CDC-RFA-DP-24-0060: Paul Coverdell National Acute Stroke Program Frequently Asked Questions (FAQs)

Applicant or jurisdictional-specific questions, i.e., requests for technical assistance, submitted to the Coverdell Notice of Funding Opportunity email box will not be reviewed, and responses will not be posted to the FAQs website.

Does CDC have a comprehensive resource that identifies specific actions to address heart disease, stroke, and other cardiovascular conditions?

CDC’s Division for Heart Disease and Stroke Prevention released the Best Practices for Heart Disease and Stroke: A Guide to Effective Approaches and Strategies. The Best Practice Guide includes 18 evidence-based strategies, highlighting each strategy’s impact on public health, economics, and health equity. The document also provides information and resources to support and guide strategy implementation, as well as policy and law-related considerations. Brief, setting-specific stories highlight examples of successful strategy implementation.

The Best Practices Clearinghouse is a complementary website designed to organize best practices resources that will aid in improving heart disease and stroke prevention and reducing health disparities. The Best Practices Clearinghouse aims to provide a centralized, sustainable system to national, state, local, and tribal public health leaders with a tool to access information and the ability to index and easily search for available resources. By providing better linkages between topics and the breadth of resources within the comprehensive Best Practices Clearinghouse, health systems, and community organizations can make changes to eliminate barriers to quality care and improve the health of many people.

In relation to Strategy 3B, are community paramedics considered health extenders? In the community paramedicine model, community paramedics deliver post-stroke care to stroke patients discharged to home. They perform patient and home safety assessments and refer patients to resources.

Community paramedics may be considered health extenders, depending on their role. Additional guidance regarding implementing the strategies will be provided to recipients post award.

Are media campaigns an allowed use of grant funding?

Proposed activities must fall within the scope of the NOFO and directly relate to the implementation of strategies, attainment of program outcomes, and improvement of the related performance measures over time. Additional guidance regarding program implementation will be provided to recipients post award.

How is this Notice of Funding Opportunity (NOFO) different from the last Coverdell NOFO?

CDC-RFA-DP24-0060 builds on the accomplishments and outcomes achieved in CDC-RFA-DP21-2102, including the implementation of comprehensive stroke systems across the continuum of care, improved quality of care and prevention services, and reduced early mortality for acute stroke patients. This NOFO also builds on efforts to “Link Community Resources and Clinical Services” under CDC-RFA-DP23-0003, CDC-RFA-DP23-0004, and CDC-RFA-DP23-0005, which all work to identify, enhance, and build systems that facilitate provider and community bidirectional referrals to support identification of and referrals for those with risk factors for cardiovascular disease (CVD) and those with CVD.

CDC-RFA-DP24-0060 aims to improve equity and quality in stroke prevention and care with a focus on those at the highest risk of stroke through 1) prevention of stroke through hypertension (HTN) detection and control, 2) improvement of stroke care through enhanced data collection, and 3) stronger linkages between clinical and community resources for those at the highest risk of stroke.

CDC-RFA-DP24-0060 also aims to address the needs of the priority population, identified as those at the highest risk of stroke, which includes those who have experienced a stroke and those with uncontrolled or undiagnosed hypertension.

Applicants must:

Describe a state crude stroke mortality rate of at least 55.9 per 100,000, using 2018-2021 CDC WONDER (cdc.gov) data for adults aged 18 years or older, with mortality identified via the ICD-10 codes for cerebrovascular disease (stroke), i.e., I60-I69.
Propose activities in communities across the state with individuals at the highest risk of stroke, as evidenced by a crude stroke prevalence at the census tract level that is at least 1.5 times greater than the crude stroke prevalence for the corresponding county.

CDC-RFA-DP24-0060 recipients will be expected to:

Create or align with a heart disease and stroke learning collaborative (LC) or stroke coalition to address clinical and social services and support needs across the continuum of care.
Use data systems to monitor in-hospital quality of care.
Ensure that prevention and post-discharge needs are addressed through community-clinical linkages.

Emphasis should be on achieving impact and reach across geographic locations where disparate populations can benefit from the strategies in this NOFO.

What is the definition of a person at risk of having a stroke?

Hypertension or high blood pressure is a critical risk factor for stroke. An estimated 120 million American adults (48.1%) have hypertension, and 1 in 5 adults are unaware they have it. High blood cholesterol, smoking, obesity, and diabetes also contribute to stroke risk.

Heart disease, stroke, and their modifiable risk factors disproportionately affect the US population based on race or ethnicity, social factors, and geography. The overall age-adjusted stroke death rate for all individuals in the US was 41.1 per 100,000 in 2021. Non-Hispanic Blacks had the highest age-adjusted stroke death rate among all races and ethnicities at 59.6 per 100,000 for the same year.

Those at the highest risk of stroke include individuals with risk factors for stroke, such as high blood pressure, high blood cholesterol, untreated heart disease, history of a prior stroke, poor dietary habits, physical inactivity, obesity or being overweight, diabetes, smoking or using commercial tobacco, and alcohol consumption. Additionally, societal and socioeconomic factors contribute to putting individuals at the highest risk of stroke, such as poverty and low SES, low educational attainment, living in resource-poor urban and rural communities, being uninsured or underinsured, having limited access to routine medical care, and other related factors.

For more information, visit the following resources:

Can you please describe in detail the rates that need to be met to apply? Please address the language that indicates applicants “must describe” they meet the burden thresholds.

This NOFO recommends using CDC data sources, i.e., CDC WONDER and CDC PLACES. CDC WONDER 2018-2021 data helped identify states with a crude stroke mortality rate of at least 55.9 per 100,000 for adults aged 18 years or older, with mortality identified via the ICD-10 codes for cerebrovascular disease (stroke), i.e., I60-I69. CDC PLACES can help identify stroke prevalence at the census tract level. Applicants must propose activities in communities most burdened by stroke as evidenced by crude stroke prevalence at the census tract level that is at least 1.5 times greater than crude stroke prevalence for the corresponding county.

What components are required for the Project Narrative and what are the formatting requirements?

The Project Narrative must be a maximum of 20 pages, single-spaced, in 12-point font, with 1-inch margins and page numbers. Content beyond the specified page number will not be reviewed. These requirements apply to all applicants.

The Project Narrative must include the following headings (including subheadings): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach, and Work Plan.

The Work Plan is NOT included in the 20-page limit for the Project Narrative. The page limit also does not include the additional attachments referenced in the Notice of Funding Opportunity (NOFO), such as the Project Abstract and Budget Narrative.

What information should be included in the Letter of Intent?

The Letter of Intent (LOI) should state the descriptive title of the proposed project along with the applicant’s assertion of its eligibility and intent to apply for the NOFO. The LOI should be emailed to Coverdell24-0060@cdc.gov no later than Friday, May 10, 2024, 11:59 PM EST.

Are letters of support and memorandums of understanding part of the 20-page limit?

Letters of Support (LOS), Memorandums of Understanding (MOUs), and Memorandums of Agreement (MOAs) are not part of the 20-page limit. They are acceptable attachments and should be submitted as PDFs. Please see section H. (Other Information) in the Notice of Funding Opportunity (NOFO).

What should an applicant include in a Letter of Support, Memoranda of Understanding (MOU), or Memoranda of Agreement (MOA)?

Letters of support, memoranda of understanding (MOU), or memoranda of agreement (MOA) with a firm commitment from providers and partners that outline the relationship, needs, and resources provided should be included in the application. Applicants should submit letters of support from organizations and entities that will have a role in helping to achieve specific NOFO activities and outcomes. Letters must be dated within 45 days of the application. These files should be named “MOUs/MOAs.applicant name” and uploaded as a PDF file at www.grants.gov.

Why do we submit the application through Grants.gov and not Grant Solutions?

All new applications are submitted through Grants.gov. However, Grants.gov and Grant Solutions systems are connected. Once an application is submitted to Grants.gov it is received and reviewed in Grant Solutions.

What is a unique entity identifier (UEI) and how is it obtained?

A UEI number is a unique 12-digit identification number assigned when an organization registers at SAM.gov. Current SAM.gov registrants have already been assigned a UEI and can view it at SAM.gov and Grants.gov. An applicant without a UEI number must obtain one by registering at SAM.gov before submitting an application for this NOFO. Please refer to NOFO Section D., Application and Submission Information for detailed registration and application instructions.

Does an organization’s UEI or SAM registration need to be renewed?

All applicant organizations must register at SAM.gov and will be assigned a Unique Entity Identifier (UEI). The SAM registration process may take 10 or more business days. SAM registration must be renewed annually.

If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. Additional information about registration procedures may be found at SAM.gov and in the SAM.gov Knowledge Base.

Is submission of a letter of intent optional?

Yes, submission of a letter of intent (LOI) is optional. The purpose of an LOI is to allow CDC program staff to estimate the number of submitted applications and plan for review.

Are applicants required to submit an SF-LLL: Disclosure of Lobbying Activities as part of the application?

All applicants must complete and submit a Disclosure of Lobbying Activities (SF-LLL) form pursuant to 31 U.S.C. 1352. If the applicant does not engage in lobbying, please insert “non-applicable” on the form and include the required Authorizing Organization Representative (AOR) name, contact information, and signature.

How do we account for counties with high stroke prevalence with a small number of census tracts that all have high stroke prevalence? Identifying tracts compared to their county rates is causing some high prevalence rate county tracts to be omitted as high-burden census tracts.

Census tracts with crude stroke prevalence that is 1.5 times the corresponding county stroke prevalence represent a significant public health challenge. Applicants must focus program interventions in those identified areas.

Required file names for some attachments include a forward slash (e.g., “MOUs/MOAs.applicant name,” “CVs/Resumes”); however, a forward slash is not a valid character in a file name. May we instead use an underscore to replace the forward slash in the file name (e.g., “MOUs_MOAs.applicant name,” “CVs_Resumes”)?

Yes, an underscore (“_”) may be used in place of a forward slash (“/”) in file names for these attachments.

Is the Evaluation Plan part of the 20-page limit for the Project Narrative?

Yes. The Project Narrative must include the following sections (including subsections): Background, Approach, Applicant Evaluation and Performance Measurement Plan, Organizational Capacity of Applicants to Implement the Approach, and Work Plan.

Who is eligible to apply for this Notice of Funding Opportunity (NOFO)?

This NOFO is limited competition. Applicants must be aligned with any of the eligibility categories listed in NOFO Section C. Eligibility Information, 1. Eligible Applicants.

May entities only apply if the state crude stroke mortality rate is at or above 55.9 per 100,000? If a state falls below this crude rate, is it ineligible to apply?

Applicants must both:

Describe a state crude stroke mortality rate of at least 55.9 per 100,000, using 2018-2021 CDC WONDER (cdc.gov) data for adults aged 18 years or older, with mortality identified via the ICD-10 codes for cerebrovascular disease (stroke), i.e., I60-I69; and
Propose activities in communities across the state with individuals at the highest risk of stroke, as evidenced by a crude stroke prevalence at the census tract level that is at least 1.5 times greater than the crude stroke prevalence for the corresponding county.

This NOFO is limited competition. Applicants must be aligned with any eligibility categories listed in NOFO Section C. Eligibility Information, 1. Eligible Applicants.

Why is the use of Geographic Information System (GIS) so important in the CDC-RFA-DP-24-0060 Coverdell NOFO?

GIS helps identify segments of the population disproportionally impacted by all conditions addressed in the NOFO.
GIS helps advance health equity by identifying geographies with the highest disease burden.
GIS uses various tools and methods to merge complex data sets and information to create detailed geographical maps that can be used for problem-solving and decision-making.
GIS uses CDC-recognized data sources at the state, county, and census tract levels.

What are some CDC Geographic Information Systems (GIS) or other geo-mapping resources available to meet the NOFO requirements to identify priority populations and select health systems and communities?

The CDC Division for Heart Disease and Stroke Prevention has several online tools to create local-level maps of heart disease and stroke outcomes, risk factors, socioeconomic conditions, health care facilities, sociodemographic populations, and more. Here are three examples:

Interactive Atlas of Heart Disease and Stroke: The Atlas contains high-quality local-level data that can be easily mapped and downloaded. Mortality and hospitalization data are available by racial or ethnic group, gender, and age. Socioeconomic and sociodemographic data are available down to the census tract level. Locations of health care facilities such as stroke centers, Federally Qualified Health Care Centers, and emergency room services are also available. Instructions for how to use the Atlas can be found here.
Local Trends in Heart Disease and Stroke Dashboard: The Dashboard provides local-level data on temporal trends in heart disease and stroke mortality by racial or ethnic group, gender, and age. Visitors to the Dashboard can create and download maps and graphs charting recent increases and decreases in heart disease and stroke mortality in their communities. Instructions for how to use the Dashboard can be found here. The following manuscript from the American Journal of Public Health offers more information on dashboards: “Data Dashboards for Advancing Health and Equity: Proving Their Promise”: https://doi.org/10.2105/AJPH.2022.306847.
CDC Population Level Analysis and Community Estimates (PLACES): PLACES reports county, place, census tract, and Zip Code Tabulation Areas (ZCTA) data and uses small area estimation methods to obtain 36 (29 in the 2022 and 2021 releases; 27 in 2020 release) chronic disease measures for the entire United States. The data are published through a public, interactive website that allows users to view, explore, and download data.

Although limited data are available at the county and metropolitan levels, PLACES represents a first-of-its-kind data analysis to release information for all US counties, places, census tracts, and ZCTAs. This system complements existing surveillance data by providing estimates necessary to understand the health issues affecting the residents of local areas of all sizes and regardless of urban or rural status; develop and implement effective and targeted prevention activities; identify health problems; and establish key health objectives.

Where can I find authoritative data to determine the stroke mortality rate in my state or CVH region?

CDC WONDER (Wide-ranging ONline Data for Epidemiologic Research) is a useful tool for determining stroke mortality rates in your state or CVH region. It is an easy-to-use, menu-driven system that makes CDC’s information resources available to public health professionals and the public.

CDC WONDER provides access to a wide array of public health information and allows users to:

Access statistical research data published by CDC, as well as reference materials, reports, and guidelines on health-related topics specific to cerebrovascular or stroke conditions (identified by ICD codes 60-69).
Query numeric data sets on CDC’s computers via “fill-in-the-blank” web pages. Public-use data sets about mortality (deaths), cancer incidence, HIV and AIDS, tuberculosis, vaccinations, natality (births), census data, and many other topics are available for query, and the requested data are readily summarized and analyzed, with dynamically calculated statistics, charts and maps.
The data are ready for desktop applications such as word processors, spreadsheet programs, or statistical and geographic analysis packages. File formats available include plain text (ASCII), web pages (HTML), and spreadsheet files (Tab Separated Values). All of these facilities are menu-driven and require no particular computer expertise.

Will this cooperative agreement always be on a September funding cycle?

The Period of Performance for CDC-RFA-DP-24-0060 is September 30, 2024, through June 29, 2029. Each Budget Year will begin on June 30. The exception to this is Year 1, which will start on September 30, 2024, and end on June 29, 2025, for a 9-month budget period. Every subsequent budget period will be 12 months in length.

Are applicants required to submit a budget for the first budget period only?

Yes, applicants are expected to submit a budget for the first 9-month budget period of the program as the full 12-month proposed award. The Year 1 budget period will be from September 30, 2024, through June 29, 2025. Every subsequent budget period will be 12 months long, beginning June 30.

Does the approximate average award of $650,000 per project period mean the recipient may expect to receive that amount per year/budget period?

Successful applicants can expect an average award of $650,000 per year/per project period, subject to the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government.

The NOFO referenced $7,775,000.00 funding for “at least” 12 sites. If only 12 sites are selected, is there an opportunity for selected sites to apply for additional funding?

The estimated floor for awards is $500,000. The estimated ceiling for awards is $750,000. The estimated average award is $650,000. Applicants may apply for more than the published amounts for the anticipated floor, ceiling, and average awards. However, there is no guarantee funding will be awarded at levels higher than indicated.

Can CDC confirm the anticipated award date is August 30, 2024? Can CDC also clarify the terms “Period of Performance” and “Project Period?”

The anticipated award date for this NOFO is August 30, 2024, which, per Office of Grant Services policy, is typically 30 days before the actual start date of the Year 1 Budget Period, which is September 30, 2024 for this NOFO. However, notification of successful awards may be made up until the day before the Project Period start date, i.e., September 30, 2024.

Total Period of Performance: September 30, 2024 through June 29, 2029
Year 1 Budget Period Start Date: September 30, 2024
Estimated Award Date: August 30, 2024

Do indirect costs come directly out of the total award?

Successful applicants are expected to account for indirect costs from the total award each year/per project period. Please refer to the required forms and documentation applicants must include with the application submission. You may preview the required documents and forms under the PACKAGE tab here: grants.gov/search-results-detail/349789

Can funds be used to purchase home blood pressure monitors or other medical supplies or equipment?

No. Funds cannot be used to purchase durable medical equipment as recipients may not use funds for clinical care except as allowed by law.

The Notice of Funding Opportunity (NOFO) does not mention required staffing. Are there staffing requirements?

Applicants will be reviewed and evaluated on the following related to staffing, program management, and organizational capacity:

Proposed staff and entities responsible for key tasks, including project leadership, implementing program strategies, monitoring progress, public health data management, data analysis and reporting, budget review and monitoring, program evaluation, and communication with partners and CDC. Applicants should identify a dedicated staff person who will focus on health inequities and build relationships at the designated levels to decrease health care disparities and advance health equity.
Nature and scope of the organization’s work, organizational structure, and capacity to implement cardiovascular, chronic disease, and stroke programs; monitor program performance, including hiring and contract execution; and take the necessary steps to address identified problems in a timely manner.
The learning collaborative or stroke coalition’s history of collaborating to achieve sustainable change and improvement in the areas outlined in the NOFO.
Staff’s experience working with partners to collect, report, and use program data for quality improvement and program evaluation and the ability to address potential challenges. Applicants should describe the ability to document and disseminate evaluation findings, outcomes, and recommendations, including the outcomes and achievements resulting from collaborative work with partners.

Capacity of staff to:

Manage programs and resources, ensuring the administrative, financial, and staff support necessary to sustain activities. This includes describing an adequate staffing plan, providing CVs or resumes for proposed personnel, describing how program performance will be monitored and how the program will be adjusted to address identified challenges, an organizational chart, and a project management structure that clearly defines staff roles and reporting structure as it applies to this funding opportunity.
Engage partners, particularly those who represent or work with priority populations, within health care and community settings to improve communication (including appropriate messaging and education), coordination, and collaborations to prevent stroke and improve stroke outcomes.
Address gaps in stroke prevention and the continuum of care through the use of a community-based workforce to implement program strategies to improve stroke outcomes and link priority populations to social services and support needs resources.
Coordinate with or establish local or state interdisciplinary or multidisciplinary stroke coalitions or learning collaboratives to exchange ideas and share best practices that support the continuum of care.
Coordinate efforts with other publicly and privately funded programs within the state to leverage resources and maximize reach and impact to address SDOH and social services and support needs related to cardiovascular disease within approved populations of focus.

Where can applicants obtain budget preparation guidance?

Once you have navigated to the Application Resources web page at https://www.cdc.gov/grants/applying/application-resources.html, click on “CDC Budget Preparation Guidelines.” This will open a PDF document with details for the required budget categories.

Is CDC requiring out-of-state travel?

Travel to Atlanta, GA or any other location is not required in Year 1 of this Notice of Funding Opportunity.

Just to clarify, we should request the full amount ($750,000) for year one, even though it is a shortened budget period of only nine months?

Yes. The year 1 budget period will be from September 30, 2024, through June 29, 2025, and applicants are expected to submit a Year 1 budget request in line with the requested award amount. Every subsequent budget period will be 12 months long, beginning June 30.

What are the Coverdell Data Elements (DEs) collection and reporting requirements?

Coverdell Data Elements (DEs) are a set of standardized data variables tailored to this Notice of Funding Opportunity (NOFO) that capture consistent and complete information across stroke systems of care. These are used to describe, monitor, and assess program progress. Additional information and guidance will be provided to recipients post-award.

Are recipients required to develop a data system to capture Data Elements (DEs)?

Recipients may utilize an existing data system or create a data system that collects all required data elements and other program data for program monitoring and reporting.

In the current grant, we are monitoring hospitals for inter-rater reliability and providing feedback to participating hospitals for quality improvement. Will CDC require information on hospitals’ data validity and reliability in this next competitive grant cycle, including conducting chart audits, assessments of inter-rater reliability (IRR) or re-abstraction, and submission of concordance reports?

Stroke certifications routinely require assessments of inter-rater reliability (IRR) or re-abstraction by hospitals. Inter-rater reliability serves as a benchmark for data quality, including data validity and data reliability. Successful applicants are expected to engage in data-driven quality improvement (QI) programs and activities for stroke care and propose data from a variety of sources to inform overall QI efforts. Additional guidance regarding reporting requirements related to selected Quality Improvement efforts will be provided post-award.

If a state doesn’t currently have an existing data system for collecting, analyzing, and reporting stroke data, what time frame would be allowed to get one up and running for data collection?

Applicants must describe the capacity to collect, analyze, and report stroke data across multiple levels and sources, including state, county, zip code, and census tract to guide quality improvement efforts and to improve the efficiency and quality of stroke data across the continuum of care using an existing data system. Applicants who do not have an existing data system must provide details in their application of how they plan to submit the required data to CDC while their data system is being developed.

CDC will work with the recipients post-award who do not have an existing data system to determine an acceptable time frame for establishing the data system. Generally, an acceptable time frame for building a data system is approximately six (6) months. Importantly, all recipients are expected to participate in all data submissions, whether or not a complete data system has been established.

Can a critical access hospital with limited resources participate in Coverdell to raise its stroke care capacity, even if it does not enter abstracts into a data system documenting stroke care within the state?

The goal of this cooperative agreement is to improve stroke care with priority populations within health care and community settings. Hospitals participating in Coverdell must report data as a requirement of the cooperative agreement.
Recipients can connect such hospitals with partners to raise their stroke care capacity. This includes measuring, tracking, and improving access to and quality of care for those individuals at the highest risk for stroke events through the continuum of care from onset of symptoms to rehabilitation.

Will submission of a CDC required list of data elements and related re-abstracted data be required?

Coverdell Data Elements (DE) are a set of standardized data variables tailored to this Notice of Funding Opportunity (NOFO) that capture consistent and complete information across stroke systems of care. CDC uses DEs to describe, monitor, and assess program progress. Additional information and guidance will be provided to recipients post-award.

Hospitals are routinely required to perform re-abstraction or assessments of inter-rater reliability IRR) to receive stroke certification. IRR serves as a benchmark for data quality, including data validity and reliability. Successful applicants will be expected to engage in data-driven quality improvement (QI) programs and activities for stroke care and propose data from a variety of sources to inform overall QI efforts. Additional guidance regarding reporting requirements for selected QI efforts will be provided post-award.

Will hospital inventories be required?

Post award, recipients will not be required to implement hospital inventory surveys with health care partners. However, the recipient may decide that surveys are useful tools to determine capacity and available resources related to accompanying program strategies. Additional guidance will be made available to recipients post-award.

For the strategies in the Evaluation and Performance Measurement Plan (EPMP), we are required to develop evaluation questions. Do these need to address the overarching evaluation questions?

The Evaluation and Performance Measurement Plan (EPMP) should address the overarching evaluation questions as described in the CDC Evaluation and Performance Measurement Strategy section. Applicants are also expected to develop recipient-specific evaluation questions that correspond to the overarching CDC core evaluation questions. Please refer to the specific guidance on developing an EPMP in the Applicant Evaluation and Performance Measurement section of the NOFO.

What are the Data Management Plan (DMP) requirements in terms of what is meant by disseminating findings to the public? For instance, if we intend to create fact sheets, evaluation snapshots, etc., and share them with partners and stakeholders, does this mean we would then need a DMP?

Please refer to Centers for Disease Control and Prevention (CDC) guidance on DMPs at https://www.cdc.gov/grants/additional-requirements/ar-25.html. Additional guidance and a template from the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) can be found at https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm.

Is the data management plan separate or is it included in the page limit?

The Data Management Plan is not part of the Evaluation and Performance Measurement Plan; however, it is included in the Project Narrative’s 20-page limit.

The Notice of Funding Opportunity (NOFO) says that CDC strongly encourages allocating at least 10% of total funding to evaluation and performance measurement. Can you provide examples of what counts toward the 10%?

Funding used for resources (such as staffing, contracting, etc.) that support evaluation and performance-measuring activities can be attributed to this allocation. Examples of evaluation and performance-measuring activities include evaluation planning, data collection, analysis, reporting, and dissemination. Applicants are encouraged to work with professional evaluators (either internal or external) to meet the evaluation and performance measure reporting requirements of this NOFO.

Will recipients report on the performance measures for all strategies?

Applicants are required to address all strategies in the application submission. Applicants are expected to provide Year 1 targets and data sources for all performance measures. Post award, recipients will report all short term and intermediate performance measures annually to track progress over the five-year period of performance.

Are recipients responsible for long-term outcomes?

As the logic model indicates, recipients will be responsible for short and intermediate outcomes within this cooperative agreement. These outcomes should lead to the long-term outcomes, but recipients are not responsible for achieving long-term outcomes or reporting long-term measures within the five-year performance period.

For performance measures, does CDC want statewide data or data that reflects the work we are doing with specific partners (e.g., Emergency Medical Services, hospitals)?

The applicants can provide targets focused on their proposed work with partners and populations of focus. Performance measures will be further defined and operationalized by CDC in collaboration with recipients prior to the first year of reporting.

Are the Strategy 1C performance measure and associated quality improvement (QI) projects based off of data from Strategy 1A and Strategy 1B, or can other data sources be used for QI projects? Can QI projects be independent of the Strategy 1A and 1B performance measures?

Strategy 1C should be addressed through each applicant’s proposed program monitoring activities. The data source can be any the applicant has determined is well-aligned with the strategy and performance measure implemented within their participating health systems. Additional technical assistance will be provided to recipients within the first six months of the award to ensure alignment with the performance measure.

Is the performance measure related to Strategy 2C asking about the number of individuals served in clinics, health systems, and community settings, or is this asking if the settings they are referred to use care teams? If they are referred outside of our partners, can we count them? Is this a count to confirm if they are using team-based care?

This measure is intended to document the extent to which the Coverdell Program’s participating partners are adopting team-based care. For an individual to be counted toward this measure, they must be served by clinics, health systems, and in community settings that use care teams comprised of both clinical and community expertise to prevent stroke. It is acceptable to count an individual toward this performance measure as long as the entity uses care teams to provide services aligned with the Coverdell program strategies, even if the entity they are referred to for these services is outside of the recipient’s partner network. Additional technical assistance will be provided to recipients within the first six months of the award.

Intermediate outcome performance measure: # and % of strokes among populations within partner, health care, and community settings. Are we reporting from each setting? If so, how do we avoid duplication? Is it statewide, by areas of focus, by county, or by zip code?

This performance measure is reported in aggregate and is specific to the participating health systems and the populations they serve. The data systems may vary from state to state. CDC Evaluation Technical Assistance Providers will work with recipients during the first six months of the award to ensure alignment of data sources with performance measures. If duplication in the count is expected based on the data sources selected, applicants are encouraged to note a best estimate of the degree of duplication and to indicate whether this is reflected in the value reported.

Intermediate outcome performance measure: # and % of strokes among individuals at the highest risk of stroke within partner, health care, and community settings reported by race, ethnicity, sex, gender identity, and selected populations. How is the highest risk of stroke defined in this outcome? Are we only asking about undiagnosed or uncontrolled hypertension or something else?

Those individuals at the highest risk of stroke include individuals with risk factors for stroke, such as high blood pressure, high blood cholesterol, untreated heart disease, history of a prior stroke, poor dietary habits, physical inactivity, obesity or being overweight, diabetes, smoking or using commercial tobacco, and alcohol consumption. Additionally, societal and socioeconomic factors such as poverty and low socioeconomic status, low educational attainment, living in resource-poor urban and rural communities, being uninsured or underinsured, having limited access to routine medical care, and other related factors contribute to putting individuals at the highest risk of stroke.

For more information, visit the following resources: