Assessing the impact of community-based interventions on hypertension and diabetes management in three Minnesota communities: Findings from the prospective evaluation of US HealthRise programs

• Published in: PloS one 2023-02, Vol.18 (2), p.e0279230-e0279230
• Main Authors: Fullman, Nancy, Cowling, Krycia, Flor, Luisa S, Wilson, Shelley, Bhatt, Paurvi, Bryant, Miranda F, Camarda, Joseph N, Colombara, Danny V, Daly, Jessica, Gabert, Rose K, Harris, Katie Panhorst, Johanns, Casey K, Mandile, Charlie, Marshall, Susan, McNellan, Claire R, Mulakaluri, Vasudha, Phillips, Bryan K, Reitsma, Marissa B, Sadighi, Naomi, Tamene, Tsega, Thomson, Blake, Wollum, Alexandra, Gakidou, Emmanuela
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Biometrics; Blood pressure; Care and treatment; Collaboration; Community health aides; Community Health Services; Community Health Workers; Demographic aspects; Diabetes; Diabetes mellitus; Diabetes Mellitus - therapy; Diabetics; Diagnosis; Disease; Economic aspects; Enrollments; Ethnicity; Glycated Hemoglobin; Health care; Health care access; Health care disparities; Health disparities; Hemoglobin; Humans; Hypertension; Hypertension - therapy; Hypotension; Impact analysis; Medical personnel; Medicine and Health Sciences; Minnesota - epidemiology; Patients; Qualitative analysis; Research and Analysis Methods; Rice; Services; Social aspects; Socioeconomic factors; Staff participation; Sustainability
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0279230

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.