NU58DP007588
Cooperative Agreement
Overview
Grant Description
Ccme Grant Application to CDC-RFA-DP-23-0005 - Our project aims to address longstanding cardiovascular disease (CVD) disparities and promote health equity by identifying gaps in the prevention, screening, treatment, and self-management of CVD in areas where hypertension (HTN) is 53% or higher in the Southeast region of the United States.
To achieve this, we will expand the successful 4-C Learning Collaboratives (LC) across the region to (1) educate healthcare providers on evidence-based CVD best practices and create peer-to-peer sharing opportunities; (2) develop electronic health record (EHR) workflow optimization and disease management detection and monitoring for improved clinical outcomes; and (3) launch a Community of Care Hub (COC Hub) to connect patients with local social supports.
We will identify our target population using CDC Places for GIS mapping to examine HTN prevalence at the census tract level, allowing us to identify tracts with HTN at 53% or higher. The preliminary analysis identifies 92 census tracts meeting the 53% HTN crude prevalence rate in the four target states in the Southeast.
This information and our collaborative relationships will aid in recruiting providers and LC members and expand our reach to relevant community-based organizations (CBO) to address social determinants of health (SDOH). We will also use a multidisciplinary approach to deliver patient care and peer learning by co-locating a pharmacist in provider offices and establishing an HTN and CVD extension for Community Healthcare Outcomes (ECHO).
Primary outcomes to be measured are (1) the increased detection of hypertension and hyperlipidemia, (2) the number of providers who adopt self-monitoring blood pressure as an evidence-based best practice in the treatment of HTN, (3) the number of referrals to the COC Hub, and (4) the number of closed loops from the COC Hub connecting patients with appropriate social supports.
In accordance with CCME data security policy, outcomes 1 and 2 will be measured using patient data from the provider's EHRs, which will be made available by provider participants for quarterly analysis. Outcomes 3 and 4 will also be measured quarterly using data from the COC Hub's Workshop Wizard data platform.
This project will engage populations with substantial healthcare disparities and gaps in the receipt of healthcare. Results will advance dissemination to providers working with similar populations and potentially reduce health disparities and improve healthcare for millions.
To achieve this, we will expand the successful 4-C Learning Collaboratives (LC) across the region to (1) educate healthcare providers on evidence-based CVD best practices and create peer-to-peer sharing opportunities; (2) develop electronic health record (EHR) workflow optimization and disease management detection and monitoring for improved clinical outcomes; and (3) launch a Community of Care Hub (COC Hub) to connect patients with local social supports.
We will identify our target population using CDC Places for GIS mapping to examine HTN prevalence at the census tract level, allowing us to identify tracts with HTN at 53% or higher. The preliminary analysis identifies 92 census tracts meeting the 53% HTN crude prevalence rate in the four target states in the Southeast.
This information and our collaborative relationships will aid in recruiting providers and LC members and expand our reach to relevant community-based organizations (CBO) to address social determinants of health (SDOH). We will also use a multidisciplinary approach to deliver patient care and peer learning by co-locating a pharmacist in provider offices and establishing an HTN and CVD extension for Community Healthcare Outcomes (ECHO).
Primary outcomes to be measured are (1) the increased detection of hypertension and hyperlipidemia, (2) the number of providers who adopt self-monitoring blood pressure as an evidence-based best practice in the treatment of HTN, (3) the number of referrals to the COC Hub, and (4) the number of closed loops from the COC Hub connecting patients with appropriate social supports.
In accordance with CCME data security policy, outcomes 1 and 2 will be measured using patient data from the provider's EHRs, which will be made available by provider participants for quarterly analysis. Outcomes 3 and 4 will also be measured quarterly using data from the COC Hub's Workshop Wizard data platform.
This project will engage populations with substantial healthcare disparities and gaps in the receipt of healthcare. Results will advance dissemination to providers working with similar populations and potentially reduce health disparities and improve healthcare for millions.
Awardee
Funding Goals
NOT APPLICABLE
Grant Program (CFDA)
Awarding Agency
Funding Agency
Place of Performance
North Carolina
United States
Geographic Scope
State-Wide
Related Opportunity
Analysis Notes
Amendment Since initial award the total obligations have increased 200% from $1,030,830 to $3,092,490.
Medical Review Of North Carolina was awarded
Health Equity Initiative: Addressing Cardiovascular Disparities in the Southeast
Cooperative Agreement NU58DP007588
worth $3,092,490
from National Center for Chronic Disease Prevention and Health Promotion in September 2023 with work to be completed primarily in North Carolina United States.
The grant
has a duration of 5 years and
was awarded through assistance program 93.945 Assistance Programs for Chronic Disease Prevention and Control.
The Cooperative Agreement was awarded through grant opportunity The Innovative Cardiovascular Health Program.
Status
(Ongoing)
Last Modified 9/26/25
Period of Performance
9/30/23
Start Date
9/30/28
End Date
Funding Split
$3.1M
Federal Obligation
$0.0
Non-Federal Obligation
$3.1M
Total Obligated
Activity Timeline
Transaction History
Modifications to NU58DP007588
Additional Detail
Award ID FAIN
NU58DP007588
SAI Number
NU58DP007588-3381647219
Award ID URI
SAI UNAVAILABLE
Awardee Classifications
Nonprofit With 501(c)(3) IRS Status (Other Than An Institution Of Higher Education)
Awarding Office
75CDC1 CDC Office of Financial Resources
Funding Office
75CUC0 CDC NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Awardee UEI
XXJEBCB6CVM9
Awardee CAGE
3KRY5
Performance District
NC-90
Senators
Thom Tillis
Ted Budd
Ted Budd
Budget Funding
| Federal Account | Budget Subfunction | Object Class | Total | Percentage |
|---|---|---|---|---|
| Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Health and Human Services (075-0948) | Health care services | Grants, subsidies, and contributions (41.0) | $1,030,830 | 100% |
Modified: 9/26/25