The National Institutes of Health has awarded Wayne State University a $18 million grant that will help to intercept chronic disease in Black communities. The proposal, which was submitted jointly by the School of Medicine and the College of Engineering, is to develop a system that uses macro-level data from health care providers and social services organizations with information about individual behavior patterns. It would then use this knowledge for interventions designed to keep patients healthy or prevent them from falling ill in the first place.
This project is based on real concerns among those who are at risk as well as public health researchers who have been working hard to find solutions. In these communities, there exists an unfortunate combination of high rates of obesity and diabetes – both conditions linked with heart disease –
The Addressing Cardiometabolic Health Inequities by Early PreVEntion in the GREAT LakEs Region, or ACHIEVE GREATER, Center is a proactive versus reactive approach to reducing overwhelming cardiometabolic health disparities and downstream Black-White lifespan inequality in Detroit and Cleveland, two uniquely comparable cities.
“The future of medicine is community health workers engaging people where they live, work or play to enhance access to not only medical care, but social services, to improve their health outcomes,”
Building upon existing collaboration and resources across Wayne State University/Wayne Health, and the Henry Ford Health System in Detroit, and Case Western Reserve University/University Hospitals in Cleveland, ACHIEVE GREATER will include three distinct but related projects that focus on interrupting early stages of pathogenesis by addressing multiple domains of influence that contribute to disparate health outcomes in the Black population, specifically biological, behavioral, physical/built environment, sociocultural environment and the health care system.
The overarching goal is to mitigate health disparities in risk factor control for chronic conditions of tremendous public health importance, which drive downstream lifespan inequality, said ACHIEVE GREATER principal investigator Phillip Levy, M.D., M.P.H., the Edward S. Thomas Endowed Professor of Emergency Medicine and assistant vice president of Translational Research for WSU, as well as Chief Innovation Officer of Wayne Health.
A core component of ACHIEVE GREATER is the use of collaborative care involving community health workers and pharmacists, to deliver a pragmatic, personalized, adaptable approach to lifestyle and life circumstance intervention, called PAL2. Community health workers serve as a liaison between the patient and health care providers, and have often shared the lived experience of the person they’re trying to help. They know the local resources and can help fill gaps in social knowledge.
“The future of medicine is community health workers engaging people where they live, work or play to enhance access to not only medical care, but social services, to improve their health outcomes,” Dr. Levy said. “How do we help people with challenging life circumstances so their lifestyle can improve? Health care has to exist beyond the four walls of a doctor’s office. Let’s get you the person who is going to help you with your needs.
The ACHIEVE GREATER center seeks to improve lifespan equality by implementing the PAL2 intervention to address multi-level risk profiles in Black patients with cardiometabolic risk factors who live in racially concentrated areas of poverty; and use the Practical Robust Implementation and Sustainability Model to assess program reach, effectiveness, adoption, implementation and maintenance, or RE-AIM. It will also profile the incidence density of chronic hypertension, heart failure and coronary heart disease in electronic health records, and interrogate multi-level risk profiles by probing interrelationships among geospatial factors, including aspects of the built environment, person-level socio-behavioral factors and clinical characteristics. In addition, early-career scientists will be trained to focus on mitigating the chronic hypertension, heart failure and coronary heart disease disparities that drive downstream lifespan inequality and disseminate key information uncovered during the project’s trajectory to policy makers, payers, public health departments and other stakeholders to drive sustainable change.