Community-Clinical Integration in the Connecticut Medicaid Context

It is well established that interventions that address social determinants of health (SDHs) are an optimal strategy to improve health equity, however the efficacy of these interventions is limited by the challenges of addressing SDHs in clinical care. As a result, building linkages between clinical providers and community-based providers of social services, formally known as community-clinical integration, is crucial to helping vulnerable populations achieve holistic, long-term health. Our team employed a mixed-methods design to understand community-clinical integration in the Connecticut Medicaid context. We conducted a realist literature review to identify models of community-clinical integration throughout the United States. We supplemented our literature review with 7 semi-structured interviews with staff from federally qualified health centers to identify best practices for and barriers to integrating community-based services into clinical care. Using insights gained from our literature review and qualitative interviews, we provide a set of recommendations to improve community-clinical integration implementation for Medicaid enrolled children and families throughout Connecticut.https://elischolar.library.yale.edu/ysph_pbchrr/1025/thumbnail.jp

Documenting the Impact of a Food Pantry Program in Promoting Stability and Independence Among New Haven Residents

An estimated 22% of New Haven residents live with food insecurity. This means more than 1 in 5 residents of New Haven do not have enough food or enough money to buy food. Notably, issues of food insecurity disproportionately affect people of color and those of lower socioeconomic status, therefore exacerbating disparities in health issues related to food insecurity.2 Christian Community Action (CCA) is a local social service organization that provides housing, financial assistance, food, and other support services for low-income New Haven residents. Their food pantry program, which operates on an appointment-only basis, has regularly provided food to over 80 individuals and families in the New Haven area. CCA is interested in identifying areas for improvement to strengthen their service provision and are also collecting data to bolster their advocacy efforts. The objectives of this project are as follows: 1. Assess satisfaction amongst users of a food pantry program in New Haven. 2. Develop a sustainable method for obtaining and incorporating feedback for quality improvement processes. 3. Strengthen understanding of how usage of CCA’s food pantry promotes stability and independence among food pantry users.https://elischolar.library.yale.edu/ysph_pbchrr/1030/thumbnail.jp

Accelerometer-Measured Physical Activity And Sedentary Time Among Samoan Adults And Associations With Type 2 Diabetes And Hypertension

Objectives: (1) To describe accelerometer-measured physical activity among Samoan adults; (2) to determine associations between physical activity and type 2 diabetes and hypertension; and (3) to assess adherence to global physical activity recommendations. Participants: Three hundred eighty-five Samoan adults aged 30-72 years. Setting: Participants were recruited from 23 villages on the Samoan island of ‘Upolu (eight urban, seven peri-urban, and eight rural). Measurements: Self-reported demographic information including age, census region of residence, and occupation was collected. Anthropometric measurements including weight and height were taken in light island clothing, and body mass index was calculated. Sedentary time, light-intensity physical activity, and moderate-to-vigorous intensity physical activity (MVPA) were measured using wrist-worn ActiGraph GT3X+ accelerometers. Outcomes: Type 2 diabetes was defined as measured hemoglobin A1c ≥ 6.5%, fasting glucose ≥ 126 mg/dL, or self-reported use of diabetes medication. Hypertension was defined as blood pressure ≥ 140/90 mmHg or self-reported use of hypertension medication. Adherence to global physical activity recommendations was defined as ≥ 150 minutes of moderate physical activity or ≥ 75 minutes of vigorous physical activity in a 7-day period. Results: The sample was 54.5% female, and mean age was 52 years (s.d.10.1). Older age and lower education level were significantly associated with higher mean minutes of sedentary time per day. Younger age and peri-urban (compared to urban) census region of residence were significantly associated with higher mean daily minutes of MVPA. Type 2 diabetes and hypertension were significantly associated with higher daily mean minutes of sedentary time and lower daily mean minutes of MVPA. Sixty or more minutes of MVPA per day was significantly associated with lower odds of type 2 diabetes after adjusting for age, occupation, genotype, and average minutes of weartime. Hypertension and mean daily minutes of MVPA were not significantly associated following adjustment for age and weartime. In a sub-analysis of 234 participants, over 85% of participants met global physical activity recommendations. Adherence to recommendations was significantly associated with younger age and no diabetes or hypertension status. Conclusions: This study is the first to describe objectively-measured physical activity among a sample of Samoan adults. Findings suggest that current global physical activity recommendations may not be appropriate in this setting where obesity prevalence and caloric intake are high. Longitudinal follow-up is warranted. Key Words: Samoa, accelerometry, global physical activity recommendations, type 2 diabetes, hypertension, physical activity Abbreviations: LPA, light-intensity physical activity; MVPA, moderate-to-vigorous intensity physical activity; HbA1c, hemoglobin A1