Our Focus Areas

The Center for Health System Improvement (CHSI) serves as the research core of the Tennessee Population Health Consortium and supports research to determine the effectiveness of innovative health system interventions to improve human health. We focus on pragmatic clinical research to evaluate innovative uses of health information technology, lay community health workers, and community-based health resources to improve the delivery of essential health services to underserved populations. We also promote sustainable community-driven health system change. Our work includes the Patient-Centered Outcomes Research Institute-funded  Management of Diabetes in Everyday Life (MODEL) study, which recently demonstrated that health coaching and text messages are effective tools in increasing healthy eating and exercise in patients with uncontrolled diabetes. Learn more about our research.

The Tennessee Heart Health Network (TN-HHN) works to implement patient-centered interventions in primary care to improve cardiovascular health. As the signature project of the Consortium, TN-HHN was launched January 1, 2021, in recognition that Tennessee's need is great. Our state ranks #3 in cardiovascular disease events because of high rates of obesity, uncontrolled hypertension and diabetes, and tobacco use. The TN-HHN works to help primary care practices implement evidence-based patient-centered interventions to improve quality and outcomes of cardiovascular care across Tenessee. Through TN-HHN, we help participating clinics offer health coaching, in-clinic pharmacists, and motivational text messages – all proven to help patients adopt healthy habits and improve their health. This work is funded by the Agency for Healthcare Research and Quality.

In recognition that obesity, diabetes, and hypertension are linked to increased deaths in Shelby County and the state, the Consortium, in partnership with UTHSC College of Medicine, established the Neighborhood Health Hubs (NHH) initiative in 2021. NHH provides a convenient entry point to primary care in underserved areas of Memphis and Shelby County. The UTHSC Health Hub in Uptown provides health coaching, some health screenings, health coaching, and referrals to needed care as well as exercise, heathy cooking, and chronic diesease management classes. The Hub also hosts the Healthy Eating and Active Living to Reverse Diabetes (HEAL Diabetes) program, which promotes food as medicine in improving or curing diabetes. ShelbyCares on 3^rd  offers similar services to residents of South Memphis, in partnership with  Mayor Lee Harris and Shelby County Government.