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Social Needs Screening and Chronic Diseases Study (WE CARE)
Improving Chronic Disease Outcomes Across the Lifespan by Addressing Structural Racism
Who can join
All ages · All sexes · Healthy volunteers welcome
Full eligibility criteria
Inclusion Criteria: * Adults and children with diagnosed chronic diseases (hypertension, diabetes mellitus, hyperlipidemia, asthma, or depression) who receive Family Medicine care at one of the study sites. * Children (\<18 years of age) with a diagnosis of asthma. * Adult patients (18 years or older) with a diagnosis of diabetes mellitus, hypertension, hyperlipidemia and/or depression. Exclusion Criteria: * In adults (\>18 years of age), those without one or more of the following diagnoses as recorded by ICD-10 codes in their EHR: hypertension, hyperlipidemia, diabetes mellitus, or depression. * In children (\<18 years of age), those without a diagnosis of asthma.
About the study
The goal of this clinical trial is to learn if the implementation of the WE CARE social determinants of health (SDOH) screening and referral intervention with an antiracist lens in primary care settings can lead to a meaningful decrease in chronic disease by monitoring conditions such as hypertension, diabetes, depression, hyperlipidemia, and asthma through clinical measures. The main question it aims to answer is:
Does the WE CARE SDOH screening and referral intervention applying an antiracism lens informed implementation strategies have the potential to reduce racial/ethnic health inequities in chronic diseases for minoritized patients?
What is being tested
- WE CARE SDOH System (other)
- Standard Pediatric Care (other)
Sponsor: University of Massachusetts, Worcester · Participants: 68,000 · Started: Oct 8, 2025
Contact the study team
- Arvin Garg · Phone: 4103363261
- Jennifer Hazelton · Phone: 9783370340
Official record on ClinicalTrials.gov — NCT06903897
Locations in the U.S.
| Massachusetts | Family Health Center of Worcester, Worcester (Not yet recruiting) UMass Memorial Medical Center - Hahnemann Campus, Worcester UMass Memorial Medical Center -Benedict Family Medicine Clinic, Worcester (Not yet recruiting) |
Conditions
From ClinicalTrials.gov, data retrieved Sep 30, 2026. Each study sets its own eligibility; the study team decides who can join.