Community health workers as change agents in improving equity in birth outcomes in Detroit.

We examined whether pairing pregnant women with community health workers improved pregnancy outcomes among 254 Black women with singleton pregnancies participating in the Women-Inspired Neighborhood (WIN) Network: Detroit using a case-control design. A subset (N = 63) of women were recontacted and asked about program satisfaction, opportunities, and health behaviors. Michigan Vital Statistics records were used to ascertain controls (N = 12,030) and pregnancy and infant health outcomes. Logistic and linear regression were used to examine the association between WIN Network participation and pregnancy and infant health outcomes. The WIN Network participants were less likely than controls to be admitted to the neonatal intensive care unit (odds ratio = 0.55, 95% CI 0.33-0.93) and had a longer gestational length (mean difference = 0.42, 95% CI 0.02-0.81). Community health workers also shaped participants' view of opportunities to thrive. This study demonstrates that community health workers can improve pregnancy outcomes for Black women.

Patient and Family Engaged Care: An Essential Element of Health Equity.

In this paper, we emphasize and explore health equity as an integral component of a culture of patient and family engaged care (PFEC), rather than an isolated or peripheral outcome. To examine the role of PFEC in addressing health inequities, we build on the 2017 NAM Perspectives discussion paper "Harnessing Evidence and Experience to Change Culture: A Guiding Framework for Patient and Family Engaged Care." Informed by both scientific evidence and the lived experience of patients, their care partners, practitioners, and health system leaders, the paper by Frampton et al. introduced a novel Guiding Framework that delineates critical elements that work together to co-create a culture of PFEC, while also depicting a logical sequencing for implementation that facilitates progressive change and improvement toward the Quadruple Aim outcomes of better culture, better care, better health, and lower costs. In this paper, the authors highlight the need to integrate addressing health and health care disparities and improving health equity as core components of the framework to ensure the culture and policy changes necessary to meaningfully engage patients, health system staff, families, and communities.

Socioeconomic and Racial Disparities: a Case-Control Study of Patients Receiving Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.

BACKGROUND: We sought to quantify socioeconomic disparities in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) at an urban, tertiary referral center. METHODS: This retrospective case-control study identified 67 patients with severe AS (aortic valve [AV] area ≤1 cm2 or AV area index ≤0.60 cm2/m2 or AV velocity ≥40 mmHg) who underwent TAVR from November 5, 2013 to June 10, 2014. Study subjects were matched to controls with severe AS without TAVR in a 4:1 age-frequency match. Demographic data were collected using electronic medical records. Area-based median household income was obtained by geocoding patients' addresses and linking with census data. Charlson comorbidity index for all subjects was calculated. RESULTS: Income disparity was significant in that with every $10,000 increase in income, the odds of receiving TAVR increased by 10% (p = 0.05). Non-blacks were significantly more likely to receive TAVR than blacks (odds ratio [OR] 2.812, confidence interval [CI] 1.007-7.853; p = 0.048). No differences in comorbidities were found between the two groups. Post hoc analysis to identify etiologies of the found disparities examined differences of AV area and AV area index, indication for two-dimensional echocardiography (echo), symptoms prior to echo, and action after echo within the control group. Black race significantly impacted the TAVR status despite the same AV area (OR 0.33, CI 0.09-0.97, p = 0.043). After echo, blacks were more likely to decline AVR, be lost to follow-up, and not be referred to cardiology (OR 4.41, CI 1.43-13.64; p = 0.010). CONCLUSION: Socioeconomic and racial disparities were associated with patients with severe AS receiving TAVR at a major referral center. This study emphasizes the importance of improving access to standard of care for these subgroups of cardiac patients.

Using social cognitive theory to predict physical activity and fitness in underserved middle school children.

Few researchers have used social cognitive theory and environment-based constructs to predict physical activity (PA) and fitness in underserved middle-school children. Hence, we evaluated social cognitive variables and perceptions of the school environment to predict PA and fitness in middle school children (N = 506, ages 10-14 years). Using multiple regression analyses we accounted for 12% of the variance in PA and 13-21% of the variance in fitness. The best predictors of PA were barrier self-efficacy, classmate social support, and gender; whereas, only gender predicted fitness. The results affirmed the importance of barrier self-efficacy and gender differences. Our findings regarding classmate social support are some of the first to illuminate the importance of school-specific peers in promoting PA.

Screening for diabetes in an African American community: identifying characteristics associated with abnormal blood glucose readings.

OBJECTIVE: To identify characteristics associated with abnormal blood glucose readings among African Americans and to determine the potential value of a more targeted approach to community-based screenings for type 2 diabetes. METHODS: Data were collected from 7113 participants with no previous diagnosis of diabetes at mobile screening events in Detroit, Michigan. Data collected included gender, race, age, self-reported height and weight, total diabetes risk score, blood pressure, and random capillary blood glucose. RESULTS: Nearly 9% of participants had abnormal random plasma glucose readings (RPG>or=160 mg/dL). Results indicated that higher age, elevated blood pressure, and body mass index (BMI) were significantly associated with abnormal glucose readings. CONCLUSION: These findings suggest that community-based screenings for diabetes that are targeted to adults aged more than 50 years who have high blood pressure or a BMI of at least 25 may enhance detection of abnormal glucose levels among African Americans.

Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults.

OBJECTIVES: We sought to determine the effects of a community-based, culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes. METHODS: One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit, Michigan, to participate in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes lifestyle intervention. The curriculum, delivered by trained community residents, was aimed at improving dietary, physical activity, and diabetes self-care behaviors. Baseline and postintervention levels of diabetes-specific quality-of-life, diet, physical activity, self-care knowledge and behaviors, and hemoglobin A1C were assessed. RESULTS: There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge. A statistically significant improvement in A1C level was achieved among REACH Detroit program participants (P<.0001) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed (P=.160). CONCLUSIONS: A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements.

Strategies for community participation in diabetes prevention: a Detroit experience.

The African-American community has been disproportionately burdened by diabetes and its associated complications. Nearly 2.8 million African Americans have diabetes. It is essential to increase community participation in diabetes prevention and health promotion as a method to improve health disparities. To address these issues, the Center for Medical Treatment Programs in Diverse Populations (MedTEP) was developed at Henry Ford Health System. The community participatory strategies described in this paper give a framework, which health systems can use to develop community-based partnerships and improve participation of community members in diabetes prevention and diabetes-related research. The strategies include receiving guidance by community leaders, providing a service, establishing partnerships, and disseminating information to the community. It is the goal of the MedTEP Center to continue to further develop and test models of community outreach to determine the most effective approaches to improve health outcomes and sustain the gain in African-American communities.

Recruitment of African Americans with type 2 diabetes to a randomized controlled trial using three sources.

OBJECTIVES: To assess the usefulness of three sources (faith-based organizations (FBOs), health system, and community) for recruitment of African Americans with type 2 diabetes to a randomized controlled trial (RCT). DESIGN: African Americans with type 2 diabetes were recruited to a diabetes self-management program at four FBO sites. An observational study of a multifaceted recruitment strategy to enroll subjects in the RCT that evaluated the effectiveness of a diabetes self-management program and the effect of recruitment source on retention after enrollment. Self-administered demographic surveys and weekly class attendance records were collected. RESULTS: Of 184 interested individuals, 109 (59.2%) were enrolled. Of those enrolled, 60.6% recruited through the health system, 13.8% FBOs, and 19.2% the community. The highest yield was achieved through the health system. However, for both the intervention (I) and control (C) groups, respectively, participants recruited from FBOs (85.7% I; 62.5% C) were more likely to attend four or more sessions than those from the health system (75.0% I; 43.3% C) and community (55.6% I; 25.0% C). Despite similar class size, participants in the intervention group (74.5%; n = 41) were more likely to attend four or more of the seven classes than those in the delayed intervention (control group) (40.7%; n = 22). CONCLUSIONS: The findings suggest that African American adults with diabetes can be successfully recruited and retained in a racially targeted RCT conducted in FBOs. Key elements to consider are the use of a multifaceted approach for participant recruitment, particularly the benefit of health system physician involvement in recruitment since the highest yield was achieved through health system providers, and importance of site location for retention.