The burden of chronic disease in Minnesota remains high with cardiovascular disease and diabetes together accounting for 25 percent of all deaths and approximately $5 billion in combined inpatient hospitalizations and associated health care costs in the State. Over the past 25 years, prevalence of diabetes and obesity in adults has more than doubled. In addition, a large proportion of the population remains unaware of their hypertension, high blood cholesterol, prediabetes and diabetes. This lack of awareness occurs in combination with problems of access to clinical care combined with social and economic factors. Although we have better health status and care delivery systems relative to many other states, Minnesota has unacceptable disparities in health status and outcomes across our populations. The health disparities in Minnesota are concentrated in lower income populations that include Medicaid enrollees, rural communities, and populations of color.
The 1815 NOFO application provides an opportunity to build on the extensive work accomplished to date through the 1422 and 1305 CDC grants that are now coming to an end of their 5-year cycle with largely the same MDH team that engineered those successes.
Purpose: The MDH will support the implementation and evaluation of a set of evidence-based strategies to prevent and control diabetes and cardiovascular disease in high-burden populations.
Outcomes: The long-term outcomes for the proposal are to: 1) decrease the proportion of people with diabetes in Minnesota with an A1c greater than 9; 2) increase the number of people with prediabetes enrolled in a CDC-recognized lifestyle change program who have achieved 5-7% weight loss; and 3) increase control among adults with known high blood pressure and high blood cholesterol. Intermediate outcomes include: 1) increased participation in ADA-recognized / AADE-accepted DSMES programs by people with diabetes; 2) increased enrollment and retention in CDC-recognized organizations delivering the National DPP lifestyle change program; 3) increased medication management/adherence among patients with high blood pressure and high blood pressure and high blood cholesterol; and 5) increased participation in evidence-based lifestyle interventions among patients with high blood pressure and high blood cholesterol. Short-term outcomes include: 1) increased access to coverage for ADA-recognized/AADE-accredited diabetes self-management education and support (DSMES) programs for people with diabetes; 2) increased use of pharmacist patient care processes for people with diabetes; 3) increased access to and coverage for the National DPP lifestyle change program for people with prediabetes; 4) increased community clinical links that facilitate referrals and provide support to enroll and retain participants in the National DPP lifestyle change program; 5) increased monitoring and tracking of clinical data for improved identification, management and treatment of patients with high blood pressure and high blood cholesterol; 6) increased usage and adherence to evidence-based guidelines and policies related to team-based care for patients with high blood pressure and high blood cholesterol; and 7) increased community clinical links that support systematic referrals, self-management, and lifestyle changes for patients with high blood pressure and high blood cholesterol.
Improvements in hypertension and high blood cholesterol, primary risk factors for CVD, along with diabetes prevention and treatment will be achieved through behavior modification improvements and health system advances necessary to reduce the need for treatment and close the gap for at-risk populations in Minnesota.