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Coordination News

Enhancing Coordination Update

Are you a chronic disease director, program manager, project officer, or national partner working in chronic disease prevention and health promotion?

The Enhancing Coordination Update is a weekly digest of crosscutting chronic disease news, tools, and resources to support state chronic disease prevention and health promotion efforts.

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Chronic Disease Prevention Work: Case Studies and Examples

Below are case studies and examples of chronic disease prevention work in some of the states we work with.

Case Study: Montana Takes Strategic Steps to Coordinate Chronic Disease Prevention Initiatives


The Chronic Disease Prevention and Health Promotion (CDPHP) Bureau of Montana’s Department of Public Health and Human Services streamlined program resources to increase the efficiency of individual chronic disease programs. The Bureau’s portfolio includes statewide programs that address cancer, diabetes, cardiovascular health, asthma, tobacco use prevention, nutrition, and physical activity. Over the past 5 years, the Bureau intentionally coordinated chronic disease prevention work to enhance efficiency and quality. The Bureau uses several strategies to streamline the work without compromising the integrity of individual program objectives: strategic internal and external communication; a coordinated state chronic disease prevention plan; core activity work plans; and workgroups that coordinate activities in communities, schools, work sites, health care organizations, and environmental settings.


Traditionally, the Bureau took a categorical approach to accomplish objectives, by creating separate programs in response to funding opportunities (government grants, cooperative agreements) for individual chronic disease conditions and risk factors instead of working holistically and addressing the interrelatedness of conditions and risk factors. A categorical approach creates a culture where staff work only in their areas and are less likely to cooperate, coordinate, and collaborate across programs to do cross-cutting work. This approach leads to

  • Misaligning priorities for greatest public health impact.
  • Not leveraging funding and other resources, such as staff working in multiple programs.
  • Creating duplication of efforts.
  • Overloading partners with too many requests and information.

In response, the staff used the National Association of Chronic Disease Director’s Public Health Framework Assessment Tool (PHFAST) to examine capacity in eight domains: epidemiology, interventions, evaluation, leadership, state plans, administration, partnership, and coordination. The average score from the coordination domain was the lowest of all domains.


Based on the survey results, the Bureau systematically looked at existing resources and created processes to streamline and coordinate activities. As a result, the Bureau developed a coordinated state chronic disease prevention plan, which articulated priority actions to support healthy citizens in Montana.

  • Created internal and external communication strategies explaining to staff and partners how their everyday work fits into state priorities and plans.
  • Identified similar work across programs and coordinated to improve collaboration, reduce duplication, and stretch limited resources.
  • Developed performance management and continuous quality improvement processes to address the barrier of status quo.
  • Used coordinated workgroups from communities, schools, work sites, health care organizations, and environmental settings to streamline the Bureau’s efforts without compromising the integrity of individual program objectives.
  • Meets regularly and monitors and reports outcomes in an established performance management system.
  • Shares resources, including staff and funding, across program lines to meet shared program needs and objectives.
  • Developed integrated processes, such as a cross-program orientation for new staff; tracking events across the bureau (i.e., press releases, educational opportunities, and other communications) for cross-collaboration opportunities; and the Community Based Program Guide highlighting evidenced-based programs in the community that support Montanans’ efforts to prevent and manage chronic conditions.
Plan Hierarchy. 1. State Health Improvement Plan (SHIP): Outlines Montana's plan to improve the overall health of Montanans. It is not specific to any one state department or organization but covers all efforts to improve health. 2. Public Health and Safety Division Strategic Plan: Outlines the strategic direction of the Public Health and Safety Division as it works to fulfill the objectives outlined in the SHIP. 3. Montana Chronic Disease Plan: Outlines Montana's plan to prevent and manage chronic disease and injury. It is not specific to the Chronic Disease Prevention and Health Promotion Bureau but applies to all of our partners as well. 4. Core Activity Work Plans: Outlines the specific tasks, performance measures, and budget for a particular activity. It is a tool for tracking and completing activities at the program level.

Every Bureau program uses the performance management system on a daily basis and uses core activity action plans to identify similar activities that multiple programs can address together. The plans show staff how their work fits into the big picture for state health improvement. (see graphic) Bureau-level partner relationships are more productive and increase opportunities to share and maximize resources between partners and the Bureau. All Bureau programs now present a unified and consistent message to partners and the public. Subsequent survey scores show an increase in PHFAST scores in coordination, demonstrating a positive shift in the culture of the Bureau.

Sustainable Success

To sustain and increase efficiencies and effectiveness, the Bureau chief established the Efficiency and Quality Section. Responsibilities of this section include assessing areas of duplication and potential collaboration, ensuring coordinated work with partners, building an environment of continuous quality improvement, and ensuring all programs are inclusive and serve communities with health disparities. The Bureau will administer the PHFAST assessment every 2 years along with staff interviews, to identify and celebrate the areas that have seen improvement overtime and those that still need to be addressed.

Case Study: Promoting and Expanding Coverage for the National Diabetes Prevention Program in Colorado

Colorado States can prevent costly and devastating diseases by helping people who have prediabetes avoid type 2 diabetes. CDC-recognized lifestyle change programs operating under the framework of the National Diabetes Prevention Program (National DPP) prevent or delay the onset of type 2 diabetes and reduce the risk of heart disease and stroke among people with prediabetes. The Colorado case study [PDF – 212 KB] shows how state officials can support the growth and sustainability of the National DPP.

  California’s Chronic Disease Prevention Messaging Toolkit

California The California Department of Public Health (CDPH) developed a Chronic Disease Prevention Messaging Toolkit to help local health departments and community-based organizations write and publish compelling chronic disease prevention messages. The Messaging Toolkit and the unifying tagline “Lifetime of Wellness” were created with input from CDPH staff and external partners through qualitative marketing research. It includes downloadable storytelling forms and templates.

In 2014, the Messaging Toolkit received a Silver Award in Excellence in Public Health Communication from the National Public Health Information Coalition (category: Webcasts/Podcasts/Web-based Training — Internet/New Media).

Case Study: The Effect of Expanding Cessation Coverage—The Massachusetts Medicaid Cessation Benefit

Massachusetts States can design and implement tobacco cessation benefits through Medicaid that are accessible, affordable, and cover all evidence-based cessation treatments including counseling and medications. This case study [PDF – 937.33 KB]  from Massachusetts explains how providing a broad cessation benefit through Medicaid can increase use of evidence-based cessation treatments, reduce smoking rates, improve health outcomes, and lower medical costs over a short period. The MassHealth cessation benefit had a major effect on all of these outcomes even though it was made available to a vulnerable, underserved, low-income population traditionally viewed as hard to reach. The lack of comprehensive Medicaid cessation coverage in most states represents a major missed opportunity to improve health outcomes in a vulnerable population while reducing health care costs.

ASTHO Launches Blog

Did you know that the Association of State and Territorial Health Officials (ASTHO) has a public health blog? The blog’s purpose is to communicate credible, timely information on issues important to state and territorial public health, and to show the relevance and effectiveness of state and territorial public health agencies.

New information is posted several times a week. Topics include the innovative work of states and territories to improve health and wellness, as well as news of the day of interest to public health professionals. To follow the blog, readers may subscribe to an RSS feed or visit the ASTHO website.

Updated Revisions to the Chronic Disease Indicators (CDI)

The chronic disease indicators (CDI) are a set of surveillance indicators developed by consensus among CDC, the Council of State and Territorial Epidemiologists (CSTE), and the National Association of Chronic Disease Directors (NACDD). CDI enables public health professionals and policy makers to retrieve uniformly defined state and selected metropolitan data for chronic diseases and risk factors that have a substantial effect on public health.

CDI has recently increased from 73 to 124 indicators in the following 18 topic groups: alcohol; arthritis; asthma; cancer; cardiovascular disease; chronic kidney disease; chronic obstructive pulmonary disease; diabetes; immunization; nutrition, physical activity, and weight status; oral health; tobacco; overarching conditions; disability; mental health; older adults; reproductive health; and school health. CDI includes 22 indicators of system and environmental change. The 124 indicators include 201 individual measures, many of which overlap multiple chronic disease topic areas or are specific to a certain sex or age group.