NU58DP007460

Virginia Cardiovascular Health Program - Virginia faces a public health crisis as cardiovascular disease (CVD) has risen to the leading cause of death in the Commonwealth since 2019. The impact is disproportionately felt in underserved areas less equipped to address CVD, CVD risk factors, and the structures in place that lead to inequitable access to quality healthcare and opportunities for optimal health.

Roughly 4,458,264 adults 18 years and older in Virginia are living with hypertension, the leading risk factor of CVD. Lack of access to healthcare services and community-based programs is a major factor that creates the conditions that further complicate and prolong the mitigation of these chronic diseases.

The Virginia Department of Health (VDH) will collaborate with partners to design, test, and evaluate innovative approaches for the delivery of clinical and community-based interventions that improve the prevention and control of cardiovascular disease across Virginia, with a specific focus on target populations and prioritized counties and cities identified based on CVD burden and low health opportunity.

The VDH has a long history of addressing CVD in Virginia through its strong partnerships with stakeholders at the government, hospital, clinic, and community level. Through its foundational work in CDC DP18-1815, CDC DP18-1817, CDC DP21-2102, the VDH established a statewide referral system with Unite Us to serve as the major platform and connector between the clinical and community setting for bi-directional referrals.

Stakeholders involved in CVD prevention, management, and treatment have regularly met in their respective learning collaboratives, namely the Virginia Hospital and Healthcare Association's (VHHA) Health Equity Collaborative, Virginia Stroke Systems Task Force, the Virginia Community Health Worker Association, and the Medical Society of Virginia's (MSV) SYNC: Transforming Healthcare Leadership.

Under the Virginia National Cardiovascular Disease Program (CDC DP23-0004) proposal, the VDH will bring together these collaboratives under the Virginia Heart Disease and Stroke Learning Collaborative (VHDS LC) to address health disparities among target populations at highest risk for CVD, including ages 45-85 years old, African Americans, males, low-income, food and housing insecure, rural area, adverse childhood events, African American pregnant and postpartum women, and those who are blind and visually impaired.

Under the VHDS LC, the VDH and key partners (VHHA, MSV, CHW Association, Virginia Pharmacists Association, and Unite Us) will implement the strategies and activities of CDC DP23-0004. Across all strategies and activities, VDH will leverage its successful models of CDC DP18-1815, CDC DP18-1817, and CDC DP21-2102 to:

1) Utilize health information technology with hospitals and clinics to identify priority patient populations at high risk for CVD.
2) Utilize the Unite Us referral system to conduct social determinants of health screenings and refer individuals to social services and supports through the referral network.
3) Implement a chronic care management model through multidisciplinary teams and promote self-monitoring through the Virginia Healthy Heart Ambassador Blood Pressure Self-Monitoring Program.

Over the 5-year period, VDH will scale and sustain successful and comprehensive interventions to 5-7 health systems and underserved areas by 2028. Through leveraging existing resources at state and local levels, building capacity in key stakeholders at the community level, and coordinating clinical and community interventions in a mutually-reinforcing approach, this proposal provides the public health response critical for mitigating the widespread CVD, risk factors, and health disparities in Virginia.

Virginia Department Of Health

NOT APPLICABLE

93.421 - Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health

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

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

Virginia 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 $1,081,945 to $3,245,835.