Paul Coverdell National Acute Stroke Program - Organization: Wisconsin Department of Health Services, 1 West Wilson Street, Madison WI 53703-3445 Serving: State of Wisconsin Application for: The Paul Coverdell National Acute Stroke Program (CDC-RFA-DP-24-0060) The Wisconsin Department of Health Services’ Wisconsin Coverdell Stroke Program (WCSP) and partners will work to address the persistent disparities in stroke and its related health factors including uncontrolled and undiagnosed hypertension (HTN), with a focus on the social determinants of health (SDoH) that drive health disparities and inequities. Our approach will implement and evaluate evidence-based and informed strategies to prevent and manage stroke in identified populations and communities. This will be achieved through regional Learning Collaboratives (LC) informed by members communities of focus. The LCs will collectively identify and implement actionable solutions to identify and control HTN, enhance data collection across the stroke continuum of care, and strengthen linkages between clinical and community resources. WCSP identified high priority counties disproportionately burdened by stroke as evidenced by crude stroke prevalence at the census tract level that is at least 1.5 times greater than crude stroke prevalence for the corresponding county. To identify populations of focus, WCSP used GIS to investigate statewide stroke hospitalization and mortality rate. Within these priority counties and communities, WCSP determined 4 regional action-oriented LCs. This will include three regional LCs: South Central Wisconsin (SC WI) including Dane and Dodge counties; Northeastern Wisconsin (NE WI) including Outagamie and Brown counties; Southeastern Wisconsin (SE WI) including Milwaukee, Racine, and Waukesha counties; as well as an LC for rural health systems. All four represent populations of focus having high prevalence of stroke, HTN, and poor SDoH. This regional LC approach ensures that a majority (≥51%) of LC collaborators and partners have demonstrated history and experience working with and representing the interests of approved populations of focus. Strategies and activities will be implemented to improve outcomes for people having experienced a stroke and people at increased risk for stroke including 1) tracking and monitoring clinical and social services and support needs using electronic health records and health information technology, 2) increasing the use of team-based care through the mitigation of barriers to clinical and social services and support needs, and, 3) linking community resources and clinical services to support bidirectional referrals, self-management, and lifestyle changes. Through this approach, WCSP will achieve the following outcomes within partner, health care, and community settings: • Decreased stroke incidence for those at the highest risk of stroke • Decreased disparities in strokes for those at the highest risk of stroke • Increased utilization of social services and support needs for those at the highest risk of stroke