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. 2023 Feb 27;18(2):e0279230.
doi: 10.1371/journal.pone.0279230. eCollection 2023.

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

Nancy Fullman  1 , Krycia Cowling  2 , Luisa S Flor  1 , Shelley Wilson  1 , Paurvi Bhatt  3 , Miranda F Bryant  1 , Joseph N Camarda  1 , Danny V Colombara  4 , Jessica Daly  3 , Rose K Gabert  5 , Katie Panhorst Harris  1 , Casey K Johanns  1 , Charlie Mandile  6 , Susan Marshall  7 , Claire R McNellan  8 , Vasudha Mulakaluri  1 , Bryan K Phillips  9 , Marissa B Reitsma  1 , Naomi Sadighi  10 , Tsega Tamene  11 , Blake Thomson  12 , Alexandra Wollum  13 , Emmanuela Gakidou  1
Affiliations

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

Nancy Fullman et al. PLoS One. .

Abstract

Background: 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.

Methods and findings: 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.

Conclusions: 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.

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Conflict of interest statement

PB and JD are employees of the Medtronic Foundation. CM, SM, NS, and TT are recipients of HealthRise grants from the Medtronic Foundation to implement HealthRise interventions. NF, KC, LSF, SW, MFB, JNC, DVC, RKG, KPH, CKJ, CRM, VM, BKP, MBR, BT, AW, and EG are recipients of funding from grants from the Medtronic Foundation to evaluate HealthRise interventions. There are no associated patents, products, or marketed products associated with this research. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. HealthRise patient shifts in disease severity categories between baseline and endline based on biometric readings for hypertension (A) and diabetes (B).
The height of each column reflects 100% of patients at each time point (baseline and endline), while the categories within each column represents the percentage of patients in each category at baseline and endline. Patient groups are color-coded by their categorization at endline (right column per site) and flow from their categorization at baseline (left column per site). By category percentages, for each site, are available in S1 Data.
See this image and copyright information in PMC

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