A strategic approach to advancing health equity for priority populations with or at risk for diabetes in montana - the montana department of public health & human services' (MT dphhs) montana diabetes…

A strategic approach to advancing health equity for priority populations with or at risk for diabetes in montana - the montana department of public health & human services' (MT dphhs) montana diabetes program (MDP) is applying for the CDC-RFA-DP23-2320 component a to address the burden of diabetes statewide. The work will include all residents of the state of montana with a specific focus on american indians, veterans, rural residents, people living with a disability, hispanics, and medicaid members. The MDP offices are located at 1400 broadway street, cogswell building, C314 b, helena, MT 59601. The MDP has the capability to serve all populations and communities across montana. The MDP will improve the health of all montanans by achieving the outcomes described in this funding opportunity. The MDP has a long history of providing diabetes prevention and management programming and services to the entire state. This includes long-standing partnerships, well-trained and experienced staff, a committed coalition of professionals working with people at risk for and living with diabetes, and existing contracts to deliver activities and services that will facilitate the work listed in this funding opportunity. The MDP will implement activities through a comprehensive, inclusive, and coordinated approach to address standards and policies; increase montanans' awareness of chronic disease risk factors, disease self-management activities, and resources; work with health care providers to implement quality improvement strategies and use health information technology; support training and service development to address prevention; and link clinical and community resources. These activities will occur statewide with increased focus on priority populations, including those living in high burden areas or those who are at high-risk that may otherwise be missed by these activities. Specifically, the MDP will focus efforts to reach american indians, veterans, rural residents, people living with a disability, hispanics, and medicaid members. Surveillance and evaluation activities will continue and be used for monitoring progress, analyzing outcomes, performing quality improvement, and reporting success. Component a will build upon the existing successful network of diabetes self-management education and support (dsmes) services and national diabetes prevention programs (dpps) in montana. Data will be collected using an existing chronic disease data system. The MDP will implement eight strategies. Strategies 1A and 5 will use similar approaches to increase access to dsmes services and dpps for all montanans, but with increased emphasis on identified priority populations. The MDP will ensure high quality services through program recognition/accreditation, training and certification for diabetes care and education specialists and lifestyle coaches, and by increasing participation by implementing BI- and multi-directional e-referral systems (strategy 10), marketing campaigns, and addressing/eliminating barriers. Strategy 7 will build on efforts to increase DPP umbrella hubs. Strategy 3 will emphasize screening and referral for people at risk for diabetes-related retinopathy and chronic kidney disease. A team-based care model will be adopted for dsmes services and dpps and will include pharmacists and other extenders of healthcare for strategy 4. Strategy 1B and 8 will implement diabetes support programs and family-based nutrition and obesity prevention classes that are culturally appropriate and relevant to the population. All work will be developed and implemented to ensure IT addresses health equity and the social determinants of health with at least 10% of the budget addressing system-level changes for the listed priority populations. Strategy 13 will emphasize training on the social determinants of health for professionals and health care providers who serve people at risk for or living with diabetes.