Wraparound Services in Primary Care Settings: Evaluating the Health Center Model for Patients with Cardiometabolic Risk Factors

Abstract

Background: Community health centers provide a wide range of services beyond standard primary care, including social and enabling services, dental services, and behavioral health care. These wraparound services may be particularly important for individuals with cardiometabolic risk factors who are at increased risk for cardiovascular disease, the number one cause of death in the United States, but little is known about this relationship.Purpose: The purpose of this study is to assess the relationship between wraparound service use and health and healthcare outcomes for individuals with cardiometabolic risk factors. Data and Methods: We used data from the 2014 Health Center Patient Survey to measure associations between enabling service use and health care access and utilization using doubly robust propensity score matching and generalized linear models. To assess associations with wraparound service use and cardiometabolic risk factor presence, we used Poisson regressions to analyze 2015-2016 electronic health records data from the federally qualified health center, Mary’s Center. Key Results: We did not find wraparound service use to be associated with changes in cardiometabolic risk factor presence from one year to the next. We did find that nationally, enabling service use is associated with a 16.1 percentage point (pp) decrease in delayed/foregone care and a 29.4 pp increase in routine check-ups among individuals with cardiometabolic risk factors. However, among those with 3+ cardiometabolic risk factors, enabling service use is associated with a 41.3 pp increase in emergency room visits and a 7.6 pp decrease in check-ups. Among Mary’s Center clients, social service use is associated with a decreased rate of cardiometabolic multimorbidity (0.73). However, interactions between social service use and age find an increased rate of cardiometabolic multimorbidity among individuals 45 to 64 (1.42) and those 65 and over (1.64). Dental service use is also associated with an increased rate of cardiometabolic multimorbidity (1.09). Conclusion: Cardiometabolic risk factors remain highly prevalent in the U.S. and contribute to serious negative health outcomes. We found some positive associations between wraparound service use and cardiometabolic health and healthcare outcomes, highlighting the need for further longitudinal research and funding of these services.