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The Unite Care Model included establishing onsite primary care, wellness support, and social needs assistance. The RE-AIM framework guided our mixed-methods evaluation. We sought to determine whether the model was associated with change in blood pressure, social or physical environment and understand model reach and implementation. Of the 251 residents, 13.1% had a clinic visit, and of respondents 70% attended at least one wellness event, and 35% received social needs assistance (reach). Clinic utilization was not associated with improved blood pressure or environment change (effectiveness). Residents reported barriers to clinic utilization including an established provider, uncertainty in transferring care, lack of urgent visits, and insurance barriers. Administrators echoed policy, staffing, and patient barriers to utilization (implementation). Expanding appointment options, increasing staffing, and overcoming insurance barriers may increase effectiveness.<\/jats:p>","DOI":"10.1177\/30495334261422615","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T16:20:43Z","timestamp":1772209243000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of a Community-Led, Cross Sector Partnership of Housing, and Healthcare to Optimize Aging: The Unite Care Model"],"prefix":"10.1177","volume":"12","author":[{"given":"Lesli E.","family":"Skolarus","sequence":"first","affiliation":[{"name":"Northwestern University, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3139-7819","authenticated-orcid":false,"given":"Abby K.","family":"Hellem","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Thrash-Sall","sequence":"additional","affiliation":[{"name":"Presbyterian Villages of Michigan, Flint, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Bailey","sequence":"additional","affiliation":[{"name":"Bridges Into the Future, Flint, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Michael","family":"Giacalone","sequence":"additional","affiliation":[{"name":"Hamilton Community Health Network, Flint, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey L.","family":"Corches","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Michigan, Ann Arbor, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Ohio State University, Columbus, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9436-7027","authenticated-orcid":false,"given":"Ran","family":"Bi","sequence":"additional","affiliation":[{"name":"Ohio State University, Columbus, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-1588","authenticated-orcid":false,"given":"James F.","family":"Burke","sequence":"additional","affiliation":[{"name":"Ohio State University, Columbus, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9360-3334","authenticated-orcid":false,"given":"Anne E.","family":"Sales","sequence":"additional","affiliation":[{"name":"University of Missouri, Columbia, USA"},{"name":"VA Ann Arbor Healthcare System, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.6414"},{"key":"e_1_3_3_3_1","first-page":"1","article-title":"Beyond health care: the role of social determinants in promoting health and health equity","volume":"20","author":"Artiga S","year":"2018","unstructured":"Artiga S, Hinton E. 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