Wayne State wins $ 18 million from National Institutes of Health to intercept chronic disease in black communities – School of Medicine News


Wayne State University and Phillip Levy, MD, MPH of Wayne Health, is the principal investigator of the ACHIEVE GREATER Center, a project that aims to reduce the overwhelming cardiometabolic health disparities in Detroit and Cleveland.

The National Institute on Minority Health and Health Disparities has awarded Wayne State University $ 18.15 million over five years to establish a Center for Multiple Chronic Diseases Associated with Health Disparities: Prevention, Treatment and management which will use community interventions deployed by three research institutes. to combat hypertension, heart failure and coronary heart disease in the black population.

The Center for Combating Cardiometabolic Health Inequalities through Early Prevention in the GREAT Lakes Region, or ACHIEVE GREATER, is a proactive versus reactive approach aimed at reducing overwhelming cardiometabolic health disparities and inequalities in duration of life between blacks and whites in Detroit and Cleveland, two particularly comparable cities.

Building on the existing collaboration and resources between 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 separate but related projects that focus on disrupting the early stages of pathogenesis by addressing multiple domains of influence that contribute to disparate health outcomes in the black population, particularly the biological, behavioral, physical / built environment, socio-cultural environment, and the health.

A graph shows the density at the chronic disease census tracts of Detroit and Cleveland.

The overall goal is to alleviate health disparities in the control of risk factors for chronic diseases of critical public health importance, which lead to downstream lifespan inequalities, the researcher said. Principal of ACHIEVE GREATER, Phillip Levy, MD, MPH, 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.

One of the main elements of ACHIEVE GREATER is the use of collaborative care involving community health workers and pharmacists, to offer a pragmatic, personalized and adaptable approach to intervention on lifestyle and the circumstances of the patient. life, called PAL2. Community health workers serve as a liaison between patient and health care providers and have often shared the lived experience of the person they are trying to help. They know 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 improve access not only to medical care, but also to social services, to improve their outcomes. in health, ”said Dr Levy. “How do we help people facing difficult life circumstances so that their way of life can improve? Health care must exist beyond the four walls of a doctor’s office. Let you find the person who will help you with your needs.

This figure shows an overview, using the National Institute’s Research Framework on Minority Health and Health Disparities, of the concepts to be applied in ACHIEVE GREATER.

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 areas of poverty at racial concentration; and use the Practical Robust Implementation and Sustainability Model to assess program reach, effectiveness, uptake, implementation and maintenance, or RE-AIM. He will also profile the incidence density of chronic hypertension, heart failure and coronary artery disease in electronic health records, and interrogate risk profiles at multiple levels by probing the interrelationships between geospatial factors. , including aspects of the built environment, socio-behavioral factors at the person level. and clinical features. In addition, early-career scientists will be trained to focus on alleviating disparities related to chronic hypertension, heart failure, and coronary artery disease that lead to unequal lifespan downstream and downstream. disseminate key information uncovered during the project trajectory to policy makers, payers, public health services and other stakeholders to drive sustainable change.

Overall life expectancy in the United States stagnated before the COVID-19 pandemic, according to the 2018 article, “Trends in health inequalities in 27 European countries”, published in the Proceedings of the National Academy of Sciences, largely due to mid-life mortality from cardiovascular disease. “Life expectancy and death rates in the United States, 1959-2017,” from the Journal of the American Medical Association, showed that age-adjusted midlife death rates for diseases hypertensives and obesity increased by 79% and 114% respectively from 1999 to 2017. According to two recent studies published in the American Journal of Public Health and JAMA Internal Medicine, people from areas of increased vulnerability linked to socio-status -economic deaths more often and younger than people from less disadvantaged areas.

COVID-19 has exacerbated an already worsened situation, and the life expectancy gap between blacks and whites in the United States has increased by 40% in the first eight months of 2020, a published 2021 study has shown in the Proceedings of the National Academy of Sciences.

Dr Levy launched in 2019 a precision approach to population health, known as the Population Health OutcomEs and Information Exchange, or PHOENIX. The new geocoded system uses anonymized electronic health records and population-level social determinants information to paint an overall picture of health in Michigan region by region, using color coding to graphically display the differences.

“When COVID hit, we were very well prepared to take advantage of PHOENIX for COVID. In my mind, PHOENIX always led to (ACHIEVE GREATER), ”said Dr Levy.

He’s also leading Wayne State’s new, nearly $ 2.64 million four-year project, which began Oct. 1, titled Linkage, Empowerment and Access to Prevent Hypertension, or LEAP-HTN, funded by the American Heart. Association under the $ 20 million RESTORE program. (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network.

Each ACHIEVE GREATER main project will be led by a principal investigator from one of the three participating institutions. All three will be supported by an administrative core headed by Dr Levy; a core community engagement, co-led by WSU Professor of Family Medicine Deborah Ellis, Ph.D., Assistant Professor of Family Medicine and Public Health Sciences, Division of Behavioral Sciences Elizabeth Towner, Ph.D., and WSU Family Assistant Professor of Medicine and Public Health Sciences Rhonda Dailey, MD; and an investigator development nucleus, led by Professor and Chair of the WSU Department of Internal Medicine, Safwan Badr, MD

WSU will serve as the ACHIEVE GREATER coordination center. The decision-making will be guided by an executive committee made up of Dr Levy, each lead partner and each principal investigator of the project.

Stakeholder advisory boards will be included in Detroit and Cleveland.

The support that Dr. Levy and his team received from the legislative community, including the Detroit Caucus and the Lansing Black Caucus, was instrumental. “Without their approval, I’m not sure we would have received this grant,” he said.

“Our three integrated research projects all focus on interventions to improve lifespan equality in black patients by shifting the trajectory of heart disease risk using improved access to care and precision tools to personalized health, ”said Dr. Levy.

Wayne Health mobile units will be used for the project.

The two Detroit-based projects will leverage the Wayne Health Mobile Unit program to improve access, overlaying planned research over regular activities that include daily deployment to different neighborhoods for the specific purpose of screening and supporting the health of the disease. population. In Cleveland, researchers partnered with the Cuyahoga Metropolitan Housing Authority, the country’s first licensed public housing authority. ACSM has 60 developments with 10,000 housing units and provides quality, safe and affordable housing to 55,000 low-income individuals and families.

“Deploying resources in black communities rather than waiting for patients to present to a healthcare facility is a key part of the lifespan equity goal that we will apply to all ACHIEVE GREATER projects. “Said Dr Levy.

Developed by Dr Levy in April 2020 to bring COVID testing to hard-hit areas, the Wayne Health Mobile Unit program has grown steadily to include vaccinations, preventative services, links to social services, as well as testing high blood pressure, diabetes and lipids at no cost to patients. The program is funded by the Michigan Department of Health and Human Services until 2024, with additional support from philanthropy and fee-for-service activities.

To date, over 45,000 people have been served by the mobile units at over 650 events, with over 250 different community partners. Since November 2020, more than 2,300 people have received social assistance during a mobile health unit event, 40% of whom needed assistance with public benefits or unemployment; 35% needed food assistance and 12% needed help navigating health insurance or utility bills.

Wayne State University President Mr. Roy Wilson.

“I am delighted but not surprised that the National Institute of Minority Health and Health Disparities has chosen Wayne State University to create a Center for Multiple Chronic Diseases Associated with Health Disparities: Prevention, Treatment and management. This has been a priority for the university and for me personally throughout my career, ”said WSU President Roy Wilson. “We have seen in Michigan how targeted efforts can eliminate health disparities, as has been the case with COVID-19. We look forward to continuing this life-saving work.

ACHIEVE GREATER is closely related to the Center for Urban Responses to Environmental Stressors at WSU, an NIH-funded P30 led by Professor of Environmental Health Sciences and Pharmacology Melissa Runge-Morris, MD, and Case Western’s P30 Reserve University on Cancer Disparities led by Nathan Berger. , MD, director of the Center for Science, Health and Society.

The grant number for this National Institute of Health study is P50MD017351.

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