Page last updated September 8, 2026
ClinicalTrials.gov#: NCT06926855(opens in new tab)
Study Design: Intervention Trial
PCORnet Infrastructure: Common Data Model (CDM), Single IRB, Patient partners or engagement
Principal Investigator: Rachel Gold, Erika Cottrell, Katherine Chung-Bridge, Dominic Mack, and Megan Douglas
Institution: OCHIN
PCORnet® Network Partner: ADVANCE, Legacy partner
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.