed
17.
18.
Norris S, Chowdhury F, Van Let K, Horsley T, Brownstein J, Zhang X, et al. Effectiveness of community health Workers in the Care of persons with diabetes. Diabet Med. 2006;23:544–56.CrossRef
19.
Ingram M, Gallegos G, Elenes J. Diabetes is a community issue: the critical elements of a successful outreach and education model on the US-Mexico Border1; 2004.
20.
Lachance LL, Friedman Milanovich AR, Garrity AN. Clinic and community: the road to integration. Am J Prev Med. 2016;51(6):1072–8.CrossRef
21.
22.
Porterfield DS, Hinnant LWP, Kane HP, Horne JBA, McAleer KM, Roussel AP. Linkages between clinical practices and community organizations for prevention. Am J Prev Med. 2012;42(6):S163–S71.CrossRef
23.
Lohr AM, Ingram M, Nuñez AV, Reinschmidt KM, Carvajal SC. Community–clinical linkages with community health Workers in the United States: a scoping review. Health Promot Pract. 2018;19(3):349–60.CrossRef
24.
Balasubramanian BA, Cohen DJ, Clark EC, Isaacson NF, Hung DY, Dickinson LM, et al. Practice-level approaches for behavioral counseling and patient health behaviors. Am J Prev Med. 2008;35(5):S407–S13.CrossRef
25.
Etz RS, Cohen DJ, Woolf SH, Holtrop JS, Donahue KE, Isaacson NF, et al. Bridging primary care practices and communities to promote healthy behaviors. Am J Prev Med. 2008;35(5):S390–S7.CrossRef
26.
Van Brunt D. Community health records: establishing a systematic approach to improving social and physical determinants of health. Am J Public Health. 2017;107(3):407–12.CrossRef
27.
28.
Wiggins N, Kaan S, Rios-Campos T, Gaonkar R, Morgan ER, Robinson J. Preparing community health workers for their role as agents of social change: experience of the community capacitation center. J Community Pract. 2013;21(3):186–202.CrossRef
29.
Ingram M, Sabo S, Rothers J, Wennerstrom A, de Zapien JG. Community health workers and community advocacy: addressing health disparities. J Community Health. 2008;33(6):417–24.CrossRef
30.
Quigley L, Matsuoka KY, Montgomery KL, Khanna N, Nolan T. Workforce development in Maryland to promote clinical-community connections that advance payment and delivery reform. J Health Care Poor Underserved. 2014;25(1):19–29.CrossRef
31.
Reinschmidt KM, Ingram M, Morales S, Sabo SJ, Blackburn J, Murrieta L, et al. Documenting community health worker roles in primary care: contributions to evidence-based integration into health care teams, 2015. Journal of Ambulatory Care Management. 2017;40(4):305–15.CrossRef
32.
Ingram M, Doubleday K, Bell ML, Lohr A, Murrieta L, Velasco M, et al. Community health worker impact on chronic disease outcomes within primary care examined using electronic health records. Am J Public Health. 2017;107(10):1668–74.CrossRef
33.
Sabo S, Ingram M, Reinschmidt KM, Schachter K, Jacobs L, De Zapien JG, et al. Predictors and a framework for fostering community advocacy as a community health worker core function to eliminate health disparities. Am J Public Health. 2013;103(7):e67–73.CrossRef
34.
Malcarney MB, Pittman P, Quigley L, Horton K, Seiler N. The changing roles of community health workers. Health Serv Res. 2017;52(1):360–82.CrossRef
35.
Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. Bmj. 2013;346:e7586.CrossRef
36.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj. 2014;348:g1687.CrossRef
37.
Ricardo AC, Hacker E, Lora CM, Ackerson L, DeSalvo KB, Go A, et al. Validation of the kidney disease quality of life short form 36 (KDQOL-36™) US Spanish and English versions in a cohort of hispanics with chronic kidney disease. Ethn Dis. 2013;23(2):202.PubMedPubMedCentral
38.
González P, Nuñez A, Merz E, Brintz C, Weitzman O, Navas EL, et al. Measurement properties of the Center for Epidemiologic Studies Depression Scale (ces-d 10): findings from Hchs/sol. Psychol Assess. 2017;29(4):372.CrossRef
39.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRef
40.
41.
42.
43.
Hasnain M, Male G, Mullner R. Mortality, Major Causes in the United States: Encyclopedia of Health Services Research; 2009.CrossRef
44.
Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, et al. A short social support measure for patients recovering from myocardial infarction: the ENRICHD social support inventory. Journal of Cardiopulmonary Rehabilitation and Prevention. 2003;23(6):398–403.CrossRef
45.
Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the state Hope scale. J Pers Soc Psychol. 1996;70(2):321.CrossRef
46.
Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D. Am J Prev Med. 1994;10(2):77–84.CrossRef
47.
Elstad J, Pedersen A. The impact of relative poverty on Norwegian adolescents’ subjective health: a causal analysis with propensity score matching. Int J Environ Res Public Health. 2012;9:4715–31.CrossRef
48.
Carvajal SC, Miesfeld N, Chang J, Reinschmidt KM, de Zapien JG, Fernandez ML, Rosales C, Staten LK. Evidence for long-term impact of Pasos Adelante: using a community-wide survey to evaluate chronic disease risk modification in prior program participants. Int J Environ Res Public Health. 2013;10(10):4701–17.CrossRef
49.
Rubin DB. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. Stat Med. 2007;26(1):20–36.CrossRef
50.
Danaei G, Rodriguez LA, Cantero OF, Logan R, Hernan MA. Observational data for comparative effectiveness research: an emulation of randomised trials of statins and primary prevention of coronary heart disease. Stat Methods Med Res. 2013;22(1):70–96.CrossRef
51.
Austin P. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res. 2011;46(3):399–424.CrossRef
52.
Austin PC. A comparison of 12 algorithms for matching on the propensity score. Stat Med. 2014;33(6):1057–69.CrossRef
53.
Grove R, Hoekstra RA, Wierda M, Begeer S. Special interests and subjective wellbeing in autistic adults. Autism Res. 2018;11(5):766–75.CrossRef
54.
Fitzmaurice G, Laird N, Ware J. Applied longitudinal analysis. Hoboken, New Jersey: Johnn Wiley & Sons 2011.
55.
Sabo S, Wennerstrom A, Phillips D, Haywoord C, Redondo F, Bell ML, et al. Community health worker professional advocacy. Journal of Ambulatory Care Management. 2015;38(3):225–35.CrossRef
56.
Ingram M. A community health worker intervention to address the social determinants of health through policy change. J Prim Prev. 2014;35(2):119–24.CrossRef
57.
Ross ME, Kreider AR, Huang Y-S, Matone M, Rubin DM, Localio AR. Propensity score methods for analyzing observational data like randomized experiments: challenges and solutions for rare outcomes and exposures. Am J Epidemiol. 2015;181(12):989–95.CrossRef
58.
Danaei G, Rodríguez LAG, Cantero OF, Logan RW, Hernán MA. Electronic medical records can be used to emulate target trials of sustained treatment strategies. J Clin Epidemiol. 2018;96:12–22.CrossRef
59.
Trickett EJ, Beehler S, Deutsch C, Green LW, Hawe P, McLeroy K, et al. Advancing the science of community-level interventions. Am J Public Health. 2011;101(8):1410–9.CrossRef
60.
Adachi-Mejia A, Reinschmidt, K.M., Lohr, A., Borawski, E.A., Kelly, S. and Petrescu-Prahova, MG. Community-clinical linkage projects across the Prevention Research Center network: Strategies and lessons learned. American public health association annual meeting; Atlanta, GA U.S.2017.
61.
Westfall JM, Mold J, Fagnan L. Practice-based research—“blue highways” on the NIH roadmap. Jama. 2007;297(4):403–6.CrossRef
Metadata
Title
Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border
Authors
Abby M. Lohr
Maia Ingram
Scott C. Carvajal
Kevin Doubleday
Benjamin Aceves
Cynthia Espinoza
Floribella Redondo
Gloria Coronado
Cassalyn David
Melanie L. Bell
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6725-1

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