Strategies to improve chronic disease management in seven metro Boston community health centers.
BACKGROUND
The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts.


OBJECTIVE
We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers.


METHODS
Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit.


RESULTS
Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented.


CONCLUSIONS
Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.
Department of Community Health, Warren Alpert Medical School, Brown University, USA.
Chima D
CD
Ndumele
Beverley E
BE
Russell
John Z
JZ
Ayanian
Bruce E
BE
Landon
Thomas
T
Keegan
A James
AJ
O'Malley
Leroi S
LS
Hicks
D001900:Boston; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control; D019090:Case Management; D002908:Chronic Disease; D003151:Community Health Centers / Q000458:organization & administration*; D019058:Community Networks / Q000458:organization & administration*; D055812:Community-Based Participatory Research; D003299:Cooperative Behavior; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000517:prevention & control; D019468:Disease Management; D004700:Endocrine System Diseases / Q000188:drug therapy / Q000517:prevention & control; D006293:Health Promotion; D054624:Health Status Disparities; D006801:Humans; D008404:Massachusetts