The B.R.I.D.G.E. Program as an Exemplar of Nurse Led Multimodal Approaches to Address Colorectal Cancer Disparities and Opioid Deaths in Metro Detroit

Abstract

Colorectal cancer (CRC) screening disparities and opioid overdose (OD) deaths continue to pose significant public health challenges in Metro Detroit, particularly affecting African American and Middle Eastern North African (MENA) communities. The B.R.I.D.G.E. (Building Relationships to Impact Disparities and Generate Equity) initiative, a nurse-led, multimodal quality improvement (QI) program, demonstrates the vital role of nursing leadership in tackling these 2 pressing epidemics through community-focused, equity-driven strategies. Utilizing the Mobilizing for Action through Planning and Partnerships (MAPP) 2.0 framework, B.R.I.D.G.E. implements targeted interventions across clinical and community settings. These initiatives include enhancing CRC screening through clinic-based QI projects, educating providers, offering transportation assistance, and expanding OD prevention via Narcan administration training, Screening, Brief Intervention, Referral to Treatment (SBIRT), and Mental Health First Aid (MHFA). By empowering nurses as trusted community advocates and cultivating strong cross-sector partnerships, B.R.I.D.G.E. effectively improves care delivery, advances health equity, and nurtures sustainable community engagement. This case study illustrates how nurse-led interventions can dismantle structural barriers, enhance health outcomes, and serve as scalable models for addressing health disparities in marginalized populations. Utilizing the Mobilizing for Action through Planning and Partnerships (MAPP) 2.0 framework, B.R.I.D.G.E. implements targeted interventions across clinical and community settings. These initiatives include enhancing CRC screening through clinic-based QI projects, educating providers, offering transportation assistance, and expanding OD prevention via Narcan administration training, Screening, Brief Intervention, Referral to Treatment (SBIRT), and Mental Health First Aid (MHFA). By empowering nurses as trusted community advocates and cultivating strong cross-sector partnerships, B.R.I.D.G.E. effectively improves care delivery, advances health equity, and nurtures sustainable community engagement. This case study illustrates how nurse-led interventions can dismantle structural barriers, enhance health outcomes, and serve as scalable models for addressing health disparities in marginalized populations.

Introduction

Metro Detroit, including Wayne County, Michigan, faces significant public health challenges, particularly disparities in colorectal cancer (CRC) screening and opioid overdose (OD) mortality. ¹ In 2023, Detroit reported 430 opioid-related deaths, which accounted for over 15% of the total in the state, highlighting the severity of the opioid crisis in the region. ² Additionally, CRC remains a leading cause of cancer-related deaths, with screening rates in Michigan at 61.8%, falling short of the national target of 80%. ³ These health disparities are intensified by long-standing social determinants of health (SDOH), such as limited access to care, medical mistrust, language barriers, and transportation challenges.

In response to these urgent issues, a College of Nursing in Southeast Michigan developed the Building Relationships to Impact Disparities and Generate Equity (B.R.I.D.G.E.) initiative. In 2024, the U.S. Department of Health and Human Services (HHS) Office of Minority Health awarded the program a $2.4 million, four-year grant as part of its $11.5 million Community Level Innovations for Improving Health Outcomes Initiative. ⁴ The innovative B.R.I.D.G.E. initiative is nurse-led and designed to improve CRC screening rates, reduce opioid-related deaths, and address the underlying social determinants of health in Metro Detroit.

Specifically, this multimodal program aims to:

1. Increase CRC screening rates among underserved populations through clinic-based quality improvement (QI) projects, provider education, and patient navigation services.

2. Reduce opioid-related deaths by implementing community-based interventions, including Narcan administration training, Screening, Brief Intervention, Referral to Treatment (SBIRT), and Mental Health First Aid (MHFA) programs.

3. Address underlying SDOH by enhancing care coordination, improving access to transportation, and fostering community engagement through partnerships with local organizations.

Literature and Practice Gaps

While nurse-led interventions have shown effectiveness in addressing individual health disparities, there is a lack of programs that tackle multiple, co-occurring public health issues within marginalized communities. The B.R.I.D.G.E. initiative fills this gap by implementing a holistic, community-centered model that simultaneously targets CRC screening disparities and opioid overdose prevention. This case study contributes to the limited literature on integrated, nurse-led approaches to complex health challenges, offering insights into scalable strategies for promoting health equity.

Background and Assessment of Need

Metro Detroit, home to 4.4 million people, faces entrenched socioeconomic inequities that have fueled a persistent public health crisis. In many urban neighborhoods, predominantly African American communities, comprising up to 80% of residents, and a sizable MENA population experience high rates of poverty, unemployment, and segregation.^{5 -9} These conditions limit access to preventive care, leaving nearly one-third of residents without routine screenings and contributing to avoidable poor health outcomes. ⁷

Epidemiological data from Wayne County reveal significant disparities in CRC burden. African Americans experience CRC incidence rates approximately 20% higher, and mortality rates nearly 40% higher, than White counterparts. ⁹ Individuals from MENA communities also face disproportionately high CRC rates, compounded by limited access to culturally appropriate care and underrepresentation in cancer data. In both groups, insufficient screening, delayed care, and deep-seated mistrust contribute to a high rate of late-stage CRC diagnoses. ⁹

Concurrently, the region continues to suffer from the opioid epidemic, with nearly 35 opioid-related deaths per 100 000 residents and over 800 overdose fatalities recorded in recent years, further exacerbating the public health crisis, particularly among African American and MENA communities, who are disproportionately affected due to systemic inequities, limited access to treatment, and culturally unresponsive care models. ²

B.R.I.D.G.E.: A Nurse-Led Initiative for Health Equity in Metro Detroit

The B.R.I.D.G.E. initiative exemplifies the role of nurse-led, community-based interventions in advancing health equity, with a focus on African American and MENA populations in Metro Detroit.^{10 -14} Targeting CRC screening and opioid-related mortality, the program addresses both urgent health needs and the structural SDOH that drive disparities, such as limited access to care, mistrust, and lack of culturally responsive services. Guided by the MAPP 2.0 framework, B.R.I.D.G.E. mobilizes nurses as trusted messengers and fosters cross-sector collaboration. ¹⁵ It partners with over 25 community-based organizations (CBOs), including clinics, faith-based groups, and Black Greek Letter Organizations, to build reach and trust (Table 1), and is led by a coordinated team of nursing faculty supported by advisory groups and evaluators (Table 2). Grounded in quality improvement and continuous evaluation, B.R.I.D.G.E. offers a scalable model for sustainable, equity-driven care in urban settings.

Table 1.

Linking MAPP 2.0 Phases to B.R.I.D.G.E. Goals and B.R.I.D.G.E. Activities.

MAPP 2.0 phase	B.R.I.D.G.E. goals	B.R.I.D.G.E. activities
Phase 1: Build the CHI foundation	Goal 1: Build and maintain a sustainable collaborative network	• Establish the B.R.I.D.G.E. infrastructure
		• Expand partnerships with primary care and cancer clinics
		• Engage community based organizations
Phase 2: Tell the community story	Goal 2: Implement clinic, provider and community-level innovations to address local health disparities	• Conduct needs assessments
		• Initiate QI initiatives
		• Evaluate transportation challenges and develop procedures to address disparity for high-risk patients
		• Host community programing, health fairs, youth symposiums, and launch multimedia campaigns
		• Develop and implement a curriculum on Social Determinants of Health (SDOH) for healthcare providers
Phase 3: Continuously improve the community	Goal 3: Evaluate project processes and outcomes	• Evaluate clinic, provider and community-level QI projects using established models
		• Implement PDSA cycles, track performance, and apply continuous improvement methods
		• Disseminate findings

Table 2.

B.R.I.D.G.E. Nurse Liaisons and Partner Agencies.

Nurse Liaison	B.R.I.D.G.E. partner agency
Nurse Liaison A	• Federally Qualified Health Center
	• Community Clinic
	• Geriatric Specialty Clinic
	• Substance use and Primary care integrated clinic
Nurse Liaison B	• Oncology Institute
	• Free Clinic
	• State Cancer Control Program
	• Caregiver Agencies
Nurse Liaison C	• Nursing Service Organizations
	• Faith-Based Community Organizations
Nurse Liaison D	• National Pan-Hellenic Council (representing Black Greek Letter Organizations)
	• Healthcare provider Training (CRC)
Nurse Liaison E	• Media Partner for public health campaigns
	• Overdose Prevention Engagement Network
	• Youth Outreach
	• Community Health Fair
Nurse Liaison F	• Social Determinant of Health Hubs
	• Community Council representing cultural groups
	• Men’s Health Initiatives
Nurse Liaison G	• SDOH curriculum development
	• Healthcare Provider training (Opioid Deaths)

A robust infrastructure, including advisory and evaluation committees, external evaluators, and administrative staff, supports evidence-based interventions and progress tracking (Figure 1). By combining quality improvement methods with community-driven strategies, B.R.I.D.G.E. advances sustainable health equity, aiming to increase CRC screening and reduce opioid-related deaths across Metro Detroit.

Figure 1.

B.R.I.D.G.E. organizational chart.

Methods

Mobilizing for Action Through Planning and Partnerships (MAPP) 2.0

The MAPP 2.0 framework guided this grant, informing the design and implementation of interventions to reduce health disparities in Metro Detroit. Developed by the National Association of County and City Health Officials, MAPP 2.0 is a community-driven planning model that promotes health equity through stakeholder collaboration, cross-sector alignment, and evidence-based strategies.^15,16 It emphasizes community engagement, addresses SDOH such as poverty and limited healthcare access, and supports continuous improvement through its 3-phase process: Build the CHI Foundation, Tell the Community Story, and Continuously Improve the Community. Table 1 aligns these phases with B.R.I.D.G.E. objectives and nursing interventions.

Quality Improvement at the Clinic Level

Nurse-led quality improvement (QI) projects have consistently demonstrated their effectiveness in boosting CRC screening rates and reducing opioid-related deaths.^{10 -14} Guided by the Johns Hopkins Nursing Evidence-Based Practice model, B.R.I.D.G.E. conducts systematic needs assessments, rigorously evaluates the latest evidence, and implements targeted interventions. These interventions include provider reminders, improved access to fecal immunochemical test (FIT) kits, and patient education strategies designed to enhance health literacy. Partner clinics, ranging from free community clinics to federally qualified health centers, collaborate closely with the B.R.I.D.G.E. team, ensuring that best practices are implemented consistently.

Addressing Transportation Barriers

A significant barrier to accessing care in Metro Detroit is transportation, particularly for high-risk patients requiring colonoscopies. ¹⁷ B.R.I.D.G.E. identified these challenges through needs assessments at partner clinics and responded by partnering with homecare agencies. These collaborations provide transportation services and ensure caregiver support, facilitating timely CRC screening and reducing delays in care. This process is continually evaluated and refined to meet evolving community needs.

Provider-Level Interventions

Recognizing that effective patient-provider communication is critical for improving health outcomes, B.R.I.D.G.E. implements extensive training programs for healthcare providers. These programs cover topics such as SDOH, Screening, Brief Intervention, and Referral to Treatment (SBIRT), Narcan administration (NA), and updated screening guidelines for both CRC and opioid use disorder. The initiative targets 50 healthcare providers annually, working with professional organizations to offer continuing education and hosting regional health conferences that emphasize cultural competence. These efforts ensure that providers are well-equipped to address health disparities and deliver high-quality, culturally sensitive care. To date, B.R.I.D.G.E. has trained about 160 medical professionals, exceeding the annual goal by more than threefold.

Community-Level Interventions

B.R.I.D.G.E. extends its reach to the community through partnerships with trusted nursing service organizations (NSOs) and CBOs. NSOs play a crucial role by training nurses as “Train the Trainers” in both NA and CRC education, thereby rapidly disseminating critical health information. To engage CBOs, the initiative employed direct outreach, leveraged pre-existing relationships, and hosted listening sessions to align priorities and build trust. These efforts led to high-impact collaborations, such as with faith-based organizations, which helped co-develop events tailored to specific community concerns.

Cultural competence was a core element of all community-facing activities. B.R.I.D.G.E. ensured that interventions were linguistically appropriate, delivered by culturally concordant staff when possible, and informed by ongoing input from African American and MENA community representatives.

Simultaneously, B.R.I.D.G.E. collaborates with CBOs serving African American and MENA communities to deliver tailored health education and promotion programs. These efforts include hosting at least 10 annual events, ranging from CRC screening awareness campaigns and health fairs to targeted training sessions like Mental Health First Aid (MHFA), which aims to train 50 community members each year. Additionally, mass media campaigns extend the initiative’s reach by disseminating health messages via radio, social media, and print, ensuring that the messaging resonates with diverse audiences.

Quality Assurance

Fidelity and program improvement were supported through quality assurance strategies, including Plan-Do-Study-Act (PDSA) cycles for iterative testing across clinical and community settings. Structured community feedback mechanisms, such as advisory meetings, training evaluations, and post-event surveys, enabled real-time responsiveness and continuous adaptation to enhance cultural relevance, engagement, and impact.

Lessons Learned and Implications for Practice

Implementing the B.R.I.D.G.E. program revealed key barriers and lessons. First, partner capacity varied widely—some organizations required intensive support with data collection and project management, while others operated more independently. Tailoring assistance to meet each partner’s needs was essential; a one-size-fits-all approach risked overburdening or underutilizing partners.

Second, B.R.I.D.G.E.’s collaborative model, co-developing goals, sharing responsibilities, and jointly evaluating outcomes, was a shift from traditional top-down interventions. Some partners initially struggled with this approach, requiring time, transparency, and trust-building to foster comfort and engagement. These efforts ultimately led to deep buy-in and long-term program ownership.

Finally, the program’s success relied on longstanding, trust-based relationships with local CBOs, NSOs, clinics, and faith-based groups. These partnerships informed culturally responsive interventions and accelerated planning. Additionally, nurses served as trusted community liaisons, and student involvement through faculty mentorship added capacity while promoting hands-on learning. Together, these strategies highlight the importance of adaptability, shared ownership, and capacity-building in advancing equitable health outcomes.

Conclusion

The B.R.I.D.G.E. initiative exemplifies the transformative potential of nurse-led, community-anchored models in advancing health equity. By simultaneously working to increase CRC screening and reduce opioid-related deaths, while also addressing the social determinants that drive these disparities, the program delivers an integrated, community-responsive approach that meets both clinical and structural needs. Additionally, the B.R.I.D.G.E.’s comprehensive, evidence-based, and multimodal approach fosters long-term sustainability by embedding culturally competent care, cross-sector collaboration, and continuous quality improvement into the fabric of community health efforts.

B.R.I.D.G.E. reaffirms that nurses are not only care providers, they are architects of equity. Positioned at the forefront of systemic change, this initiative challenges traditional public health paradigms and demonstrates the full potential of nursing leadership to drive population-level impact. By amplifying the voice and role of nurses, B.R.I.D.G.E. shifts the trajectory of care toward justice, inclusion, and enduring community trust, laying the groundwork for a more equitable future in public health.