TY - JOUR
T1 - Cross-Sectional Associations
T2 - Social Risks and Diabetes Care Quality, Outcomes
AU - Gold, Rachel
AU - Kaufmann, Jorge
AU - Gottlieb, Laura M.
AU - Weiner, Saul J.
AU - Hoopes, Megan
AU - Gemelas, Jordan C.
AU - Torres, Cristina Huebner
AU - Cottrell, Erika K.
AU - Hessler, Danielle
AU - Marino, Miguel
AU - Sheppler, Christina R.
AU - Berkowitz, Seth A.
N1 - Funding Information:
The authors would like to thank the ASCEND (ApproacheS to CHC ImplEmeNtation of SDH Data Collection and Action) and COHERE (COntextualized care in cHcs’ Electronic health REcords) project teams and the OCHIN collaborative for the support that made these analyses possible. The manuscript content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the institutions with which the authors affiliate. The funding body did not participate in the design of the study or the writing of this manuscript. Research reported in this publication was supported by (1) the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH under Award Number R18DK114701 and (2) the National Institute on Minority Health and Health Disparities of the NIH under Award Number R01MD014886. Funding for SAB's role in the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH under Award Number K23DK109200. This work was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network. OCHIN leads the ADVANCE network in partnership with Health Choice Network, Fenway Health, and Oregon Health & Science University. ADVANCE is funded through the Patient-Centered Outcomes Research Institute, contract number RI-CRN-2020-001. SAB received payment of honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from the ASPEN Institute. No other financial disclosures were reported. Rachel Gold: Writing – original draft. Jorge Kaufmann: Writing – original draft, Methodology, Formal analysis. Laura M. Gottlieb: Methodology, Writing – review & editing, Conceptualization. Saul J. Weiner: Formal analysis, Writing – review & editing. Megan Hoopes: Methodology. Jordan C. Gemelas: Conceptualization, Writing – original draft. Cristina Huebner Torres: Writing – review & editing. Erika K. Cottrell: Conceptualization, Methodology, Writing – review & editing. Danielle Hessler: Methodology, Writing – review & editing. Miguel Marino: Formal analysis, Methodology, Writing – original draft. Christina R. Sheppler: Writing – review & editing. Seth A. Berkowitz: Conceptualization, Writing – review & editing.
Funding Information:
Research reported in this publication was supported by (1) the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH under Award Number R18DK114701 and (2) the National Institute on Minority Health and Health Disparities of the NIH under Award Number R01MD014886 . Funding for SAB's role in the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH under Award Number K23DK109200 . This work was conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network. OCHIN leads the ADVANCE network in partnership with Health Choice Network, Fenway Health, and Oregon Health & Science University . ADVANCE is funded through the Patient-Centered Outcomes Research Institute , contract number RI-CRN-2020-001 .
Publisher Copyright:
© 2022 American Journal of Preventive Medicine
PY - 2022/9
Y1 - 2022/9
N2 - Introduction: Social risks (e.g., food/transportation insecurity) can hamper type 2 diabetes mellitus (T2DM) self-management, leading to poor outcomes. To determine the extent to which high-quality care can overcome social risks’ health impacts, this study assessed the associations between reported social risks, receipt of guideline-based T2DM care, and T2DM outcomes when care is up to date among community health center patients. Methods: A cross-sectional study of adults aged ≥18 years (N=73,484) seen at 186 community health centers, with T2DM and ≥1 year of observation between July 2016 and February 2020. Measures of T2DM care included up-to-date HbA1c, microalbuminuria, low-density lipoprotein screening, and foot examination, and active statin prescription when indicated. Measures of T2DM outcomes among patients with up-to-date care included blood pressure, HbA1c, and low-density lipoprotein control on or within 6‒12 months of an index encounter. Analyses were conducted in 2021. Results: Individuals reporting transportation or housing insecurity were less likely to have up-to-date low-density lipoprotein screening; no other associations were seen between social risks and clinical care quality. Among individuals with up-to-date care, food insecurity was associated with lower adjusted rates of controlled HbA1c (79% vs 75%, p<0.001), and transportation insecurity was associated with lower rates of controlled HbA1c (79% vs 74%, p=0.005), blood pressure (74% vs 72%, p=0.025), and low-density lipoprotein (61% vs 57%, p=0.009) than among those with no reported need. Conclusions: Community health center patients received similar care regardless of the presence of social risks. However, even among those up to date on care, social risks were associated with worse T2DM control. Future research should identify strategies for improving HbA1c control for individuals with social risks. Trial Registration: This study is registered at www.clinicaltrials.gov NCT03607617.
AB - Introduction: Social risks (e.g., food/transportation insecurity) can hamper type 2 diabetes mellitus (T2DM) self-management, leading to poor outcomes. To determine the extent to which high-quality care can overcome social risks’ health impacts, this study assessed the associations between reported social risks, receipt of guideline-based T2DM care, and T2DM outcomes when care is up to date among community health center patients. Methods: A cross-sectional study of adults aged ≥18 years (N=73,484) seen at 186 community health centers, with T2DM and ≥1 year of observation between July 2016 and February 2020. Measures of T2DM care included up-to-date HbA1c, microalbuminuria, low-density lipoprotein screening, and foot examination, and active statin prescription when indicated. Measures of T2DM outcomes among patients with up-to-date care included blood pressure, HbA1c, and low-density lipoprotein control on or within 6‒12 months of an index encounter. Analyses were conducted in 2021. Results: Individuals reporting transportation or housing insecurity were less likely to have up-to-date low-density lipoprotein screening; no other associations were seen between social risks and clinical care quality. Among individuals with up-to-date care, food insecurity was associated with lower adjusted rates of controlled HbA1c (79% vs 75%, p<0.001), and transportation insecurity was associated with lower rates of controlled HbA1c (79% vs 74%, p=0.005), blood pressure (74% vs 72%, p=0.025), and low-density lipoprotein (61% vs 57%, p=0.009) than among those with no reported need. Conclusions: Community health center patients received similar care regardless of the presence of social risks. However, even among those up to date on care, social risks were associated with worse T2DM control. Future research should identify strategies for improving HbA1c control for individuals with social risks. Trial Registration: This study is registered at www.clinicaltrials.gov NCT03607617.
UR - http://www.scopus.com/inward/record.url?scp=85129680593&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85129680593&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2022.03.011
DO - 10.1016/j.amepre.2022.03.011
M3 - Article
C2 - 35523696
AN - SCOPUS:85129680593
SN - 0749-3797
VL - 63
SP - 392
EP - 402
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 3
ER -