Dataset Information

Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial.

ABSTRACT:

Background

Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs.

Objective

We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes.

Design

Randomized, controlled, single-blind parallel-groups.

Participants

Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population.

Interventions

Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs.

Main measures

The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined.

Key results

In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses.

Conclusions

In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed.

Trial registration

ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.

SUBMITTER: Gallo LC

PROVIDER: S-EPMC9876654 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial.

Gallo Linda C LC Fortmann Addie L AL Clark Taylor L TL Roesch Scott C SC Bravin Julia I JI Spierling Bagsic Samantha R SR Sandoval Haley H Savin Kimberly L KL Gilmer Todd T Talavera Gregory A GA Philis-Tsimikas Athena A

Journal of general internal medicine 20230125 9

<h4>Background</h4>Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs.<h4>Objective</h4>We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. ...[more]

PMID: 36697929

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Project description:BackgroundMultimorbidity affects four of ten US adults and eight of ten adults ages 65 years and older, and frequently includes both cardiometabolic conditions and behavioral health concerns. Hispanics/Latinos (hereafter, Latinos) and other ethnic minorities are more vulnerable to these conditions, and face structural, social, and cultural barriers to obtaining quality physical and behavioral healthcare. We report the protocol for a randomized controlled trial that will compare Mi Puente (My Bridge), a cost-efficient care transitions intervention conducted by a specially trained Behavioral Health Nurse and Volunteer Community Mentor team, to usual care or best-practice discharge approaches, in reducing hospital utilization and improving patient reported outcomes in Latino adults with multiple cardiometabolic conditions and behavioral health concerns. The study will examine the degree to which Mi Puente produces superior reductions in hospital utilization at 30 and 180 days (primary aim) and better patient-reported outcomes (quality of life/physical health; barriers to healthcare; engagement with outpatient care; patient activation; resources for chronic disease management), and will examine the cost effectiveness of the Mi Puente intervention relative to usual care.MethodsParticipants are enrolled as inpatients at a South San Diego safety net hospital, using information from electronic medical records and in-person screenings. After providing written informed consent and completing self-report assessments, participants randomized to usual care receive best-practice discharge processes, which include educational materials, assistance with outpatient appointments, referrals to community-based providers, and other assistance (e.g., with billing, insurance) as required. Those randomized to Mi Puente receive usual-care materials and processes, along with inpatient visits and up to 4 weeks of follow-up phone calls from the intervention team to address their integrated physical-behavioral health needs and support the transition to outpatient care.DiscussionThe Mi Puente Behavioral Health Nurse and Volunteer Community Mentor team intervention is proposed as a cost-effective and culturally appropriate care transitions intervention for Latinos with multimorbidity and behavioral health concerns. If shown to be effective, close linkages with outpatient healthcare and community organizations will help maximize uptake, dissemination, and scaling of the Mi Puente intervention.Trial registrationClinicalTrials.gov: NCT02723019. Registered on 30 March 2016.

Project description:IntroductionWe conducted admixture mapping and fine-mapping analyses to identify ancestry-of-origin loci influencing cognitive abilities.MethodsWe estimated the association of local ancestry intervals across the genome with five neurocognitive measures in 7140 diverse Hispanic and Latino adults (mean age 55 years). We prioritized genetic variants in associated loci and tested them for replication in four independent cohorts.ResultsWe identified nine local ancestry-associated regions for the five neurocognitive measures. There was strong biological support for the observed associations to cognitive function at all loci and there was statistical evidence of independent replication at 4q12, 9p22.1, and 13q12.13.DiscussionOur study identified multiple novel loci harboring genes implicated in cognitive functioning and dementia, and uncovered ancestry-relevant genetic variants. It adds to our understanding of the genetic architecture of cognitive function in Hispanic and Latino adults and demonstrates the power of admixture mapping to discover unique haplotypes influencing cognitive function, complementing genome-wide association studies.HighlightsWe identified nine ancestry-of-origin chromosomal regions associated with five neurocognitive traits. In each associated region, we identified single nucleotide polymorphisms (SNPs) that explained, at least in part, the admixture signal and were tested for replication in independent samples of Black, non-Hispanic White, and Hispanic/Latino adults with the same or similar neurocognitive tests. Statistical evidence of independent replication of the prioritized SNPs was observed for three of the nine associations, at chr4q12, chr9p22.1, and chr13q12.13. At all loci, there was strong biological support for the observed associations to cognitive function and dementia, prioritizing genes such as KIT, implicated in autophagic clearance of neurotoxic proteins and on mast cell and microglial-mediated inflammation; SLC24A2, implicated in synaptic plasticity associated with learning and memory; and MTMR6, implicated in phosphoinositide lipids metabolism.

Project description:BACKGROUND:Many older Hispanics/Latinos are physically inactive and suffer the harmful health consequences associated with prolonged periods of inactivity. Negative age attributions that equate getting older with "slowing down" reinforce this inactive behavior. We implemented a community-based exercise intervention among insufficiently active older Hispanics/Latinos with a randomized trial of an attribution-retraining program, ¡Caminemos! (Let's Walk!), and measured the effect of the program on walking behavior. METHODS:Five hundred and seventy-two older Hispanics/Latinos (?60 years) were enrolled in an exercise program that randomly assigned participants to the exercise class and one of two conditions: (a) treatment (attribution retraining to dispel the notion that physical activity inevitably ceases with age) or (b) control (generic health education). Data were collected at baseline and follow-up (1, 12, and 24 months). Physical activity was determined through pedometer data and the Yale Physical Activity Survey. We also measured the intervention effects on age-expectations, self-efficacy expectations, and outcome expectations for physical activity. Mixed-effects regression models were used to determine intervention effects on prospective measures of physical activity and intrapersonal expectations. RESULTS:The sample had a mean age of 73 years (SD?=?6.8) and was 77% female, and 76% of the sample reported income <$20,000. At baseline, control and treatment groups walked about 3000 steps/day. By 24 months, participants in both arms of the intervention maintained greater than 10,000 mean steps/day, but the difference between the groups was not statistically significant. In analyses adjusted for age, sex, education, income, health status, and acculturation, participants in both trial arms increased their mean numbers of steps at 12 and 24 months, with the treatment group showing a greater number of mean steps compared to the controls at 12 months. CONCLUSIONS:In this group of physically inactive older Hispanics/Latinos, attribution retraining in combination with an exercise class was superior to the exercise class alone with regard to increasing walking behavior. This success was sustained at 12 months (the pre-defined primary study outcome) but not at 24 months. For older Hispanics/Latinos, enrollment in an attribution-retraining exercise program can improve an inactive lifestyle. TRIAL REGISTRATION:clinicaltrials.gov identifier: NCT00183014 .

Dataset Information

Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial.

Background

Objective

Design

Participants

Interventions

Main measures

Key results

Conclusions

Trial registration

Publications

Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial.

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