<qa>  What is the primary cause of the observational cohort?The observational cohort will be comprised of individuals with diabetes receiving care at one of the participating health facilities. Cases include individuals participating in the COPE intervention; controls are non-COPE participants identified within the same hospital and matched based on similar baseline characteristics. Study findings will improve clinical and patient-decision making and the health of marginalized AIANs by informing policies to promote CHR interventions in rural and underserved communities. 