Community health centers serving a higher percentage of unhoused patients and patients who are best served in a language other than English had lower rates of diabetes control, hypertension control, or both, according to an analysis from the iPATH research team. The findings can inform initiatives to improve care in community health centers.

The report was published online ahead of print in AJPM Focus.

iPATH, an NIH Collaboratory Trial led by principal investigator Sara Singer of Stanford University, is a stepped-wedge, cluster randomized, hybrid effectiveness-implementation trial of a practice transformation strategy for type 2 diabetes in federally qualified health centers in California, Massachusetts, Ohio, and Puerto Rico. The study will evaluate the impact of the practice transformation strategy and identify process elements that influence implementation effectiveness.

In the research team’s analysis of community health center characteristics, facilities serving a large percentage of unhoused patients had lower performance for both diabetes and hypertension control. Facilities serving a large percentage of patients best served in a non-English language had poorer performance for diabetes control.

“The association between having more unhoused patients and lower performance for diabetes and hypertension management points to housing inequality as a key source of disparity,” the authors wrote. Facilities serving more unhoused patients may benefit from additional support and evidence-based healthcare strategies.

The iPATH team also found that facilities serving more patients at high risk for cardiovascular events and receiving statin therapy had better performance for diabetes management. Statin treatment is an evidence-based standard of care for the prevention of cardiovascular events in patients with diabetes.

“Our finding for cardiovascular risk management suggests that [community health centers] capable of adhering to these evidence-based standard of care guidelines for cardiovascular disease may also be able to follow therapeutic protocols more generally, and to those supporting diabetes management in particular,” the authors wrote.

iPATH is supported within the NIH Pragmatic Trials Collaboratory by the National Institute on Minority Health and Health Disparities. Learn more about iPATH.