Health Equity

Targeting COVID-19 inequities requires a data-driven approach

Sara Berg, MS , News Editor

While Massachusetts was hit hard with COVID-19 cases early, the state has seen a decline in hospitalizations and rates of positive cases. However, the state is seeing an uptick in COVID-19 cases again. To address this increase and reach underserved populations, Cambridge Health Alliance (CHA) is undertaking innovative and upstream outpatient strategies that leverage existing community partnerships.

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“In the recent weeks we’ve had a better partnership between CHA and local public health departments, including in Everett, Massachusetts, which has really been a hot spot,” said Lora Council, MD, senior medical director of primary care at CHA. “Through reaching out to the towns, we have been doing more testing both for our patients and for the public.”

CHA is a health system that serves over 140,000 patients in Cambridge, Somerville, and the greater Boston area. Serving working-class and immigrant populations, CHA maintains a longstanding commitment to vulnerable and diverse patients.

To reach these underserved populations, CHA teams use their greatest asset: their link to the community. Here is how their community outreach enhances patient care during the COVID-19 pandemic.

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Throughout the pandemic, CHA has prioritized social determinants of health work such as helping people find alternative housing if necessary or addressing food insecurity.

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But another area that is not immediately clear is how “iterative process improvement really relates to an equity approach,” said Jessamyn Blau, MD, an internist at CHA. “It does because that’s one of the things that’s been really helpful to us is that we were able to early on see trends in our micro data.”

“We identified, for example, that the Latinx population was at higher risk before we were seeing it in the popular press and in the literature,” she said. “It’s not anything miraculous, but it was just the fact that we were attuned to this micro data and just trying to make sure that we were responding to the trends that we were seeing in our own population.”

Looking at the data, CHA found that when testing the general public in Malden, Massachusetts—a mixed economy city—there is about a 10% positive rate while “Everett, which is a working class city with a lot of immigrants, very crowded housing, in the general public testing shows about 18% positive. But patients with symptoms from this area have been positive more than 60% of the time,” said Dr. Council. “The patients with symptoms and high-risk factors from Cambridge and Somerville are about 25% positive.”

“Every population is different. We started with the data from China because that’s what we had, but now there is a lot in our own data that are pertinent to our own population,” said Dr. Blau.

Learn more about COVID-19’s impact in Latinx communities.

Many of the physicians and other health professionals at CHA are first-generation immigrants from the surrounding communities.

“Because we have a robust population health approach, which we believe is an equity approach, we knew a little bit of what to anticipate,” said Janice John, a primary care physician assistant at CHA. “It is also because in our community we’re able to really have not just the trust, but also that ear to the ground and then be able to learn quickly.”

While the data-driven piece takes time to build, “we have to look for a weak signal and then rapidly adapt their practice and then really understand what’s the right approach,” she said. For example, the conversations happening at the national level suggest that the Latinx population is higher risk because of poor access to primary care and increased chronic disease.

“What we are seeing is higher rates of hospitalization and intubation in our immigrant communities compared with our whole population," said John. "A population health approach is allowing us to dig deeper into this trend to understand whether this is due to high exposure jobs, poor living conditions, or weathering. It does not seem to be wholly explained by underlying comorbidities."

The AMA is compiling an ongoing list of health equity resources related to COVID-19.

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Using grassroots outreach helps CHA reach different populations in their surrounding communities. For example, after learning that the WhatsApp was a primary form of communication in their communities, CHA sent messages over the app to help lessen fears caused by outside resources.

“A lot of the messaging is not from us and we can’t control that, but we can influence that,” said John.

CHA also benefits from having a “community outreach team that existed prior to COVID-19 and was already embedded in a lot of our population,” said Dr. Blau, adding that there is a large Haitian Creole population, as well as Brazilian and El Salvadoran populations in CHA’s immediate area.

The community outreach team “already had preexisting links to those communities,” she said, which allowed them to reach “the Haitian Creole population by going through faith leaders, which was perceived as a better way to do things.”

This is the same for the Brazilian American population. CHA reached out to local Brazilian celebrities with large followings to host Facebook Live events to share important information about COVID-19.

“This is one of the ways where we can illustrate that having a payment system that promotes population health through community partnerships and an organizational structure that acknowledges that community is part of the work that we do inside a health care organization set us up to start off in a better place,” said Dr. Council. “Partnering with community agencies has been longstanding. We didn't have to build this when COVID-19 started. We just used those channels.”