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.

项目摘要 交叉流行病，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），精神健康和物质使用障碍（例如，共 发生酒精使用障碍和抑郁症）已经测试了历史上医疗保健系统的局限性， 边缘化社区，如拉丁裔和美国的移民人口。早期发现和 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， 初级保健和拘留。在这项研究中，我们提出，在初级保健中提供法律的服务， 通过解决法律的需求（如健康保险的障碍， 医疗、住房安全、就业稳定性和其他法律的需要），这可能会中断对患者的护理。 这项由SBU社会福利学院和SBU改变权力体系中心领导的拟议研究， 与GWU公共卫生学院的Gill-Lebovic加勒比社区卫生中心一起， 拉丁美洲、波多黎各大学社会决定因素中心、国家医学法律的中心 合作伙伴关系，UCF医学院的实施科学实验室，和六个联邦合格的健康中心; 将精确地检查法律的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、纽约州纽约/长岛和波多黎各圣胡安的6个联邦合格的健康中心（CDC）， 测试关键时间干预医疗法律的合作伙伴关系（CTI-MLP）方法，与 在乎三个难民署人道主义协调中心将接受反恐执行机构-多边伙伴关系办法，其中包括提供法律的援助和能力建设 通过面向团队的法律的支持。其他三个人权中心将接受法律的教育和认识，包括 关于社区法律的组织的信息。在12个月的时间里，该小组将收集（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 总体感知生活质量;（2）关于法律的需求和风险因素的数据;（3）纵向患者临床结局 （N=960）;和（4）CIMHC工作人员（N=180）和临床水平指标，包括提供者-患者沟通和 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 咨询委员会和一个具有医疗-法律伙伴关系专门知识的科学咨询委员会。积极参与将 确保将我们的调查结果有效地转化和传播到实践中。新的医疗补助模式 新出现的为一些社会护理提供报销的政策，州政府官员也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的服务。完成 该项目的实施将产生一个创新的、以证据为基础的干预方案， 非常脆弱的社区。