CDC-RFA-DP24-0060: Paul Coverdell National Acute Stroke Program

Notice of Funding Opportunity: Paul Coverdell National Acute Stroke Program

DP23-0060 Notice of Funding Opportunity Announcement

In 2001, Congress provided funding to CDC to establish the Paul Coverdell National Acute Stroke Registry, named after the late US Senator Paul Coverdell of Georgia, who suffered a fatal stroke in 2000. In 2012, the program expanded and became the Paul Coverdell National Acute Stroke Program. The aim has been to support the implementation of comprehensive stroke prevention and management strategies across the continuum of care, from the onset of stroke symptoms through rehabilitation and recovery. In subsequent years, Congress has directed DHDSP to continue to strengthen and expand evidence-based heart disease and stroke prevention activities focused on high-risk populations. As directed, this iteration will address the needs of those at the highest risk of stroke, which includes those who have experienced a stroke and those with uncontrolled or undiagnosed hypertension. This NOFO aims to improve equity and quality in stroke prevention and care with a focus on those at the highest risk of stroke. Recipients will use funding to:

1. Prevent strokes through HTN detection and control.
2. Improve stroke care through enhanced data collection.
3. Strengthen linkages between clinical and community resources for those at the highest risk of stroke.

These objectives will be realized by creating or aligning with a heart disease and stroke learning collaborative (LC) or stroke coalition. The LC will address clinical and social services and support needs from prevention to in-hospital to post-discharge. Data systems will be used to monitor in-hospital quality of care. Community-clinical links will be strengthened to address stroke prevention through messaging, education, and post-discharge in home and rehab settings.

This NOFO recommends the use of 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.

Eligibility

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

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:

• Strategy 1: Track, monitor, and assess clinical and social services and support needs measures and referrals across the stroke continuum of care for those who have experienced a stroke, those at the highest risk of stroke due to undiagnosed or uncontrolled hypertension, and to identify health care disparities.
• Strategy 2: Promote the implementation of a team-based care approach across the stroke continuum of care for those who have experienced a stroke and those at the highest risk of stroke, focusing on hypertension prevention, detection, control, and management through the mitigation of barriers to social services and support needs to improve outcomes.
• Strategy 3: Link individuals to community resources and clinical services to support bidirectional referrals, self-management, and lifestyle changes for those who have experienced a stroke and those at the highest risk of stroke and to mitigate barriers to social services and support needs to improve outcomes.

Outcomes

Short-Term Outcomes by Strategy:

Strategy 1:

• Increased use of EHR and HIT to identify those who have experienced a stroke and those at the highest risk of stroke due to undiagnosed or uncontrolled hypertension.
• Increased use of standardized procedures to identify, monitor, and assess clinical and social services and support needs, and to provide referrals to those services and assess their utilization through a bidirectional referral system.
• Increased use of metrics from EHR/HIT and program data to guide quality improvement activities.
• Increased monitoring and assessment of statewide data across the stroke continuum of care and within proposed service areas for those who have experienced a stroke and those at the highest risk of stroke due to undiagnosed or uncontrolled hypertension.

Strategy 2:

• Increased number of individuals with identified social services and support needs referred to those services using standardized procedures among the care team, to include both clinical and community-based entities and individuals, across the stroke continuum of care.
• Expanded collection and use of data across the stroke continuum of care to improve efficiency and quality of care among the care team, to include both clinical and community-based entities and individuals.
• Increased number of individuals served by clinics, health systems, and in community settings that use care teams comprised of both clinical and community expertise to prevent stroke.

Strategy 3:

• Increased number of newly established and strengthened partnerships that provide support for those who have experienced a stroke and those at the highest risk of stroke across the stroke continuum of care.
• Increased engagement of the community-based workforce (including community health workers, community health representatives, social workers, patient navigators, etc.) across the stroke continuum of care to manage community resources and clinical services for those who have experienced a stroke and those at the highest risk of stroke.
• Increased reach of stroke prevention messaging and education across the stroke continuum of care.

Intermediate Outcomes:

• Reduced strokes within partner, health care and community settings for those at the highest risk of stroke.
• Reduced disparities in strokes within partner, health care and community settings for those at the highest risk of stroke.
• Increased utilization of social and support services within partner, health care and community settings for those at the highest risk of stroke.

Long term Outcomes:

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