September 14, 2026
In the summer of 2026, poor air quality caused by wildfires, along with extreme heat, affected millions of Americans. These increasingly common events present a growing challenge for community health centers across the United States. They can worsen chronic health conditions, disrupt clinic operations and disproportionately affect patients who already face challenges maintaining their health.
To address this growing concern, health centers need better evidence on how extreme heat and poor air quality affect their patients and operations. An OCHIN-led research initiative, the Impacts of Extreme Heat and Air Quality Research Center, or CATALYST, is building a research infrastructure for community health centers that links clinical and environmental data and identifies community-prioritized research questions. This work aims to help health centers better prepare for and respond to extreme heat and poor air quality events.
“Community health centers are on the front lines of caring for people most affected by extreme heat and poor air quality,” said Rachel Gold, PhD, MPH, one of the principal investigators of the CATALYST project. “Health centers need evidence about what works, both for protecting patient health and for maintaining clinic operations during extreme weather events. CATALYST is building the foundation needed to generate that evidence.”
Developing the foundation for a new research center
CATALYST is a National Institutes of Health-funded planning grant designed to establish the infrastructure needed for a future research center focused on how extreme weather and air quality events affect health centers and the communities they serve.
The future center will support research across a range of questions, including:
- How do heat and air quality risks affect the health of patients served by community health centers?
- Which patients are most at risk?
- How do extreme weather events affect clinic operations, staffing and financial stability?
- What interventions can health centers implement to reduce health impacts on patients and communities?
- Which approaches are most effective, feasible and sustainable in real-world health center settings?
The project is grounded in a simple reality: While many health centers are already developing strategies to address these challenges, little rigorous evidence exists to guide those efforts.
Why patients served by health centers are especially at risk
Patients served by health centers often experience circumstances that increase their risk from hazardous heat and air quality conditions.
Many live in neighborhoods with fewer trees, higher temperatures, and greater exposure to air pollution. Others face housing, transportation or financial challenges that may limit their ability to avoid exposure during heat waves or poor air quality events.
These same communities also experience higher rates of chronic conditions that heat, and poor air quality and other environmental hazards may worsen. For example, a recent analysis of U.S. community health center patients found that 20% have asthma, compared with 15% of the general U.S. population, and 35% have high blood pressure, compared with 32% of the U.S. population. As a result, millions of health center patients are at greater risk of health problems related to extreme heat, poor air quality and wildfire smoke.
Because health centers provide care for more than 31 million Americans, including large numbers of rural residents, Medicaid beneficiaries, uninsured individuals and people living below the federal poverty level, they are especially well positioned to understand and address these impacts.
Building three key pieces of infrastructure
CATALYST is creating three resources that will support future extreme weather and air quality research in health center settings.
- A community-prioritized research agenda
- The first component is a national research agenda developed in partnership with health center leaders, clinicians, staff, patients, community organizations and researchers.
- Rather than researchers deciding independently which questions to study, CATALYST uses an extensive community engagement process to identify priorities that matter most to health centers and the communities they serve. The CATALYST Community Advisory Board includes three committees: health system advisors, scientific advisors and community organization advisors.
- Through a structured three-year process, these committees share perspectives on the health impacts of extreme weather, discuss and prioritize potential interventions, and identify questions for further research. This approach helps ensure that future research addresses practical challenges health centers face and produces findings that can be translated into action.
- A nationally unique data resource
- The second component is a nationally unique dataset that links electronic health record data from the OCHIN network with many years of retrospective environmental exposure data.
- This resource allows researchers to examine the relationship between heat events, air quality conditions and patient health outcomes across a large health center population with varying needs and circumstances.
- The linked data set creates opportunities to study environmental impacts across geographic regions, patient populations and health conditions in ways that have not previously been possible.
- Real-time heat and air quality data in the EHR
- The third component is bringing real-time heat risk and air quality information directly into OCHIN Epic. This capability positions OCHIN to develop informatics tools that help health centers identify and alert patients whose health risks are elevated on a given day.
- For example, these tools could help care teams proactively engage patients with conditions such as hypertension or asthma before heat waves or poor air quality events occur. Real-time data could also help health centers identify patients with upcoming appointments who may be better served through telehealth, allowing them to stay indoors.
- This capability also lays the groundwork for prospective research and intervention testing. In the future, clinics may be able to use these data to identify patients at elevated risk during extreme events and provide targeted outreach, education or other support.
Early research is already generating new insights
Although CATALYST’s primary goal is to develop infrastructure for future research, the project has already begun generating evidence.
Researchers first examined the impact of extreme heat on blood pressure among health center patients. Results from the analysis, “Extreme Heat Exposure and Blood Pressure in Community Health Center Patients,” led by OCHIN’s Brenda McGrath, PhD, were published September 10, 2026, in JAMA Network Open. This analysis found that patients at OCHIN member clinics who experienced extreme heat on the day of an appointment had modestly lower blood pressure than those who did not. The findings may help inform cardiovascular risk assessment on days of extreme heat.
The CATALYST team is also studying:
- The impact of extreme heat on asthma outcomes
- The relationship between poor air quality and blood pressure or asthma outcomes
- How many health center patients take medications that increase vulnerability to heat
These studies are helping build understanding of how exposure to extreme heat and poor air quality affects health center patients and where interventions may have the greatest impact.
Researchers also worked with a wide range of community members to identify potential health center-led interventions to reduce the health impacts of extreme heat and poor air quality events. These interventions range from staff training and connections to local resources for free air purifiers to clinical decision-support tools.
As the research infrastructure expands, investigators will be able to explore a broader range of questions related to patient health and clinic operations. The evidence generated through these efforts will help inform health centers seeking effective strategies to reduce the health impacts of extreme heat and poor air quality on their patients.
What this means for community health centers
“As extreme heat and poor air quality events become more common, health centers will increasingly need evidence-based approaches to protect patients and maintain access to care,” said Karen Albright, PhD, another principal investigator of the project. “Based on the work underway through CATALYST, health centers may benefit from several future opportunities.”
These opportunities include:
- Access evidence developed specifically for health center settings
- Most existing research on primary care responses to extreme heat and poor air quality comes from healthcare systems outside the United States. CATALYST is designed to generate evidence directly relevant to health centers, their patients and the operational realities they face.
- Better identify and support high-risk patients
- By linking environmental exposure data with EHR information, researchers can identify which populations are most at risk and which interventions are most likely to reduce adverse outcomes. This knowledge can help clinics target limited resources where they are likely to have the greatest effect.
- Strengthen clinic preparedness and resilience
- Extreme events can affect more than patient health. They can disrupt staffing, patient access, clinic operations and financial performance. Future research from the center will help health centers understand these impacts and evaluate strategies for maintaining services during environmental emergencies.
Looking ahead
Many health centers are already responding to heat and air quality risks through patient outreach, community partnerships, resiliency planning, and other innovative approaches. What remains largely unknown is which approaches work best and how they can be implemented sustainably across different communities.
CATALYST is creating the foundation needed to answer those questions. By developing a community-driven research agenda, building a unique national data infrastructure, and bringing real-time environmental data into electronic health records, the project positions health centers to lead the next generation of research on environmental health and healthcare delivery.
Most importantly, it is doing so in partnership with the communities most affected by these growing challenges.
As the challenges posed by extreme weather events become part of routine care delivery, CATALYST aims to help health centers move from improvising during crises to using evidence-informed strategies before, during and after these events.
Learn more
To learn more about the CATALYST project and opportunities to participate in future research activities, contact the OCHIN research team.
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Research reported in this publication was supported by the National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD019799. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
