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Research ArticleOriginal Research

The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations

Kim Hanh Nguyen, Jessica D. Fields, Anupama G. Cemballi, Riya Desai, Anjali Gopalan, Tessa Cruz, Aekta Shah, Antwi Akom, William Brown, Urmimala Sarkar and Courtney Rees Lyles
The Journal of the American Board of Family Medicine July 2021, 34 (4) 698-708; DOI: https://doi.org/10.3122/jabfm.2021.04.200591
Kim Hanh Nguyen
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
ScD, MPH
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Jessica D. Fields
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
BA
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Anupama G. Cemballi
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
MA
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Riya Desai
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
MPH
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Anjali Gopalan
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
MD, MS
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Tessa Cruz
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
BA
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Aekta Shah
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
PhD
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Antwi Akom
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
PhD
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William Brown III
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
PhD, DrPH
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Urmimala Sarkar
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
MD, MPH
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Courtney Rees Lyles
From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
PhD
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  • Article
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Article Information

vol. 34 no. 4 698-708
DOI 
https://doi.org/10.3122/jabfm.2021.04.200591
PubMed 
34312263

Published By 
The Journal of the American Board of Family Medicine
Print ISSN 
1557-2625
Online ISSN 
1558-7118
History 
  • Received for publication November 12, 2020
  • Revision received January 29, 2021
  • Accepted for publication February 8, 2021
  • Published online July 26, 2021.

Copyright & Usage 
© Copyright 2021 by the American Board of Family Medicine.

Author Information

  1. Kim Hanh Nguyen, ScD, MPH,
  2. Jessica D. Fields, BA,
  3. Anupama G. Cemballi, MA,
  4. Riya Desai, MPH,
  5. Anjali Gopalan, MD, MS,
  6. Tessa Cruz, BA,
  7. Aekta Shah, PhD,
  8. Antwi Akom, PhD,
  9. William Brown III, PhD, DrPH,
  10. Urmimala Sarkar, MD, MPH and
  11. Courtney Rees Lyles, PhD
  1. From the Center for Vulnerable Populations, University of California, San Francisco (KHN, JDF, AGC, RD, AA, WB, US, CRL); UCSF Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, CA (KHN, JDF, AGC, US, CRL); Department of Epidemiology and Biostatistics, University of California, San Francisco (KHN, JDF, RD, US, CRL); Kaiser Permanente Northern California, Division of Research, Oakland (AG, CRL); Streetwyze, Oakland, CA (TC, AS, AA); Social Innovation and Universal Opportunity Lab (SOUL), University of California, San Francisco, San Francisco State University (TC, AS, AA); Center for AIDS Prevention Studies, University of California, San Francisco (WB); Bakar Computational Health Science Institute, University of California, San Francisco (WB, CRL).
  1. Corresponding author: Kim Hanh Nguyen, ScD, MPH, UCSF School of Medicine, 1001 Potrero Ave, San Francisco, CA 94110 (E-mail: kim.nguyen2{at}ucsf.edu).
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The Journal of the American Board of Family     Medicine: 34 (4)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 4
July/August 2021
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The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations
Kim Hanh Nguyen, Jessica D. Fields, Anupama G. Cemballi, Riya Desai, Anjali Gopalan, Tessa Cruz, Aekta Shah, Antwi Akom, William Brown, Urmimala Sarkar, Courtney Rees Lyles
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 698-708; DOI: 10.3122/jabfm.2021.04.200591

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The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations
Kim Hanh Nguyen, Jessica D. Fields, Anupama G. Cemballi, Riya Desai, Anjali Gopalan, Tessa Cruz, Aekta Shah, Antwi Akom, William Brown, Urmimala Sarkar, Courtney Rees Lyles
The Journal of the American Board of Family Medicine Jul 2021, 34 (4) 698-708; DOI: 10.3122/jabfm.2021.04.200591
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