Notice Number: NOT-MD-24-022
Background
According to the National Academies of Sciences, Engineering, and Medicine (NASEM), access to health care is the “timely use of personal health services to achieve the best possible health outcomes.” Obstacles that limit access to timely high-quality health care disproportionately affect populations that experience health disparities, increase the risk of poor health outcomes, and widen health disparity gaps. Factors that limit access to health care include provider shortages, restrictive office hours, limited transportation options, long travel distances to care, absence of culturally and linguistically appropriate services, having low household income, and being either uninsured or underinsured. Models of care that address barriers to accessing care and improving health outcomes are needed to reduce health disparities and advance health equity.
MHCs have long been a model of community-based healthcare delivery. The estimated 2,000 MHCs in the US serve a large proportion of patients from populations that experience health disparities. Data from 1,229 MHCs throughout the US show that 61.2% of patients are from racial or ethnic minoritized groups, 64.2% either have Medicaid or are uninsured and 31.3% of MHCs are positioned in rural communities. Nationally, the number of MHCs operating during the pandemic increased to expand access to COVID-19 testing and vaccinations in communities at highest risk for poor COVID-19-related outcomes. Now, many of the same MHCs provide a variety of health care and social needs services. The services that individual MHCs offer differ based on the physical design of the MHC vehicle, funding, staffing, and community needs and resources. Approximately 50% of the health care delivered in MHCs is preventive care (e.g., blood pressure screening, immunizations, health education) and over 40% is full range primary care, but behavioral health, dental, vision, mammography screening tests, and specialized care is also delivered. Additionally, MHCs may assist patients in accessing social and health benefits and coordinate follow up care.
Patients who are most likely to use MHCs as their usual source of care are predominantly from populations that experience health disparities. Continued growth of the MHC healthcare delivery model is expected partly due to the Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act amendment to the Public Health Service Act. Therefore, understanding the effectiveness of MHCs to improve healthcare access and address the health care needs of populations that experience health disparities is a priority.
Research Objectives
This initiative will support innovative multidisciplinary collaborative research designed to investigate the effectiveness of MHCs in improving healthcare access and addressing the health care needs of populations that experience health disparities and whether they result in improved health outcomes and increased health equity. Projects across the lifespan including children (under 18 years), adults (18 – 64 years), and/or older adults (65 years and older) are encouraged. Proposed projects would be expected to evaluate existing strategies used by MHCs or develop new strategies to advance health equity using one or more of the following outcome measures: (1) optimal clinical health outcomes (e.g., blood pressure control, diabetes control), (2) optimal quality of care (e.g., adherence to evidence-based recommendations for preventive care, diagnosis and disease management), (3) access to care (e.g., comprehensiveness, continuity of care), (4) coordination of care (e.g., timely referrals for imaging and specialty care), (5) community services (e.g., medication assistance, partnerships with community organizations to address social determinants of health), and (6) utilization of health services (e.g., telehealth, urgent care/emergency department visits).
Research projects responsive to this NOSI can consist of impact evaluations, implementation studies, retrospective and prospective observational studies, mixed-methods studies, natural experiments, quasi-experimental studies, clinical trials (including cluster-randomized trials and pragmatic trials) and others to assess the impact of MHCs and to delineate aspects of MHCs that are particularly effective. Of particular interest are projects that include research collaborations across multiple MHC sites in different states and communities (e.g., rural and urban), and with different funding sources (e.g., philanthropy and federal or state government) and organizational affiliations (e.g., academic and non-academic) to bolster regional or national generalizability of study findings. Projects must include a focus on one or more populations that experience health disparities. Of specific interest are meritorious applications that focus on racial or ethnic minority populations and/or socioeconomically disadvantaged populations. The intersectionality of race or ethnicity and/or socioeconomically disadvantaged populations with rural populations, sexual and gender minority groups, or people with disabilities, is also a priority.
Areas of Interest
National Institute on Minority Health and Health Disparities (NIMHD)
Examples of potential topic areas include but are not limited to:
- Studies that evaluate the effectiveness of MHCs to improve health outcomes among populations that experience health disparities:
- Examine differences in receipt of evidence-based preventive care, diagnosis and disease management before and after using the MHC as the usual source of care
- Examine healthcare or community-level changes in health outcomes (e.g., reductions in emergency department visits, increases in vaccination rates)
- Compare outcomes for patients who identify the MHC as their usual source of primary health care to outcomes for patients who identify other healthcare delivery models (e.g., private or public stationary primary care clinics, free health clinics, or school-based health centers) as their usual source of primary health care and identify factors associated with measured differences
- Assess whether outcomes differ among populations that seek care at MHCs (e.g., greater improvement in blood pressure for one population compared to another). Of particular interest are comparisons of populations that experience health disparities and appropriate reference populations
- Studies that evaluate the effectiveness of MHCs in improving access to care, quality of care, and utilization of healthcare services among populations that experience health disparities:
- Evaluate the effectiveness of strategic MHC placement within a community, operating hours, healthcare service delivery, or workforce composition
- Evaluate the effectiveness of integrating digital health technology (e.g., telemedicine, retinal imaging, or wearables for glucose or blood pressure monitoring) into MHC healthcare delivery
- Evaluate the effectiveness of integrating social needs services into MHC healthcare delivery
- Assess MHC utilization by populations that may not readily seek care in traditional healthcare settings (e.g., people experiencing homelessness, sex workers, migrant workers, transgender individuals, and others)
- Studies that evaluate existing strategies used by MHCs or develop new strategies to (1) reduce health disparities, (2) recruit and retain a diverse MHC workforce or (3) recruit and retain diverse research participants
- Studies that evaluate the role of MHCs in the medical neighborhood and the effect on outcomes
- Assess the effectiveness of collaborative inter-agency partnerships to expand health and social needs services and improve health outcomes
- Compare outcomes associated with different collaborative inter-agency partnerships and identify factors associated with measured differences
- Investigate the intersection and outcomes of a collaborative care model between MHCs, retail clinics and primary care
For more information, please see the opportunity webpage.