The hospital collaborative strategic approach to advancing health equity for black residents with or at risk for diabetes in wayne county, michigan - component identification: michigan public health…

The hospital collaborative strategic approach to advancing health equity for black residents with or at risk for diabetes in wayne county, michigan - component identification: michigan public health institute (mphi) is applying for component b. High-need county where work will occur & population: wayne county, MI. Population reach of project: 674,000 black adults. Priority population: black people in wayne county, MI living with or at risk for diabetes the black adult population in wayne county, MI is disproportionately affected by type 2 diabetes and poverty. The goal of "the hospital collaborative strategic approach to advancing health equity for black residents with or at risk for diabetes in wayne county, michigan" project is to decrease risk for type 2 diabetes among adults with prediabetes and improve self-care practices, quality of care, and early detection of complications. The project will reach 674,000 black adult residents. The center for health equity practice-detroit health innovations at the michigan public health institute (mphi) is serving as the applicant/health equity backbone organization, and the hospital collaborative of southeast michigan is serving as the community-based organizations. The collaborative includes four major health systems-ascension, core well health, henry ford health system, and trinity health, in addition to the national kidney foundation of michigan. The project will maximize an existing infrastructure developed between the michigan public health institute and the hospital collaborative, which will support the project in reaching 674,000 black adults in wayne county. Five strategies will be implemented: (1) strengthen self-care practices by improving access, appropriateness, and feasibility of diabetes self-management education and support services for black adult residents in wayne county. (2) increase enrollment and retention of priority populations in the national diabetes prevention program (national DPP) lifestyle intervention and the mdpp by improving access, appropriateness, and feasibility of the programs. (3) improve sustainability of community health workers by building or strengthening a supportive infrastructure to expand their involvement in evidence-based diabetes prevention and management programs and services. (4) improve the capacity of the diabetes workforce to address factors related to the social determinants of health that impact health outcomes for priority populations with or at risk for diabetes. (5) capture the voice of the black community through storytelling about prediabetes and diabetes to advance health equity. The outcomes of the project will be: - increase in number of organizations implementing evidence-based diabetes prevention and management programs by convening four health systems along with a key CBO, to provide collective impact that use a coordinated system to improve access, appropriateness and feasibility of diabetes self-management educate and support the priority population in wayne county. - offer increased tailoring of DPP with 100% black population, led by a black lifestyle coach with a focus on equity. - increase in # of patients referred to resources by engaging stakeholders to refer black residents with or at risk for diabetes to support-coupling programs. - increased sdoh screenings in clinical settings through education and trainings for clinical providers on sdoh screenings. - increased participation in DPP and the mdpp by 35%, with a 30% (4TH month), 40% (7TH month), and 30% (10TH month) retention rates of national DPP lifestyle interventions and the mdpp. - increased multi-directional communication between clinical and community resources using 10 chws in wayne county as provider point of contact.