CDC-RFA-DP22-2204.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Improving and Enhancing the US Vision and Eye Health Surveillance System

CDC-RFA-DP22-2204

03/14/2022

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP22-2204. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes.

A. Federal Agency Name:

Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substances and Disease Registry (ATSDR) B. Notice of Funding Opportunity (NOFO) Title:

Improving and Enhancing the US Vision and Eye Health Surveillance System C. Announcement Type: New - Type 1:

This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52- 2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP22-2204

E. Assistance Listings Number:

93.068 F. Dates:

1. Due Date for Letter of Intent (LOI):

01/20/2022

2. Due Date for Applications:

https://www.grants.gov/ https://www.grants.gov/ https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html

03/14/2022 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

N/A

G. Executive Summary:

1. Summary Paragraph This NOFO solicits non-research cooperative agreement applications to enhance CDC’s Vision and Eye Health Surveillance System (VEHSS), using data from a variety of sources, in order to assess U.S. national-, state-, and county-level prevalence of major eye diseases, vision impairment, and utilization of eye care. The strategies and activities in this NOFO focus on maintaining, improving, and enhancing the VEHSS, which is the only interactive, comprehensive collection of vision and eye health data in the United States. The VEHSS includes data from 5 national surveys, 4 administrative claims databases, an electronic health record registry, and published examination studies. Important activities of this NOFO include adding new years of data, streamlining indicators, identifying data gaps, and prioritizing data sources and key indicators that have the greatest value for public health surveillance. The project will also identify and add other sources of vision and eye health data, for example, data from Veterans Affairs, Indian Health Service, and other electronic health record systems. The NOFO will incorporate into the VEHSS national-, state-, and county-level data on social determinants of health and improve functionality of the VEHSS and end-user experience by enhancing data visualization and presentation. Lastly, this project will focus on outreach and dissemination of the VEHSS to key partners to drive an increase in end-user engagement with the surveillance system.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards

d. Total Period of Performance Funding:

$2,550,000

e. Average One Year Award Amount:

$850,000

f. Total Period of Performance Length:

g. Estimated Award Date:

August 30, 2022

h. Cost Sharing and / or Matching Requirements:

No Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged.

https://www.grants.gov/

Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview Vision impairment (VI) is a significant health problem, affecting more than 7 million people in the United States (1). VI is associated with a higher prevalence of comorbid conditions such as diabetes, heart disease, falls, injuries, depression, and premature mortality (2-5). Vision impairment, which can be prevented through early detection and timely treatment of common eye diseases, costs the nation more than $130 billion annually (6). The most common eye diseases that may cause irreversible vision loss include age-related macular degeneration, diabetic retinopathy, and glaucoma. Other treatable forms of vision loss, such as cataract and refractive errors, affect millions of Americans. These conditions are common and expected to increase over the next 30 years due to changing demographics in the U.S. population and an increase in risk factors such as diabetes (7). Eye diseases contribute to health disparities in the population. Glaucoma, which affects more than 2.7 million individuals in the U.S. (8), is the leading cause of irreversible blindness among African Americans (9). National and state data suggest that only about a half of those at high risk for serious vision loss had visited an eye doctor in the past year (10). Surveillance of eye diseases is essential to track the magnitude of disease and associated risk factors, prioritize target groups for intervention, set national objectives, allocate resources, and evaluate the public health response.

The purpose of this project is to maintain and enhance CDC’s Vision and Eye Health Surveillance System (VEHSS) (https://www.cdc.gov/visionhealth/vehss/index.html), using valid and reliable data from a variety of sources, in order to assess U.S. national, state, and county-level prevalence of the major eye diseases, vision impairment, and utilization of eye care.

The VEHSS is the only interactive, comprehensive collection of vision and eye health data in the United States. Currently, the VEHSS includes data from 5 national surveys, 4 administrative claims databases, an electronic health record registry, and published examination studies.

Surveillance indicators within four topic areas (eye health conditions, visual function, service utilization, and medical payments and costs) are displayed on the VEHSS website using data visualization tools. This interactive national data system summarizes over 220 vision and eye health indicators from 10 different datasets, aggregating data from 250 million patient records per year.

This next NOFO will focus on maintaining, improving, and enhancing the VEHSS. An important task will be to streamline indicators, identify data gaps, and prioritize data sources and key indicators that have the greatest value for public health surveillance. The project will also identify and add other sources of vision and eye health data, for example, data from Veterans Affairs, Indian Health Service, and other electronic health record systems. The NOFO will add national-, state-, and county-level data on social determinants of health and CDC’s social vulnerability index. Lastly, this project will enhance the visualization and presentation of the data on the website and focus on outreach and dissemination of the surveillance system to key partners, researchers, scientists, public health practitioners, and policy makers.

b. Statutory Authorities https://www.cdc.gov/visionhealth/vehss/index.html

Sections 301(a) and 317(k) (2) of the Public Health Service Act, 42 U.S.C., Section 241(a) and 247b (k) (2), as amended.

c. Healthy People 2030 This NOFO supports the following Healthy People 2030 topic areas:

Reduce vision loss from:

o Diabetic retinopathy o Glaucoma o Age-related macular degeneration o Cataract o Refractive errors

Reduce vision loss in children and adolescents Increase the proportion of adults who have had a comprehensive eye exam in the last 2 years Increase the proportion of children aged 3 to 5 years who get vision screening Increase the proportion of adults with diabetes who have a yearly eye exam https://health.gov/healthypeople/objectives-and-data/browse-objectives/sensory-or-communication-disorders https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes

d. Other National Public Health Priorities and Strategies Strategies to promote eye health are outlined by the National Academies of Sciences Engineering and Medicine: https://www.nap.edu/catalog/23471/making-eye-health-a-population-health-imperative-vision-for-tomorrow U.S. Department of Health and Human Services Strategic Plan and Annual Performance Plan:

https://www.hhs.gov/about/budget/fy2021/performance/index.html?language=es Goal 4. Objective 1: Improve surveillance, epidemiology, and laboratory services Goal 2. Objective 2: Prevent, treat, and control communicable diseases and chronic conditions Goal 3. Objective 4: Maximize the independence, well-being, and health of older adults, people with disabilities, and their families and caregivers

e. Relevant Work This NOFO builds on CDC-RFA-DP15-004 and CDC-RFA-DP-19-005, which established the Vision and Eye Health Surveillance System (https://www.cdc.gov/visionhealth/vehss/index.html).

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

https://health.gov/healthypeople/objectives-and-data/browse-objectives/sensory-or-communication-disorders https://health.gov/healthypeople/objectives-and-data/browse-objectives/sensory-or-communication-disorders https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes https://www.nap.edu/catalog/23471/making-eye-health-a-population-health-imperative-vision-for-tomorrow https://www.nap.edu/catalog/23471/making-eye-health-a-population-health-imperative-vision-for-tomorrow https://www.hhs.gov/about/budget/fy2021/performance/index.html?language=es

CDC-RFA-DP22-2204 Logic Model: Improving and Enhancing the US Vision and Eye Health Surveillance System.

Strategies and Activities

Short-term Outcomes

Intermediate Outcomes

Long-term Outcomes

Maintain VEHSS by adding data from newer iterations of key datasets and providing trend analyses

Streamline surveillance system by prioritizing data and indicators that have the greatest value and utility for public health surveillance

Add national-, state-, and county-level data on social determinants of vision health, including CDC’s social vulnerability index

Standardize questions on self-reported vision impairment and visual function in national surveys

Add new data sources (e.g.

Veterans Affairs and Indian Health Service)

Include vision and eye health data from

Increased number of years of vision and eye health surveillance data, and improved prioritization and streamlining of vision and eye health surveillance topics and indicators

Improved and standardized self-reported vision impairment and visual function questions in national surveys

Increased access to new data on populations of interest (e.g.

Veterans, American Indian/ Alaska Natives), comorbidities (e.g.

falls/injuries), social determinants of vision health

Improved alignment of the VEHSS with the NCCDPHP data modernization strategy by including

Increased use of the

VEHSS

demonstrated through online metrics and data from various sources like Adobe Analytics

Increased utilization of the VEHSS website as well as data products and publications will support, promote, and inform the identification of at-risk populations and improved vision care and outcomes

Increased use of VEHSS surveillance data to monitor progress toward Healthy People 2030 objectives and inform the Healthy People 2030 Mid-course Review report

Improved user experience and usability of the VEHSS website application

Increased use of VEHSS by researchers for impactful vision

Improved comprehensiveness, timeliness, and public health relevance of vision and eye health data maintained on VEHSS website application

Improved use of VEHSS data to inform Healthy People 2040 vision objectives

Increased and consistent utilization of the VEHSS website by key partners other electronic health record systems

Add data on comorbidities of vision impairment (e.g. poor mental health outcomes or falls and injuries)

Support monitoring of Healthy People 2030 objectives for vision health

Improve functionality and user experience by enhancing the visualization and presentation of website data

Conduct outreach and dissemination of the surveillance system among key partners

Promote the availability of this valuable source of vision and eye health surveillance data through publications in peer reviewed scientific journals and presentations at scientific conferences.

electronic health record data

Increased frequency of website updates to provide timely and accurate dissemination of VEHSS surveillance data and trends

Increased number of products and publications pertaining to the

VEHSS

and eye health research

i. Purpose

The NOFO purpose is to maintain and enhance CDC’s Vision and Eye Health Surveillance System, using valid and reliable data from a variety of sources, in order to assess national, state, and county-level prevalence of eye diseases, vision loss, and utilization of eye care. The objective is to provide researchers, health departments, and policy makers with vital data on the burden of vision impairment and eye diseases, in order to inform research, resource allocation, and the development of policies and interventions to reduce the burden of vision impairment and blindness in at risk communities.

ii. Outcomes By the end of the performance period:

Increased number of years of vision and eye health surveillance data, and improved prioritization and streamlining of vision and eye health surveillance topics and indicators

Increased number of products and publications pertaining to the VEHSS Increased use of the VEHSS demonstrated through online metrics and data from various sources like Adobe Analytics

iii. Strategies and Activities This NOFO will focus on the following strategies and activities:

Maintain the existing Vision and Eye Health Surveillance System (VEHSS) [https://www.cdc.gov/visionhealth/vehss/index.html] by adding data (at the national-, state-, and county-level) from newer iterations of the key datasets that comprise the surveillance system:

o National surveys American Community Survey (ACS) Behavioral Risk Factor Surveillance System (BRFSS) National Health Interview Survey (NHIS) National Survey of Children’s Health (NSCH) National Health and Nutrition Examination Survey (NHANES); newer data will be added if the NHANES ophthalmology module is implemented again and data are available during the period of performance o Administrative claims Medicare, from Centers for Medicare & Medicaid Services (CMS) Medicaid, from CMS Marketscan commercial health insurance VSP (Vision Service Plan) Global managed vision care o Electronic Health Records Intelligent Research in Sight (IRIS®) registry created by the American

Academy of Ophthalmology using electronic health record data. IRIS® is the largest U.S. ophthalmology registry, as it contains aggregated, de-identified data on nearly 350 million patient visits from 60 million unique patients. Approximately 16,000 clinicians in ophthalmology practices contribute data to the registry.

Streamline the surveillance system and improve usability by prioritizing the data and indicators that have the greatest value for the purposes of public health surveillance.

o Utilize existing feedback from CDC’s vision surveillance Expert Panel as well as user data from Adobe Analytics reports to identify the most commonly viewed datasets and indicators and those deemed by experts to have the greatest value for the purposes of public health surveillance. Establish a new vision and eye health surveillance Expert Panel and facilitate periodic meetings to seek their recommendations throughout the duration of the NOFO.

o Employ data visualization tools to highlight these prioritized datasets and indicators and drive end users to these data.

o Maintain the comprehensive, robust set of data and indicators in archival form, while improving the long-term sustainability of the VEHSS by prioritizing the indicators most informative for public health surveillance.

Enhance the utility of the VEHSS for both research and public health decision-making by incorporating national-, state-, and county-level data on social determinants of health

(SDOH).

o Perform an inventory of available national-, state-, and county-level data on vision-relevant SDOH.

o For survey datasets that contain data on both self-reported vision impairment and SDOH, stratify vision impairment indicators by SDOH variables in the interactive VEHSS database. (Some examples of relevant datasets include ACS, BRFSS, and

NHIS).

o For healthcare claims data, explore the possibility of stratifying eye disease prevalence and service utilization by z codes for SDOH.

Following are resources for SDOH z codes:

https://www.cdc.gov/nchs/data/icd/social-determinants-of-health.pdf https://www.cms.gov/files/document/zcodes-infographic.pdf Johns Hopkins Medicine: ICD-10 Codes to Identify Social

Determinants of Health https://www.uhcprovider.com/en/resource-library/news/2019-net-bulletin-featured-articles/0619-social-determinants-health.html https://pubmed.ncbi.nlm.nih.gov/32925453/ o Create data visualization tools that allow users to explore the relationship between county-level prevalence of vision impairment or eye diseases and county-level indicators of the social determinants of health. (An example of such a data visualization is the United States Diabetes Surveillance System (USDSS), which provides county-level chloropleth maps of diabetes prevalence alongside county-level chloropleth maps of CDC’s Social Vulnerability Index:

https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html).

o Incorporate into the VEHSS county-level measures of health care access, such as the number of ophthalmologists and optometrists per 10,000 people (found in the HRSA Area Health Resource Files: https://data.hrsa.gov/topics/health-workforce/ahrf).

https://www.cdc.gov/nchs/data/icd/social-determinants-of-health.pdf https://www.cdc.gov/nchs/data/icd/social-determinants-of-health.pdf https://www.cms.gov/files/document/zcodes-infographic.pdf https://www.hopkinsmedicine.org/johns_hopkins_healthcare/providers_physicians/resources_guidelines/provider_communications/2021/PRUP135_ICD10-km.pdf https://www.hopkinsmedicine.org/johns_hopkins_healthcare/providers_physicians/resources_guidelines/provider_communications/2021/PRUP135_ICD10-km.pdf https://www.uhcprovider.com/en/resource-library/news/2019-net-bulletin-featured-articles/0619-social-determinants-health.html https://www.uhcprovider.com/en/resource-library/news/2019-net-bulletin-featured-articles/0619-social-determinants-health.html https://pubmed.ncbi.nlm.nih.gov/32925453/ https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html https://data.hrsa.gov/topics/health-workforce/ahrf https://data.hrsa.gov/topics/health-workforce/ahrf

The HHS Healthy People objectives provide a useful framework for conceptualizing the social determinants of health:

https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Examples of SDOH indicators can include employment, food security, access to healthy foods, housing security and quality, household income, education, access to health care, health insurance, health literacy, environmental conditions, neighborhood safety, and the built environment.

Collaborate with the administrators of national surveys (BRFSS, ACS, NHIS) to improve and standardize questions on self-reported vision impairment and visual function, based on the results of a validation study performed in a previous NOFO (DP-19-005 – Research to Enhance the US Vision and Eye Health Surveillance System). This study validated self-reported questions on vision impairment and visual function against the gold standard of clinical chart review in a sample of ophthalmology clinic patients. The results of this study, which will be made available to the NOFO recipient, will inform efforts to improve self-reported vision-related questions on national surveys, an important source of surveillance data for vision and eye health.

Identify, assess, and analyze other relevant sources of data for vision and eye health and incorporate these new datasets and indicators into the VEHSS. Perform a landscape assessment of other datasets not currently in the VEHSS that contain important vision and eye health indicators. Examples may include but are not limited to data from Veterans Affairs, Indian Health Service, Tricare, and the National Institutes of Health All of Us Research Program. Focus on sources of surveillance data that help address disparities in vision and eye health and on data sources that provide estimates and indicators at various geographic levels. Collaborate with administrators of these datasets to establish data sharing agreements for data access. As data sources allow, identify opportunities to disaggregate prevalence estimates and provide more granular data for different racial/ethnic groups, in order to better understand populations that are disproportionately affected by vision loss and eye diseases.

In order to align the VEHSS with CDC’s data modernization efforts, implement an exploratory pilot project to incorporate into the VEHSS vision and eye health data from other electronic health record systems (in addition to the IRIS® registry). Examples of other electronic health record (EHR) systems include but are not limited to datasets from IQVIA, Kaiser Permanente, and Cerner. Using expert statisticians and modelers, explore the possibility of weighting and adjusting EHR data to produce population estimates of disease. Develop a statistical methodology to make population inferences from large EHR datasets like IQVIA.

Identify important comorbidities of vision impairment, such as poor mental health outcomes, cardiovascular disease, dementia/cognitive decline, falls, and injuries. Using https://health.gov/healthypeople/objectives-and-data/social-determinants-health

VEHSS datasets that contain information on both vision impairment and comorbidities, create data visualization tools that allow users to explore the relationship between vision impairment and these comorbid outcomes.

Support monitoring of Healthy People 2030 objectives for vision health by creating a featured section of the VEHSS website that allows users to track trends in key indicators related to Healthy People objectives.

Through discussions with end users, identify opportunities to improve the functionality of the website and user experience with the site. Elucidate how users search for information on the VEHSS and ways in which the VEHSS could be improved to help users find information more readily. Address these opportunities for functionality improvement by enhancing the layout, visualization, and presentation of the data on the website.

Conduct outreach and dissemination of the surveillance system among key partners:

researchers, scientists, public health practitioners, state health departments, and policy makers. Improve awareness and use of the VEHSS by presenting at partner meetings, hosting webinars for end users of the surveillance system, issuing press releases for important data updates, and developing fact sheets, data summaries, and briefs for the website.

Promote the availability of this valuable source of vision and eye health surveillance data through publications in peer reviewed scientific journals and presentations at scientific conferences. Leverage these scientific manuscripts as opportunities to both promote the VEHSS and publish important findings on the public health burden of vision loss and eye diseases, health service utilization, and population disparities in the prevalence and treatment of eye disease.

Develop and implement an evaluation plan to quantify end-user engagement with the VEHSS and assess the impact and usefulness of the VEHSS among end-users such as public health professionals, health care providers, and policy makers.

Provide final project report that includes but is not limited to describing the data sources, data sets, and data analysis (e.g., coding and computer programs) to allow CDC to maintain the surveillance system in the future.

1. Collaborations

a. With other CDC projects and CDC-funded organizations:

The recipient is expected to collaborate with CDC programs, as needed, to establish data sharing agreements and obtain access to any data relevant to vision and eye health surveillance that are not publicly accessible. These collaborations could include working with CDC’s National Center for Health Statistics, which administers NHANES and NHIS, or CDC’s Division of Population Health, which administers BRFSS.

b. With organizations not funded by CDC:

To successfully carry out the activities listed in this NOFO, the recipient will be expected to collaborate with a variety of organizations external to CDC for the purposes of establishing data sharing agreements for data access and disseminating important surveillance data to key partners.

Applicants should demonstrate established (or the capacity to establish) collaborations with institutions that administer novel sources of vision and eye health data, or that serve populations that are disproportionately affected by vision loss and eye diseases or other chronic diseases.

Applicants should also demonstrate the ability to establish data use agreements for access to data relevant to vision and eye health or chronic disease surveillance or demonstrate evidence of existing partnerships or proposed collaborations to implement the strategies and activities and achieve outcomes.

Possible collaborations may include but are not limited to partnerships with:

Other federal agencies: Centers for Medicare & Medicaid Services, Department of Veterans Affairs, Indian Health Service, National Institutes of Health or National Eye Institute

Non-profit organizations Professional medical associations Academic institutions

Collaborations necessary to establish data sharing agreements and gain data access are required;

all others are optional. Applicants should explain how each collaboration would assist in implementing activities and achieving the NOFO period of performance outcomes.

As evidence of collaboration, applicants are strongly encouraged to file the MOU/MOA or letter of support, as appropriate. Name the file "MOUs/MOAs" or "Letters of Support," and upload as a PDF file as part of the appendix to www.grants.gov.

2. Target Populations The recipient is expected to focus surveillance efforts and provide data on populations at higher risk and disproportionately affected by vision impairment and the major eye diseases. This may include a focus on racial/ethnic minorities, tribal communities, veterans, populations with lower income or medically underserved, and on estimates and indicators at various geographic levels (e.g., national/state/county and urban/rural).

a. Health Disparities The NOFO aims to focus surveillance efforts on social determinants of health, on populations that are disproportionately affected by vision impairment and the major eye diseases, and on data sources that provide estimates and indicators at various geographic levels (e.g., national/state/county, urban/rural). These efforts to document and monitor trends in vision impairment and the major eye diseases, risk factors, health service utilization, and outcomes will http://www.grants.gov be crucial in identifying health disparities, informing targeted interventions, and assessing the success of interventions in reducing health disparities.

iv. Funding Strategy N/A

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

Following are the proposed process and outcome measures for the strategies and activities in the logic model. Those that are bolded are proposed outcome measures for the period of performance outcomes in the logic model. These measures will be finalized and operationalized after the awards are made.

Increased number of years of vision and eye health surveillance data, and improved prioritization and streamlining of vision and eye health surveillance topics and indicators

Improved and standardized self-reported vision impairment and visual function questions in national surveys

Increased access to new data on populations of interest (e.g. Veterans, American Indian/Alaska Natives), comorbidities (e.g. falls/injuries), social determinants of vision health

Improved alignment of the VEHSS with the NCCDPHP data modernization strategy by including electronic health record data

Increased frequency of website updates to provide timely and accurate dissemination of VEHSS surveillance data and trends

Increased number of products and publications pertaining to the VEHSS Increased use of the VEHSS demonstrated through online metrics and data from various sources like Adobe Analytics

Performance Measures

Number of years of data, demonstrating expansion and growth of the surveillance system with up-to-date data, trends, and visualization tools.

Number of visits, type of unique visits, and diversity of visits (e.g., from researchers, public health practitioners, healthcare providers, policymakers, general public) to the website.

Number of publications or products using VEHSS data to disseminate VEHSS findings, raise awareness of vision impairment/eye disease and its risk factors, and promote early detection, treatment, and improved outcomes.

CDC will work with the recipient to develop and implement an evaluation plan to quantify end-user engagement with the VEHSS and assess the impact and usefulness of the VEHSS to end-users such as public health professionals, health care providers, and policy makers. Potential data sources include Adobe Analytics metrics and data and discussions with end-users. Key evaluation questions include:

What has been the change (percent increase or decrease) in the number (per month) of page visits and unique visitors to the VEHSS website during the period of performance for this NOFO?

What datasets and indicators are most frequently viewed?

What types of organizations are frequent visitors to the VEHSS (e.g. academic institutions/researchers, public health practitioners, state or local public health departments, policymakers, nonprofit organizations, media, general public, international visitors)?

What are specific use cases that illustrate how the VEHSS has been used for hypothesis generation in research or public health decision-making?

What has been the experience of end-users in searching for and finding data on the

VEHSS?

How can the data presentation and functionality of the VEHSS be enhanced or changed to improve user experience with searching for data on the website?

These performance measures and evaluation findings will be used to demonstrate the value of the NOFO by quantifying use of the surveillance system and describing how the VEHSS has been used for hypothesis generation in research or public health decision-making. Evaluation findings will be used by CDC for continuous improvement of the surveillance system.

A data management plan (DMP) is required for this NOFO and at a minimum, needs to include the following requirements. Applicants may not be able to provide all of this information when applying; in these instances, applicants should include a DMP that is as complete as possible.

Applicants should use the approved DMP template for the National Center for Chronic Disease Prevention and Health Promotion, which can be found here: https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm

DMP elements should include:

A description of the data to be collected or generated in the proposed project;

The standards to be used for the collected or generated data;

Mechanisms for, or limitations to, providing access to the data, including a description for the provisions for the protection of privacy, confidentiality, security, and intellectual property, or other rights;

Statement of the use of data standards that ensure all documentation that describes the method of collection, what the data represent, and

Plans for archiving and long-term preservation of the data, or explaining why long-term preservation and access are not justified; and, Other additional requirements based on the program.

Applicants are advised that any activities involving information collections (i.e., surveys, questionnaires, applications, audits, data requests, reporting, record-keeping and disclosure requirements) from 10 or more non-Federal entities, including State and local governmental agencies, are subject to the conditions of the Paperwork Reduction Act of 1995 (PRA). Under https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm the PRA, a Federal agency sponsoring a standardized data collection or directly obtaining standardized or substantially similar information from ten or more persons or entities (other than Federal employees within the scope of their employment) in any 12-month period must obtain advance written approval from the Office of Management and Budget (OMB). Regardless of form or format (oral, written, or electronically transmitted), responses of opinion or fact requested or required by or for CDC, except those specifically exempted or excluded, are subject to the provisions of the PRA and its implementing regulation, 5 CFR 1320 (Controlling Paperwork Burdens on the Public).

ii. Applicant Evaluation and Performance Measurement Plan Applicants must provide an evaluation and performance measurement plan that demonstrates how the recipient will fulfill the requirements described in the CDC Evaluation and Performance Measurement and Project Description sections of this NOFO. At a minimum, the plan must describe:

How the applicant will collect the performance measures, respond to the evaluation questions, and use evaluation findings for continuous program quality improvement.

How key program partners will participate in the evaluation and performance measurement planning processes.

Available data sources, feasibility of collecting appropriate evaluation and performance data, and other relevant data information (e.g., performance measures proposed by the applicant)

Plans for updating the Data Management Plan (DMP) as new pertinent information becomes available. If applicable, throughout the lifecycle of the project. Updates to DMP should be provided in annual progress reports. The DMP should provide a description of the data that will be produced using these NOFO funds; access to data;

data standards ensuring released data have documentation describing methods of collection, what the data represent, and data limitations; and archival and long-term data preservation plans. For more information about CDC’s policy on the DMP, see https://www.cdc.gov/grants/additional-requirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, the applicant should be directed to:

Describe the type of evaluations (i.e., process, outcome, or both).

Describe key evaluation questions to be addressed by these evaluations.

Describe other information (e.g., measures, data sources).

Recipients will be required to submit a more detailed Evaluation and Performance Measurement plan, including a DMP, if applicable, within the first 6 months of award, as described in the Reporting Section of this NOFO.

In addition to the above requirements, the Evaluation and Performance Measurement Plan must include:

https://www.cdc.gov/grants/additional-requirements/ar-25.html

How the applicant will assess the utility of vision and eye health indicators (e.g., criteria to add or retire indicators from the surveillance system) and processes to identify gaps in surveillance data and future needs.

How the applicant will assess Web analytics and usability of the website application to improve the surveillance system and ensure program and user needs are identified and met.

c. Organizational Capacity of Recipients to Implement the Approach Applicants are expected to demonstrate:

Adequate staffing and oversight to accomplish the program goals.

Applicants should clearly define staff roles and demonstrate a team of diverse staff members with the appropriate experience in managing vision and eye health (or chronic disease) surveillance systems. The team should bring complementary and integrated expertise to the project, including expertise in vision and eye health (or other related chronic diseases), biostatistics, epidemiology, communications, informatics, computer programming, graphics and visualization technologies, and Web development and design. The team should include a board-certified ophthalmologist on staff or contracted to provide technical and clinical expertise for the surveillance system. The team should have strong analytical skills and extensive, demonstrable experience in conducting surveillance and in managing, integrating, and analyzing large datasets containing vision and eye health or other chronic disease information. The team should have significant experience in designing, managing, and updating interactive website applications that disseminate surveillance data and trends related to vision and eye health (or other chronic diseases). Applicant must provide a staffing plan that defines the roles, responsibilities, and qualifications of the team and the expected contributions of the key/collaborative partners. In addition to the staffing plan, documents that can be provided to demonstrate organizational capacity include resumes / CVs, position descriptions, organizational charts, and additional subcontractor materials (if applicable). This additional information should be uploaded in a PDF file format to Grants.gov and should be named: Staffing Plan, Curriculum Vitae/Resumes, Position Descriptions, Organizational Charts, and Additional Subcontractor Materials.

Prior work on vision and eye health or other chronic disease surveillance.

Applicants should provide evidence of significant experience in establishing and maintaining surveillance systems. Applicants should describe prior work on surveillance systems that focus on providing surveillance data for racial/ethnic minority groups, disproportionately affected groups, and populations at higher risk, or applicants should describe previous work in monitoring and documenting trends in health disparities, risk factors, social determinants of health, health service utilization, and outcomes. The applicant should demonstrate experience in publishing and disseminating vision and eye health (or other chronic disease) surveillance findings and in particular highlighting or addressing health disparities. Documents that can be provided to demonstrate organizational capacity include resumes / CVs and a bibliography of relevant publications. These supplemental documents should be uploaded in a PDF file format to Grants.gov and should be named: Curriculum Vitae/Resumes and Bibliography of Relevant Publications.

Prior work supporting surveillance website applications Applicants should describe previous work in integrating, visualizing, and disseminating data on vision and eye health (or other chronic diseases) and health disparities using information technology. Applicants should have experience in using website analytics for evaluation and in performing usability testing of website applications. Documents that can be provided to demonstrate organizational capacity include resumes / CVs and a bibliography of relevant publications. These supplemental documents should be uploaded in a PDF file format to Grants.gov and should be named: Curriculum Vitae/Resumes and Bibliography of Relevant Publications.

Appendices will not be counted toward the narrative page limit and there is no limit to the number of allowable electronic attachments uploaded per application.

d. Work Plan Applicants should provide a detailed work plan for the first year of the project and a high-level work plan for subsequent years. Applicants should:

Stratify the workplan by outcomes for the budget period and for the performance period, clearly identifying the outcomes expected to be achieved by the end of the budget period and the outcomes expected by the end of the performance period.

Outline how the proposed strategies and activities will be carried out together with the evaluation and performance measurements to assess progress towards achieving the proposed outcomes.

Include quantitative process and outcome measures and proposed strategies and activities that are feasible and adequate to achieve the desired outcomes.

Provide a detailed timeline with realistic and measurable outcomes for the proposed project strategies and activities.

Describe how the plan will accomplish the NOFO goals of supporting and improving the Vision and Eye Health Surveillance System in the United States (as well as the website:

https://www.cdc.gov/visionhealth/vehss/index.html) with relevant data sources and indicators, up-to-date data and trends, and state-of-the-art technologies and visualization tools.

Describe collaborative agreements to address the intent and goals of this NOFO and provide evidence of demonstrated partnerships for data access or evidence of data use agreements for the existing or proposed collaborations.

Describe dissemination plans for producing reports, such as interim progress reports, system documentation, Web analytics, technical reports, final reports, as well as professional presentations and publications that will be produced in collaboration with CDC and other partners.

No specific work plan format is required, as long as it is clear how the components in the work plan crosswalk to the strategies and activities, outcomes, and evaluation and performance measures presented in the logic model and the narrative sections of this NOFO. A sample work plan format is presented below to show how a traditional work plan aligns with the logic model and narrative. In this format, the table would be completed for each period of performance outcome. If a particular activity leads to multiple outcomes, it should be described under each outcome measure.

Period of Performance Outcome:

[from Outcomes section and/or logic model]

Outcome Measure:

[from Evaluation and Performance Measurement section]

Strategies and Activities

Process Measure [from Evaluation and Performance Measurement section]

Responsible Position / Party

Completion Date

1.

2.

3.

4.

5.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting).

Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements:

Tracking recipient progress in achieving the desired outcomes.

Ensuring the adequacy of recipient systems that underlie and generate data reports.

Creating an environment that fosters integrity in program performance and results.

Monitoring may also include the following activities deemed necessary to monitor the award:

Ensuring that work plans are feasible based on the budget and consistent with the intent of the award.

Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets.

Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels.

Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients.

f. CDC Program Support to Recipients

CDC staff will act as consultants for this project. In collaboration with the recipients, CDC activities will include:

Providing consultation and guidance on all phases of the project.

Providing expert advice on developing and maintaining surveillance systems.

Communicating relevant surveillance findings and public health recommendations related to the project.

Fostering collaborations with other CDC internal and external partners.

Following up on the recommendations resulting from this project to continue supporting, updating, and improving the Vision and Eye Health Surveillance System.

References

1. Flaxman AD, Wittenborn JS, Robalik T, Gulia R, Gerzoff RB, Lundeen EA, et al. The Prevalence of Visual Acuity Loss or Blindness in the US: A Bayesian Meta-analysis.

JAMA Ophthalmol. 2021; doi: 10.1001/jamaophthalmol.2021.0527. Online ahead of print.

2. Crews JE, Chou C-F, Sekar S, Saaddine JB. The Prevalence of Chronic Conditions and Poor Health Among People With and Without Vision Impairment, Aged ≥65 Years, 2010-2014. Am J Ophthalmol. 2017;182:18-30.

3. Patino CM, McKean-Cowdin R, Azen SP, Allison JC, Choudhury F, Varma R. Central and peripheral visual impairment and the risk of falls and falls with injury.

Ophthalmology. 2010;117(2):199-206.

4. Ehrlich JR, Hassan SE, Stagg BC. Prevalence of Falls and Fall-Related Outcomes in Older Adults With Self-Reported. Vision Impairment J Am Geriatr Soc. 2019;67(2):239- 245.

5. McCarty CA, Nanjan MB, Taylor HR. Vision impairment predicts 5 year mortality. Br J Ophthalmol. 2001;85(3):322-6.

6. Prevent Blindness America. The Cost of Vision Problems: The Economic Burden of Vision Loss and Eye Disorders in the United States. Accessed May 11, 2021 from https://preventblindness.org/wp-content/uploads/2020/04/Economic-Burden-of-Vision- Final-Report_130611_0.pdf.

7. Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015;314(10):1021-9.

8. National Eye Institute. Glaucoma Tables. Accessed on May 11, 2021 at:

https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/glaucoma-data-and-statistics/glaucoma-tables

9. Cole BS, Gudiseva HV, Pistilli M, Salowe R, McHugh CP, Zody MC, et al. The Role of Genetic Ancestry as a Risk Factor for Primary Open-angle Glaucoma in African Americans. Invest Ophthalmol Vis Sci. 2021;62(2).

https://preventblindness.org/wp-content/uploads/2020/04/Economic-Burden-of-Vision-Final-Report_130611_0.pdf https://preventblindness.org/wp-content/uploads/2020/04/Economic-Burden-of-Vision-Final-Report_130611_0.pdf https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/glaucoma-data-and-statistics/glaucoma-tables https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/glaucoma-data-and-statistics/glaucoma-tables

10. Lundeen EA, Wittenborn J, Benoit SR, Saaddine J. Disparities in Receipt of Eye Exams Among Medicare Part B Fee-for-Service Beneficiaries with Diabetes - United States, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(45):1020-3.

B. Award Information

1. Funding Instrument Type:

CA (Cooperative Agreement) CDC's substantial involvement in this program appears in the CDC Program Support to Recipients Section.

2. Award Mechanism:

U58

3. Fiscal Year:

4. Approximate Total Fiscal Year Funding:

$850,000

5. Total Period of Performance Funding:

$2,550,000 This amount is subject to the availability of funds.

Estimated Total Funding:

$2,550,000

6. Total Period of Performance Length:

year(s)

7. Expected Number of Awards:

8. Approximate Average Award:

$850,000 Per Budget Period

9. Award Ceiling:

$850,000 Per Budget Period

This amount is subject to the availability of funds.

10. Award Floor:

$425,000 Per Budget Period

11. Estimated Award Date:

August 30, 2022

12. Budget Period Length:

12 month(s)

Throughout the project period, CDC will continue the award based on 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 total number of years for which federal support has been approved (project period) will be shown in the “Notice of Award.” This information does not constitute a commitment by the federal government to fund the entire period. The total period of performance comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

13. Direct Assistance Direct Assistance (DA) is not available through this NOFO.

If you are successful and receive a Notice of Award, in accepting the award, you agree that the award and any activities thereunder are subject to all provisions of 45 CFR part 75, currently in effect or implemented during the period of the award, other Department regulations and policies in effect at the time of the award, and applicable statutory provisions.

C. Eligibility Information

1. Eligible Applicants Eligibility Category:

00 (State governments)

01 (County governments)

02 (City or township governments)

04 (Special district governments)

06 (Public and State controlled institutions of higher education)

07 (Native American tribal governments (Federally recognized))

11 (Native American tribal organizations (other than Federally recognized tribal governments))

12 (Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education)

13 (Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education)

20 (Private institutions of higher education)

22 (For profit organizations other than small businesses)

23 (Small…