Individual-level and neighborhood-level factors associated with longitudinal changes in cardiometabolic measures in participants of a care coordination program

Abstract

IntroductionIdentifying individual and neighborhood-level factors associated with less improvement or worsening cardiometabolic measures in participants of clinic-based interventions may help identify candidates for supplementary community-based interventions.MethodsStudy design: Secondary data analysis of data from care coordination program cohort, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2). Participants: Medicare, Medicaid, or dual-eligible adults from the University of Missouri Health System enrolled in LIGHT2. Intervention: Nurse-led care coordination in ten primary care clinics. Outcomes: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed changes in outcomes after adjusting for clinical and sociodemographic factors, neighborhood-level factors, and driving time to primary care clinics.Results6378 participants had pre-and post-intervention cardiometabolic measures reported (61% women, 86.3% White, non-Hispanic ethnicity, mean age 62.7 [SD, 18.5] years). In adjusted models, pre-intervention measures and female gender were associated with worsening of all cardiometabolic measures. Women’s LDL-cholesterol worsened compared to men irrespective of pre-intervention levels (β 7.87, 95% CI 5.24 to 10.5, p<.001). Women with hemoglobin A1C> 6.8% had worsening hemoglobin A1C compared to men (main effect β −1.28, 95% CI −1.95 to −0.61, p<.001; interaction effect β 0.19, 95% CI 0.09 to 0.28, p<.001). Women with systolic blood pressure >121 mm of Hg had worsening diastolic blood pressure compared to men (main effect β −5.42, 95% CI −9.8 to 0.098, p = 0.016; interaction effect β 0.04, 95% CI 0.01 to 0.078, p = 0.009). Adding neighborhood-level factors or driving time to primary care clinics did not improve the overall fit of the models.ConclusionsIn a solely clinic-based care coordination program, increasing baseline cardiometabolic measures and female gender were associated with worsening cardiometabolic outcomes. Further research to understand the causes of these associations may help tailor clinic-community-linked interventions.