Delta State Rural Development Network Grant Program (DELTA) - The Arkansas Health Improvement Coalition will collaborate to plan, develop and implement systematic interventions to improve the health outcomes of adults aged 18-74 diagnosed with diabetes and/or obesity in the 20 eligible counties of Arkansas Service Region B. The goals of the proposed project are to 1) improve health outcomes for adults aged 18-74 with diabetes and/or obesity living in Arkansas Service Region B and 2) strengthen the rural healthcare system in this region. By expanding the evidence-based models of Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Diabetes Self-Management Education (DSME), in addition to clinical pharmacy services and Medical Nutrition Therapy throughout the region, the project is expected to increase patient engagement in care, improve chronic disease self-management skills, enhance continuity of care, and strengthen disease monitoring and early intervention for high-risk patients. The project will strengthen the rural healthcare delivery system by building sustainable organizational capacity among network partners. Through technical assistance, training, workflow development, and implementation support, partner organizations will establish and sustain CCM, RPM, and Registered Dietitian-led nutrition programs capable of serving patients independently beyond the grant period. Workforce development activities will increase the capacity of clinical and care coordination staff to deliver evidence-based diabetes and obesity prevention and management services. The project will also enhance collaboration among coalition members through regular network meetings, shared performance monitoring, coordinated care delivery, and joint sustainability planning. Ultimately, these efforts will create a stronger, more integrated rural health network with the infrastructure, workforce, and reimbursement strategies necessary to sustain chronic disease prevention and management services long after federal funding ends. The proposed initiative directly advances the Federal Make America Healthy Again (MAHA) priorities by implementing a coordinated, structural framework to address the root causes of rural health disparities across our 20-county footprint. By embedding a Registered Dietitian-led infrastructure into under-resourced medical spaces, the project explicitly targets the MAHA mandate to reduce the chronic disease epidemic, aggressively countering the region's elevated adult obesity and diabetes rates before they escalate into terminal cardiovascular events. Furthermore, by deploying dedicated Chronic Care Management and Remote Patient Monitoring nurses to integrate these specialized nutritional services into existing brick-and-mortar partnering clinics, the program fulfills the MAHA mandate of expanding access to primary care, effectively optimizing clinical workforce capacity and mitigating the area's severe 2,160:1 physician shortage. This project shifts the local paradigm from reactive medical treatment to proactive, upstream intervention, establishing a scalable model for healthcare delivery that restores long-term wellness to vulnerable Delta communities.
