Protocol for LINKS (linking individual needs to community and clinical services): a prospective matched observational study of a community health worker community clinical linkage intervention on the U.S.-Mexico border

Abstract

Background Latinos are currently the largest and fastest growing racial/ethnic group in the United States and have the lowest rates nationally of regular sources of primary care. The changing demographics of Latino populations have significant implications for the future health of the nation, particularly with respect to chronic disease. Community-based agencies and clinics alike have a long history of engaging community health workers (CHWs) to provide a broad range of tangible and emotional support strategies for Latinos with chronic diseases. In this paper, we present the protocol for a community intervention designed to evaluate the impact of CHWs in a Community-Clinical Linkage model to address chronic disease through innovative utilization of electronic health records (EHRs) and application of mixed methodologies. Linking Individual Needs to Community and Clinical Services (LINKS) is a 3-year, prospective matched observational study designed to examine the feasibility and impact of CHW-led Community-Clinical Linkages in reducing chronic disease risk and promoting emotional well-being among Latinos living in three U.S.-Mexico border communities. Methods The primary aim of LINKS is to create Community-Clinical Linkages between three community health centers and their respective county health departments in southern Arizona. Our primary analysis is to examine the impact of the intervention 6 to 12-months post program entry. We will assess chronic disease risk factors documented in the EHRs of participants versus matched non-participants. By using a prospective matched observational study design with EHRs, we have access to numerous potential comparators to evaluate the intervention effects. Secondary analyses include modeling within-group changes of extended research-collected measures. This approach enhances the overall evaluation with rich data on physical and emotional well-being and health behaviors of study participants that EHR systems do not collect in routine clinical practice. Discussion The LINKS intervention has practical implications for the development of Community-Clinical Linkage models. The collaborative and participatory approach in LINKS illustrates an innovative evaluation framework utilizing EHRs and mixed methods research-generated data collection. Trial registration This study protocol was retrospectively registered, approved, and made available on Clinicaltrials.gov by NCT03787485 as of December 20, 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-6725-1) contains supplementary material, which is available to authorized users.

Linking cohort-based data with electronic health records: a proof-of-concept methodological study in Hong Kong

“…It is also very important to assess the validity and practicability of the record-linkage beforehand to make sure that it is useful for researchers. 6 In many countries including Australia, 7 the USA, 8 Scotland, 9 New Zealand, 10 China 11 etc, data linkage has been practised in medical and social research.…”

A Community Health Worker–Led Community–Clinical Linkage Model to Address Emotional Well-Being Outcomes Among Latino/a People on the US–Mexico Border

“…Therefore, in Santa Cruz County, we formed a community–clinical linkage across clinic departments. Details on LINKS methodology are available elsewhere ( 6 ). Our research was approved by the University of Arizona Institutional Review Board.…”

“…Although the terms mental health and emotional well-being are often used synonymously, our study team used the construct of emotional well-being. Emotional well-being has been defined as the perception among people that “their lives are going well,” including “the quality of their relationships, their positive emotions and resilience, realization of their potential, or their overall satisfaction with life — ie, their ‘well-being’” ( 6 , 7 ). Emotional well-being stems from a broad, comprehensive view of health that includes positive outcomes and traditionally reviewed indicators such as quality of life.…”

Examining Associations between Community Health Worker-Rated Health and Mental Health among Latino Adults with Chronic Disease

“…Data for the current study were derived from baseline assessment data of the Linking Individual Needs to Community and Clinical Services (LINKS) study, assessing a community-clinical intervention to improve chronic disease risk and emotional well-being among Latinos in three predominantly Mexican-origin communities. Full details on study protocols are published elsewhere [ 33 ]. To complete the baseline assessment questions, participants met with a community-based CHW at each of the three sites who facilitated the assessment in English or Spanish.…”