CDC-RFA-DP-23-0004: The National Cardiovascular Health Program

Notice of Funding Opportunity: The National Cardiovascular Health Program

DP-23-0004 Notice of Funding Opportunity Announcement

The National Cardiovascular Health Program is a 5-year cooperative agreement that aims to implement and evaluate evidence-based strategies contributing to the prevention and management of cardiovascular disease (CVD) in populations disproportionately at risk. Given the importance of health equity, this new NOFO also addresses social and economic factors to help communities and health systems respond to social determinants present in their communities to offer those at risk of or burdened with CVD the best health outcomes possible. Core strategies include tracking and monitoring clinical and social services and support needs measures, implementing team-based care, and linking community resources and clinical services.

An applicant must demonstrate the capacity to achieve outcomes that reduce hypertension and high blood cholesterol in alignment with the broad strategies indicated. The applicant must accomplish these outcomes by aligning with and joining an existing, or creating a new, learning collaborative (LC). LCs will support health agencies in various jurisdictions to facilitate communication and the exchange of ideas and leverage technical and financial resources to support programs to improve cardiovascular health outcomes for all persons but specifically focus on those with or at highest risk of poor cardiovascular health outcomes. The LCs should directly intervene on a clinical or community basis to address the social determinants of health.

This new funding opportunity builds on the outcomes achieved via CDC-RFA-DP18-1815 and CDC-RFA-DP18-1817 and provides a structured environment for states to work more deliberately for the advancement of health equity.

Eligibility

Per the program’s authorizing statute or regulation: Sec 317(a) of the Public Health Service Act [42 USC 247b] only State governments, including the District of Columbia, or their bona fide agents are eligible to apply.

Strategies

Successful applicants will be expected to implement activities designed to achieve the short, intermediate, and long term outcomes specified in this NOFO  that are in alignment with the following broad strategy categories:

1. Track and Monitor Clinical and Social Services and Support Needs Measures Shown to Improve Health and Wellness, Health Care Quality, and Identify Patients at Highest Risk of Cardiovascular Disease (CVD) with a Focus on Hypertension and High Cholesterol.
2. Implement Team-Based Care to Prevent and Reduce CVD Risk with a Focus on Hypertension and High Cholesterol Prevention, Detection, Control, and Management through the Mitigation of Social Support Barriers to Improve Outcomes.
3. Link Community Resources and Clinical Services that Support Bidirectional Referrals, Self-Management, and Lifestyle Change to Address Social Determinants that Put the Priority Populations at Increased Risk for Cardiovascular Disease with a Focus on Hypertension and High Cholesterol.

Outcomes

Short term outcomes:

• Increased use of EHRs or HIT to report, monitor, and track clinical and social services and support needs data to improve detection of health care disparities and the identification, management, and treatment of patients at highest risk of cardiovascular disease, with a focus on hypertension and high cholesterol.
• Increased use of standardized processes or tools to identify, assess, track, and address the social services and support needs of patient populations at highest risk of CVD.
• Increased use of EHRs or HIT to support communication and coordination among care team members to monitor and address patients’ hypertension and high cholesterol.
• Increased use of multidisciplinary care teams adhering to evidence-based guidelines to address patients’ social services and support needs and improve the management and treatment of hypertension and high cholesterol.
• Increased multidisciplinary partnerships that address identified barriers to social services and support needs within populations at highest risk of CVD.
• Increased community clinical links to identify and respond to social services and support needs of populations at highest risk of CVD with a focus on hypertension and high cholesterol.
• Increased engagement of CHWs (or their equivalents) to provide a continuum of care extending clinical interventions and addressing social services and support needs.
• Increased use of SMBP with clinical support within populations at highest risk of hypertension.

Intermediate Outcomes:

• Improved blood pressure control among populations within partner health care and community settings.
• Reduced disparities in hypertension control among populations within partner health care and community settings.
• Increased utilization of social services and support among populations at highest risk of CVD, with a focus on hypertension and high cholesterol.

Long term Outcomes:

• Improved cardiovascular health.
• Reduced disparities in cardiovascular health.