NU58DP007428

NC National Cardiovascular Health Program - The Community and Clinical Connections for Prevention and Health Branch (CCCPH) within the NC Department of Health and Human Services is physically located at 5505 Six Forks Rd., Raleigh, NC. CCCPH will lead the implementation of 23-0004 strategies throughout North Carolina (NC). The goal of CCCPH is to improve the prevention and management of cardiovascular disease (CVD) for populations at disproportionate risk for CVD morbidity and mortality in NC. The proposed strategies aim to implement evidence-based/informed activities to address both physical and social determinants of health risk factors for CVD in areas of the state with high CVD mortality and morbidity rates.

CCCPH will develop new activities as well as expand partner networks and activities previously established under 1815 funding. The short-term outcomes by strategy are as follows:

Strategy 1:
1) Increased use of electronic health records (EHRs) or health information technology (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 CVD, with a focus on hypertension and high cholesterol.
2) 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.

Strategy 2:
1) Increased use of EHRs or HIT to support communication and coordination among care team members to monitor and address patients' hypertension and high cholesterol.
2) 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.
3) Increased multidisciplinary partnerships that address identified barriers to social services and support needs within populations at highest risk of CVD.

Strategy 3:
1) 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.
2) Increased engagement of community health workers (CHWs), or their equivalents, to provide a continuum of care extending clinical interventions and addressing social services and support needs.
3) Increased use of self-measurement of blood pressure (SMBP) with clinical support within populations at highest risk of hypertension.

The intermediate outcomes are as follows:
1) Improved blood pressure control among populations within partner healthcare and community settings.
2) Reduced disparities in hypertension control among populations within partner healthcare and community settings.
3) Increased utilization of social services and support among populations at highest risk of CVD, with a focus on hypertension and high cholesterol.

The long-term outcomes are as follows:
1) Improved cardiovascular health.
2) Reduced disparities in cardiovascular health.

North Carolina Department Of Health & Human Services

NOT APPLICABLE

93.945 - Assistance Programs for Chronic Disease Prevention and Control

CDC Office of Financial Resources (OFR) [HHS - CDC]

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) [HHS - CDC]

North Carolina United States

State-Wide

The National Cardiovascular Health Program (CDC-RFA-DP-23-0004)

Amendment Since initial award the total obligations have increased 200% from $1,212,817 to $3,638,451.