Partnerships for Cardiometabolic Disparities in Native and Pacific Peoples

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DESCRIPTION (provided by applicant): The Comparative Effectiveness Research (CER) Approaches to Eliminate Cardiometabolic Disparities (ECD)" is a revision application that includes 4 CER activities to integrate comparative effectiveness research methods with existing health disparities approaches to address persistent gaps in cardiometabolic health care disparities in Native and Pacific Peoples. These 4 activities are: #1: The Pay-for-Outcomes (P40) Study: Incentivized Partnerships to Reduce Diabetes Disparities. #2: Building Human Capital: provides 4 new CER-health disparities training activities. #3: Data Infrastructure: will establish CER patient registries for diabetes and cardiometabolic diseases. #4: Dissemination and Translation: will translate a heart failure intervention to prevent re-hospitalization into clinical practice and build a clinical providers network. All 4 activities invests in the Center for Native and Pacific Health Disparities Research (The Center) to leverage its existing Infrastructure to support CER for eliminating health disparities, especially cardiometabolic health disparities, in the priority populations of Native Hawaiians, Alaska Natives and Pacific Peoples (Filipino, Micronesian, Samoan. etc.). The P40 Study is an innovative Intervention that integrates CER and health disparities approaches to address diabetes disparities among low Income, racial/ethnic minorities with known gaps in diabetes care. The specific aims are: 1. Compare the effectiveness of incentivized partnerships on reducing mean HbAlc to <7% in multi-ethnic, low-income patients with diabetes versus usual care. 2. Compute the incremental cost-effectiveness of financial incentives plus education to achieve glycemic goals compared with usual care. 3. Examine whether effectiveness and incremental cost-effectiveness ratios differ by race and ethnicity. The P40 Study will use a block randomized control trial design to examine the effectiveness of education and financial incentives to patient-provider pairs for improving HbAlc levels to goal (HbAlc <7%) compared with usual care in an ethnically diverse Medicaid population. The potential impact of this study and the investment of all 4 CER activities are substantial since considerable uncertainty exists on which treatments are most effective among racial/ethnic minorities who are challenged with suboptimal diabetes care. Our CER-ECD initiative fills a unique role In addressing health care disparities that other organizations are unlikely to do and our strategic partnerships will allow for the CER investments to have multiplicative and far reaching returns throughout the Pacific region and across diverse priority populations including Native and Pacific Peoples.