While the Hopkins findings favor enhanced community-based care for blacks, they do not explain why blacks suffer from higher rates of heart disease than white Americans or why 100 percent control of risk factors was not achieved, the researchers say.
"The solution is far more complex than simply a structural problem of resources and delivery systems, where adding tests, medications and services will do the trick," says Becker. "Our study's results help solve part of the problem, but still missing are explanations of the cultural and social factors underlying the inequities and what actions are necessary to achieve parity in health status.
"The next step has to be a sincere dialogue with the black community as to what they need to resolve health inequities. More resources are not the only answer."
Becker attributes the success of the Hopkins model of community care to early input from the local black community in East Baltimore. Prior to the start of the study, two local pastors, a community health worker and local residents helped design the types of services and activities offered. Specific requests included a welcoming, nonclinical look to the community care center, which resembled a living room and kitchen, and contained an exercise center for testing that participants used regularly. The center also had flexible scheduling, allowing participants to phone in for checkups and counseling, or to schedule appointments with as little as 24 to 48 hours' notice.