Addressing durable health disparities through critical time legal interventions in medically underserved Latinx and migrant communities in the United States.

通过在美国医疗服务不足的拉丁裔和移民社区的关键时刻进行法律干预，解决持久的健康差距。

• 批准号: 10778961
• 负责人: MIGUEL A MUNOZ-LABOY
• 金额: $ 81.2万
• 依托单位: STATE UNIVERSITY NEW YORK STONY BROOK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10778961
• 关键词: Address; Affect; Asthma; Award; Awareness; COVID-19; Cardiovascular system; Caribbean region; Caring; Clinic; Clinical; Communicable Diseases; Communities; Community Health; Consolidated Framework for Implementation Research; Continuity of Patient Care; Costs and Benefits; Data; Development; Diabetes Mellitus; Disability Insurance; Discrimination; Domestic Violence; Early Diagnosis; Education; Employment; Ensure; Epidemic; Evidence based intervention; Fatigue; Federally Qualified Health Center; Food Access; Gills; HIV; Health; Health Insurance; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Housing; Hybrids; Hypertension; Individual; Insurance; Insurance Coverage; Intervention; Latin America; Latino; Latinx; Lead; Legal; Legal Intervention; Long Island; Low income; Medicaid; Medicaid services; Medical; Medical center; Mental Depression; Mental Health; Metabolic; Migrant; Modeling; Neighborhood Health Center; New York; Outcome; Pain; Patient-Focused Outcomes; Patients; Perceived quality of life; Persons; Population; Primary Care; Public Health Schools; Puerto Rico; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Reduce health disparities; Reporting; Research Personnel; Resources; Risk Factors; Safety; Schools; Service delivery model; Services; Severities; Social Welfare; Substance Use Disorder; System; Testing; Time; Translations; United States; United States National Institutes of Health; Universities; Work; Workplace; alcohol use disorder; arm; barrier to care; care outcomes; cluster randomized design; community engagement; cost effective; effectiveness testing; effectiveness/implementation trial; enhancing factor; experience; food security; global health; health care delivery; health care service; health disparity; health equity; health inequalities; implementation outcomes; implementation science; implementation strategy; improved; innovation; marginalization; marginalized community; marginalized population; medical schools; medically underserved; medically underserved population; migration; patient-clinician communication; physical conditioning; prevent; primary care patient; primary care provider; professional atmosphere; programs; prototype; research study; scale up; social; social determinants; standard of care; systemic barrier; underserved community; urban setting; vulnerable community; Address; Affect; Asthma; Award; Awareness; COVID-19; Cardiovascular system; Caribbean region; Caring; Clinic; Clinical; Communicable Diseases; Communities; Community Health; Consolidated Framework for Implementation Research; Continuity of Patient Care; Costs and Benefits; Data; Development; Diabetes Mellitus; Disability Insurance; Discrimination; Domestic Violence; Early Diagnosis; Education; Employment; Ensure; Epidemic; Evidence based intervention; Fatigue; Federally Qualified Health Center; Food Access; Gills; HIV; Health; Health Insurance; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Housing; Hybrids; Hypertension; Individual; Insurance; Insurance Coverage; Intervention; Latin America; Latino; Latinx; Lead; Legal; Legal Intervention; Long Island; Low income; Medicaid; Medicaid services; Medical; Medical center; Mental Depression; Mental Health; Metabolic; Migrant; Modeling; Neighborhood Health Center; New York; Outcome; Pain; Patient-Focused Outcomes; Patients; Perceived quality of life; Persons; Population; Primary Care; Public Health Schools; Puerto Rico; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Reduce health disparities; Reporting; Research Personnel; Resources; Risk Factors; Safety; Schools; Service delivery model; Services; Severities; Social Welfare; Substance Use Disorder; System; Testing; Time; Translations; United States; United States National Institutes of Health; Universities; Work; Workplace; alcohol use disorder; arm; barrier to care; care outcomes; cluster randomized design; community engagement; cost effective; effectiveness testing; effectiveness/implementation trial; enhancing factor; experience; food security; global health; health care delivery; health care service; health disparity; health equity; health inequalities; implementation outcomes; implementation science; implementation strategy; improved; innovation; marginalization; marginalized community; marginalized population; medical schools; medically underserved; medically underserved population; migration; patient-clinician communication; physical conditioning; prevent; primary care patient; primary care provider; professional atmosphere; programs; prototype; research study; scale up; social; social determinants; standard of care; systemic barrier; underserved community; urban setting; vulnerable community

PROJECT SUMMARY Intersecting epidemics such as cardio-vascular conditions (e.g., hypertension), communicable diseases (e.g., COVID-19, HIV), metabolic conditions (e.g., diabetes), mental health and substance use disorders (e.g., co- occurring alcohol use disorder and depression) have tested the limits of healthcare systems in historically marginalized communities such as Latinx and migrant populations in the United States. The early detection and severity of the above conditions in medically underserved communities are aggravated by systemic barriers to primary care and detention. In this study, we proposed that providing legal services within primary care can enhance healthcare delivery efficiency through addressing legal needs (such as barriers to health insurance, medical treatments, housing safety, employment stability, and other legal needs) that can disrupt care to patients. The proposed study, led by the SBU School of Social Welfare and SBU Center for Changing Systems of Power, together with the GWU School of Public Health's Gill-Lebovic Center for Community Health in the Caribbean and Latin America, the University of Puerto Rico's Social Determinants Center, the National Center for Medical Legal Partnerships, UCF School of Medicine's Implementation Science Lab, and six federally qualified health centers; will precisely examine the effects of legal services on primary care outcomes for medically underserved communities. We will conduct a hybrid type II effectiveness-implementation trial with a cluster randomized design in 6 federally qualified health centers (FQHCs) in Orlando, FL, New York/Long Island, NY and San Juan, PR to test a Critical-time Intervention Medical Legal Partnership (CTI-MLP) approach compared to the standard of care. Three FQHCs will receive a CTI-MLP approach that includes provision of legal aid and capacity building through team-facing legal support. The other three FQHCs will receive legal education and awareness, including information about community-based legal organizations. Over a 12-month period, the team will collect (1) patients' health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life; (2) data on legal needs and risk factors (3) longitudinal patient clinical outcomes (N=960); and (4) FQHC staff (N=180) and clinic-level indicators, including provider-patient communication and readiness for continued implementation and sustainability. We will assemble a Latinx and migrant community advisory board and a scientific advisory board with medical-legal partnership expertise. Active engagement will ensure the effective translation and dissemination of our findings into practice. With new Medicaid models emerging that offer reimbursement for some social care provision, state officials can also use data to consider expansion of Medicaid services to include the coordination and provision of social and legal services. Completion of this project will result in an innovative, evidence-based intervention package to improve health outcomes for highly vulnerable communities.

项目摘要 相交的流行病，例如心血管疾病（例如高血压），传染病（例如， Covid-19，HIV），代谢状况（例如糖尿病），心理健康和药物使用障碍（例如，共同 发生酒精疾病和抑郁症）已经测试了历史上医疗保健系统的限制 在美国，拉丁裔和移民人口等边缘化社区。早期检测和 系统障碍加剧了上述条件的严重性。 初级保健和拘留。在这项研究中，我们建议在初级保健中提供法律服务可以 通过满足法律需求来提高医疗保健效率（例如健康保险障碍， 可以破坏患者护理的医疗治疗，住房安全，就业稳定和其他法律需求。 拟议的研究，由SBU社会福利学院和SBU中心领导，用于改变权力系统， 与GWU公共卫生学院的Gill-Lebovic Center for Caribbean和 拉丁美洲，波多黎各大学的社会决定因素中心，国家医疗法律中心 合作伙伴关系，UCF医学学院的实施科学实验室和六个具有联邦合格的卫生中心； 将精确检查法律服务对医学欠缺欠缺的初级保健结果的影响 社区。我们将使用群集随机设计进行一项混合II型有效性试验 在奥兰多，佛罗里达州，纽约/纽约州长岛和圣胡安的6个联邦资格卫生中心（FQHC）中 与标准相比 关心。三个FQHC将获得CTI-MLP方法，其中包括提供法律援助和能力建设 通过面向团队的法律支持。其他三个FQHC将接受法律教育和意识，包括 有关社区法律组织的信息。在12个月的时间里，团队将收集（1） 患者的健康和功能，包括整体身体健康，心理健康，社会健康，疼痛，疲劳以及 总体感知的生活质量； （2）有关法律需求和风险因素的数据（3）纵向患者临床结果 （n = 960）; （4）FQHC工作人员（n = 180）和诊所级指标，包括提供者 - 患者交流和 准备继续实施和可持续性。我们将组建一个拉丁裔和移民社区 顾问委员会和医学法律合作伙伴专业知识的科学顾问委员会。积极参与将 确保我们发现的有效翻译和传播。使用新的医疗补助模型 新兴的报价为某些社会护理提供的报销，州官员还可以使用数据来考虑 扩大医疗补助服务以包括社会和法律服务的协调和提供。完成 该项目将导致创新的，基于证据的干预措施，以改善健康状况 高度脆弱的社区。