NIH/NHLBI

Community Health Workers Systematically Assessing and Addressing Social Determinants of Health to Improve Outcomes in Community Health Centers (CHW-SYSTIM)

Posted on by Jodi Snare

Page last updated August 6, 2026

ClinicalTrials.gov#: NCT06926855
Study Design: Intervention Trial
PCORnet Infrastructure: Common Data Model (CDM), Single IRB, Patient partners or engagement
Principal Investigator: Rachel Gold and Erika Cottrell
Institution: OCHIN
PCORnet® Network Partner: ADVANCE
Funder: Federal (NIH/National Heart, Lung, and Blood Institute (NHLBI))
Funding Date: 2023
Study Duration: 2024 – 2026
Therapeutic Area: Healthcare Delivery, Cardiovascular, Health Disparities, Metabolic Disorders
Status: Completed

Research Question(s):

Community health workers (CHWs) often provide patient education and care coordination in community health center (CHC) settings. CHWs have unique skill sets to support patient education, connect patients with resources, and understand patient needs in the context of their culture and community. Both CHCs and CHWs are recognized as valuable research partners because of the trust and knowledge they hold with the patient populations they serve. This study asked if CHWs can help improve health for people with diabetes or high blood pressure by asking about and helping to address their social needs. CHWs asked people about needs related to food, housing, transportation, or medications and then helped to connect them with available services based on each patient’s given needs. CHWs then followed-up with each patient to see if they connected with any resources.

Equity in Treatment for Asthma Between Latinos and Whites

Posted on by Jodi Snare

Page last updated May 11, 2026

Study Design: Retrospective Observational Study
PCORnet Infrastructure: Common Data Model (CDM), Single IRB, Patient partners or engagement
Principal Investigator: John Heintzman
Institution: OCHIN
PCORnet® Network Partner: ADVANCE
Funder: Federal (NIH/NHLBI)
Funding Date: 2025
Study Duration: 2025 – 2028
Participating PCORnet® Clinical Research Networks: ADVANCE, REACHnet
Therapeutic Area: Pulmonology
Status: Active, not recruiting

Research Question(s):

  1. How does the quality of asthma care - including timely diagnosis, assessment, immunization, medication prescription, and access to testing - vary when comparing Latino adults to non-Latino white adults?
  2. Among adults with asthma, how do Latino adults vary from non-Latino white adults in how they utilize primary asthma care in Community Health Centers?
  3. How do Latino and non-Latino white adults with asthma vary in how they utilize acute care, including clinic visits, emergency department visits, and inpatient hospitalization?
  4. Do different subgroups of Latino-Americans, such as Latinos of Mexican, Dominican, or Cuban heritage, utilize asthma care at different rates and receive care of differing quality?
  5. Relatively, do individual factors (e.g., income, preferred language, insurance coverage, and migrant status) or community-level factors (e.g., community poverty, education, and environmental factors) contribute more to a person's (focusing on Latinos, but including others as well) likelihood of receiving primary asthma care, utilizing acute care, or experiencing asthma-related death?