Organization: Wisconsin Department of Health Services, 1 West Wilson Street, Madison WI 53703-3445
Serving: State of Wisconsin
The Wisconsin Department of Health Services’ Chronic Disease Prevention Program and the MKE Heart Health Learning Collaborative will implement practice and evidence-based strategies to reduce health care disparities and improve health outcomes. We will focus on the 1860 census tract with a hypertension crude prevalence of greater than 53% and engage community members to understand their strengths and challenges that affect cardiovascular health. Our comprehensive approach has been designed with a health equity lens and operationalizes linkages between public health, community, and clinical sectors.
The 1860 census tract is located on the north side of Milwaukee and includes Bronzeville, parts of the Hillside, and Halyard Park neighborhoods, and parts of the 53205 and 53212 zip codes.
Persistent residential segregation is seen in this area that was once redlined and rated “hazardous” on maps used by lending institutions, denying housing and economic opportunity to Black and minority residents.
The MKE Heart Health Learning Collaborative will be co-led by organizations who understand the history and challenges faced by the people in/around the 1860 census tract, the strengths, and assets of the community, who have lived experience and are trusted community leaders. Health Connections, Inc. will lead the Learning Collaborative Clinical Care Section, and Y-EAT Right will lead the Learning Collaborative Community Engagement Section and provide deep community connection and engagement to understand root causes and support community members in identifying and working towards solutions as part of the Learning Collaborative.
Strategies and activities will be implemented to improve outcomes for people at increased risk for cardiovascular disease including 1) track and monitor clinical and social services needs using electronic health records and health information technology, 2) increase the use of multidisciplinary teams to address social services and support needs and referrals to resources, and, 3) link community resources and clinical services to support bidirectional referrals, self-management and engagement of Community Health Workers.
Through innovative and collaborative approaches, the MKE Heart Health Learning Collaborative partners will achieve these outcomes by September 29, 2028.
• Increased blood pressure control among populations within partner health care and community settings.
• Decreased disparities in blood pressure control among populations within partner health care and community settings.
• Increased utilization of social support services among approved populations of focus.