AAPI Nexus: Policy, Practice and Community

Four Hawai‘i Federally Qualified Health Centers, a Managed Care Organization, and the Hawai‘i Primary Care Association established a partnership to pilot a unique Patient-Centered Health Care Home model. All sites were successful in implementing care coordination and a patient registry. A cohort of 432 patients with a diagnosis of diabetes and/or depression was activated into the program. Sixty percent of the cohort was Native Hawaiian, Other Pacific Islander, or Asian. Patients with uncontrolled diabetes lowered their HbA1c by one point (p < .05), and patients with severe depression lowered their PHQ-9 scores by 4.6 points (p < .05).