PROJECT SUMMARY Health disparities in the burden of multiple chronic conditions for low-income and racial/ethnic minority groups are pervasive and have their roots in social determinants of health and unequal access to evidence-based health care services during critical periods of life. A long history of racial segregation in the Chicago region has resulted in neighborhoods that are disproportionately burdened by poverty and related social determinants of health as well as poor access to high quality health resources. Unequal distribution of resources across the Chicago region results in geographic “hotspots” where high numbers of residents suffer from multiple cardiometabolic conditions. Innovative local solutions are necessary to bridge gaps in the healthcare system, gaps in the traditional approach to delivering preventive and management services, and gaps generated by the traditional siloed approach to science. The Chicago Chronic Condition Equity Network (C3EN) will address these gaps by strengthening collaborations across community-based organizations, practice networks, and academic researchers, by promoting a comprehensive approach to the prevention and management of multiple chronic conditions that accounts for mental health, functional health and social life, and by supporting interventions that actively seek to cross boundaries of disease-specific management, professional training, community and practice. This network will be the communication channel for multi-directional exchange of ideas regarding how to address disparities in communities, the community-based research network where both pilot studies and larger regional studies of scalable interventions will take place, and the training ground for new investigators. Our research projects have been selected to demonstrate our scientific thematic interest in promoting a comprehensive view of health that acknowledges the importance of physical, psychological, and social functioning as outcomes as well as potential avenues for health improvement. The C3EN will benefit from a foundation of multiple institutes and centers at the University of Chicago and Rush that set the stage for conducting interdisciplinary research aligned with public health goals of the Chicago region, inter-institutional collaboration, and models for training programs. Our Center’s Specific Aims are: 1) To build a Chicago regional community-based research network based on collaborations with key stakeholder groups including community-based organizations, networks of ambulatory practices, and academic institutions, to identify innovative, effective, and scalable interventions that reduce disparities for multiple chronic conditions; 2) To provide cutting edge research support and expertise (intersectoral health, informatics, implementation science, community-resource referral software systems, remote sensor technology) to facilitate chronic condition health disparities research conducted across practice networks, in community settings, and in the home; and 3) To attract and support diverse new investigators by providing education, training, mentoring, support for community and stakeholder engagement, pilot grant funding, and access to research support.

PROJECT NARRATIVE Health disparities in the burden of multiple chronic conditions in the Chicago region are attributed to a history of racial segregation leaving gaps in economic opportunities and gaps in the healthcare system. The Chicago Chronic Condition Equity Network (C3EN) will address these gaps by strengthening and building collaborations across community-based organizations, practice networks, and academic researchers, by promoting a comprehensive approach to the prevention and management of multiple chronic conditions that accounts for mental health, functional health and social life, and by supporting interventions that actively seek to cross boundaries of disease-specific management, professional training, community and practice.