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

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.

项目概要 交叉流行病，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）、心理健康和物质使用障碍（例如共存） 发生的酒精使用障碍和抑郁症）在历史上已经测试了医疗保健系统的极限 边缘化社区，例如美国的拉丁裔和移民人口。及早发现和 在医疗服务不足的社区，上述情况的严重性因系统性障碍而加剧 初级护理和拘留。在这项研究中，我们提出在初级保健中提供法律服务可以 通过解决法律需求（例如健康保险障碍、 医疗、住房安全、就业稳定性和其他法律需求）可能会扰乱对患者的护理。 这项拟议的研究由 SBU 社会福利学院和 SBU 电力系统变革中心牵头， 与乔治华盛顿大学公共卫生学院的吉尔-勒博维奇加勒比地区社区卫生中心一起 拉丁美洲，波多黎各大学社会决定因素中心，国家医疗法律中心 合作伙伴、UCF 医学院的实施科学实验室和六个联邦合格的健康中心； 将精确研究法律服务对医疗服务不足的初级保健结果的影响 社区。我们将采用整群随机设计进行混合 II 型有效性实施试验 在佛罗里达州奥兰多、纽约州/长岛和波多黎各州圣胡安的 6 个联邦合格健康中心 (FQHC) 中 与标准相比，测试关键时间干预医疗法律合作伙伴关系 (CTI-MLP) 方法 关心。三个 FQHC 将接受 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 个月的时间内，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、疲劳和 总体感知生活质量； (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) 和诊所层面的指标，包括提供者与患者的沟通和 为持续实施和可持续性做好准备。我们将组建一个拉丁裔和移民社区 顾问委员会和具有医疗法律合作专业知识的科学顾问委员会。积极参与将 确保我们的研究结果有效转化和传播到实践中。有了新的医疗补助模式 新兴的一些社会护理服务提供报销，国家官员还可以使用数据来考虑 扩大医疗补助服务，包括协调和提供社会和法律服务。完成 该项目将产生一个创新的、基于证据的干预方案，以改善健康结果 高度脆弱的社区。