The Neighborhood Health Hub Model: Extending Primary Care into Medically Underserved Neighborhoods to Improve Health Equity.

Abstract

Limited research documents feasibility of deploying health coaches to extend primary care into medically underserved neighborhoods. To assess early experience implementing the Neighborhood Health Hub Model, an innovative, person-centered, place-based, neighborhood-level approach for providing convenient access to essential preventive services. Memphis/Shelby County, Tennessee PARTICIPANTS: Adults seeking care from January 2022-June 2024 at Neighborhood Health Hub facilities. Hubs are staffed by lay health coaches recruited from the community, trained in motivational interviewing, and supervised by a telehealth-connected health professional. Services include: 1) screening for obesity, hypertension, diabetes, and social determinants; 2) individual/group health coaching for chronic disease management; 3) referrals for medical, behavioral, and social needs. A total of 1,252 clients were served, 1,151 received health coaching, and 383 (31%) participated in ≥ 2 coaching sessions, for a total of 3367 coaching sessions and 2,951 group visits. Average weight change with obesity was - 3.32 pounds (95% confidence interval [CI] - 5.72, - 0.92) and systolic blood pressure change with hypertension was - 15.17 mmHg (CI - 19.64, - 10.69). Higher number of health coaching sessions was significantly associated with greater weight loss. Dissemination of the Neighborhood Health Hub Model could improve health equity nationwide.