The Virginia Department of Health (VDH) will implement the LivingWell in Virginia (LivingWell) project to continue support of public health investments that strengthen and expand evidence-based strategies and activities resulting in improved care coordination, increased participation in self-management and preventive behaviors, and sustainability of care models and clinical reporting that prevent and manage cardiovascular and diabetes disease outcomes.
Diabetes prevention and management programs will be strengthened through unique partnerships and statewide infrastructure to increase referral and participation in evidence-based programs, including diabetes self-management education programs and National Diabetes Prevention Programs. Existing programs will be strengthened through training and mentoring opportunities to increase sustainability. New programs will be established in areas that lack access. Furthermore, pharmacists and community health workers (CHWs) will become integrated into care teams through team-based care models that support diabetes medication management and referral to community resources.
Hypertension and cholesterol efforts will rely heavily on engagement of clinical partners and systems of care. Data collection and monitoring will be initiated at a statewide level through predictive modeling to focus preventive efforts. Local data collection will utilize real-time dashboards to support patient identification and referral to management programs. Providers and pharmacists will have opportunities to test and share best-practices through capstone projects and active learning sessions. CHWs will be further utilized in heart disease efforts through the establishment of regional hubs that provide clinical integration and connections to community resources.
Over the next five years, through increased access to prevention and management programs, improved systems of care, and successful linkages to community resources, the VDH intends to improve the prevention and control of prediabetes, diabetes, hypertension, and high cholesterol.