DP17-1702.1.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

State-based Perinatal Quality Collaboratives

CDC-RFA-DP17-1702

Application Due Date: 04/24/2017

State-based Perinatal Quality Collaboratives

CDC-RFA-DP17-1702

TABLE OF CONTENTS

Part I. Overview Information Federal Agency NameA.

Funding Opportunity TitleB.

Announcement TypeC.

Agency Funding Opportunity NumberD.

Catalog of Federal Domestic Assistance (CFDA) NumberE.

Dates F.

Executive Summary G.

Part II. Full Text Funding Opportunity Description A.

Award Information B.

Eligibility Information C.

Application and Submission Information D.

Review and Selection Process E.

Award Administration Information F.

Agency Contacts G.

Other Information H.

Glossary I.

Part I. Overview Information Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DP17-1702. 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. Funding Opportunity Title:

State-based Perinatal Quality Collaboratives

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 http://www.cdc.gov/od/science/integrity/docs/cdc -policy-distinguishing-public-health-research-nonresearch.pdf.

D. Agency Funding Opportunity Number:

CDC-RFA-DP17-1702

E. Catalog of Federal Domestic Assistance (CFDA) Number:

93.946

F. Dates:

1. Due Date for Letter of Intent (LOI): 03/24/2017

2. Due Date for Applications: 04/24/2017, 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

Date & Time:

Thu, Mar 16, 2017, 1:00 PM Eastern Daylight Time Meeting Type:

Web & Audio Audio Details:

Dial-In Number(s):

U.S. & Canada: 866.740.1260 Access Code: 4886003 Registration Link:

; ; ; ; ; ; ; ; ; ; ; https://cc.readytalk.com/r/dy9op8wa1aei&;eom

G. Executive Summary:

1. Summary Paragraph:

State Perinatal Quality Collaboratives (PQCs) are networks of multidisciplinary teams that work to improve measurable outcomes for maternal and infant health by advancing evidence-informed clinical practices using quality improvement (QI) principles. PQCs work with clinical teams, experts, and stakeholders, including patients and families, to spread best practices and optimize resources to improve perinatal care and outcomes.

Strategies include use of the collaborative learning model, rapid-response data, and QI science. The ultimate goal is to improve population-level outcomes in maternal and infant health. Module A will support states to enhance the capacity of PQCs in early stages of development (≤ 6 years) to improve perinatal care by actively conducting QI projects that improve maternal and infant health, including but not limited to: reduction of maternal morbidity and mortality, improvements in care for infants impacted by neonatal abstinence syndrome, and reduction of medically unnecessary cesarean deliveries. Module B will support a coordinating center for the National Network of Perinatal Quality Collaboratives (NNPQC), which will serve as a consultative resource for Module A awardees and other state-based PQCs. Program strategies include use of QI science and methods to improve maternal and infant outcomes (Module A) and coordination of NNPQC activities (Module B). Anticipated results include development of more fully functioning PQCs, leading to improvements in perinatal measures and outcomes.

a. Eligible Applicants: Open Competition

b. FOA Type: Cooperative Agreement

c. Approximate Number of Awards: 6 Module A (5 awards) Module B (1 award)

d. Total Project Period Funding: $6,000,000

e. Average One Year Award Amount: $200,000 This is the estimated amount of funding for each anticipated individual award. This amount is for the first 12-month budget period and includes both direct and indirect costs.

f. Total Project Period Length: 5 https://foa.grantsolutions.gov/www.grants.gov https://foa.grantsolutions.gov/www.grants.gov https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf http://www.grants.gov https://cc.readytalk.com/r/dy9op8wa1aei&eom

g. Estimated Award Date: 07/31/2017

h. Cost Sharing and / or Matching Requirements: N

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Perinatal morbidity and mortality are key indicators of a nation’s health status. The 2014 U.S. infant mortality rate was 5.8 infant deaths/1,000 live births, and the U.S. ranks 26th in infant mortality among Organisation for Economic Co-operation and Development countries. Although recent data suggest a decline in the infant mortality rate, any change since the beginning of the 21st century has been modest. The main cause of the high infant mortality rate in the U.S. compared to other industrialized nations is the high preterm birth rate in the United States. This rate rose by more than one-third from 1981 to 2006, but the preterm birth rate fell for the eighth straight year in 2014 to 9.57%. However, the preterm birth rate rose slightly in 2015 to 9.63%, there are still marked racial disparities, and the high rate of preterm birth is still a major contributor to infant morbidity and mortality. Another measure of our nation’s health, pregnancy-related mortality, has been on the rise. The number of reported pregnancy-related deaths in the U.S. steadily increased from 7.2 deaths/100,000 live births in 1987 to a high of 17.8 deaths/100,000 live births in 2011. Maternal deaths are sentinel events, and severe complications of pregnancy are at least 100 times more common. Substantial components of these measures of our nation’s health are influenced by decisions in health care facilities and by health care providers. State Perinatal Quality Collaboratives (PQCs) are networks of perinatal care providers and public health professionals, working to improve pregnancy outcomes for women and newborns by advancing evidence-based clinical practices and processes through continuous quality improvement (CQI). Members of PQCs identify processes of care that require improvement and use the best available methods to improve outcomes as quickly as possible. There is ongoing evidence of how PQCs have contributed to important changes in health care delivery, and how CQI has led to significant improvements in perinatal measures including reductions in elective deliveries without a medical indication prior to 39 weeks gestation, reductions in health care–associated bloodstream infections in newborns, and increases in appropriate use and documentation of use of antenatal corticosteroids. While PQCs in some states have experienced considerable success in achieving statewide improvements in processes and outcomes of perinatal care, others need additional support and technical assistance. This funding will build on the work of CDC-RFA-DP11-1110 and CDC-RFA-DP14-1404, which has resulted in various improvements such as reductions in scheduled deliveries at <39 weeks gestation without a medical indication, reductions in hospital acquired infections in NICUs, reductions in maternal morbidity, and improvements in birth certificate accuracy. There is a need to expand these successes to more states by building PQC capacity. These previous funding opportunities have also revealed the need for formal mentoring and technical assistance provided among PQCs, which also led to the initiation of the National Network of Perinatal Quality Collaboratives (NNPQC) (under FOA OT13-1302). The mission of the NNPQC is to support the development and enhance the ability of state PQCs to make measurable improvements in statewide maternal and infant health care and health outcomes. This funding opportunity also supports efforts to improve the health of populations disproportionately affected by poor perinatal outcomes by addressing perinatal health issues that are more prevalent among these populations.

b. Statutory Authorities This program is authorized under Section 301(a) of the Public Health Service Act, 42 U.S.C. 241(a) and Section 317K, 42 U.S.C. 247b-12 (Safe Motherhood) Module A - The National Center for Vital Statistics has legislative authority and is mandated under 42 U.S.C. § 242k, Section 306(h) of the Public Health Service Act to collect vital statistics annually. In the United States, legal authority for the registration of these events resides individually with the 50 States, 2 cities (Washington, DC, and New York City), and 5 territories (Puerto Rico, the Virgin Islands, Guam,American Samoa, and the Commonwealth of the Northern Mariana Islands). http://www.cdc.gov/nchs/nvss/about_nvss.htm. The ability to collect and obtain information from core data sets for statewide population-based vital events is essential for Module A of this funding opportunity.

c. Healthy People 2020 This program addresses the “;Healthy People 2020”; focus area of M aternal, Infant and Child Health,MICH-1, MICH-5, MICH-6, MICH-7, MICH-8, MICH-9, MICH-21, MICH-33

( http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=26 )

d. Other National Public Health Priorities and Strategies This FOA aligns with and supports other relevant national strategies including:

National Prevention Strategy, Sexual and Reproductive Health Priority CMS Partnership for Patients National Partnership for Action to End Health Disparities US National Strategy to Combat Antibiotic Resistant Bacteria Alliance for Innovation in Maternal Health Infant Mortality Collaborative Innovation and Improvement Network (IM CoIIN)

e. Relevant Work This FOA will focus on PQCs in early development since CDC support for PQCs began (≤ 6 years), and builds on past activities performed under http://www.cdc.gov/nchs/nvss/about_nvss.htm http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26 http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=26 http://www.surgeongeneral.gov/priorities/prevention/strategy/reproductive-and-sexual-health.html http://partnershipforpatients.cms.gov/ http://minorityhealth.hhs.gov/npa/ http://www.cdc.gov/drugresistance/federal-engagement-in-ar/national-strategy/index.html http://safehealthcareforeverywoman.org/aim-program/ http://mchb.hrsa.gov/maternal-child-health-initiatives/collaborative-improvement-innovation-networks-coiins

This FOA will focus on PQCs in early development since CDC support for PQCs began (≤ 6 years), and builds on past activities performed under CDC-RFA- DP11-1110, and CDC-RFA-DP14-1404, which supported PQCs to increase the number of participating hospitals in their PQC, address a broader range of perinatal health issues, and provided assistance to PQCs earlier in development. Successful outcomes included implementation of a maternal data center and interactive web-based tool for quality improvement, reduction in severe morbidity among women with hypertensive disorders of pregnancy, improvements in safe sleep practices in the hospital, and improvements in care for infants impacted by neonatal abstinence syndrome. This FOA also builds on the work of OT13-1302, which supported the development of a national network for state-based PQCs.

http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PQC.htm

2. CDC Project Description

a. Approach

Bold indicates project period outcome.

Module A Strategies and Activities Short-term Outcomes Intermediate Outcomes Long-Term Outcomes

Identify perinatal quality measures to be used and how data will be collected.

Validate data sources and perinatal quality measures.

Do rapid-cycle collection, analysis, and feedback of perinatal data.

Use quality improvement (QI) science and methods to:

Examine and improve data quality Identify service delivery issues and opportunities for improvement

Evaluate effectiveness of QI work.

Do active recruitment of hospitals across the state.

Increased participation of hospitals throughout the state in the PQC.

Fully functioning statewide perinatal quality collaborative actively disseminating data and improvement projects.

Service delivery improvements made statewide.

Improvements in perinatal measures Improvements in perinatal outcomes (e.g. reduced preterm birth, NICU admissions, racial/ethnic disparities) Reduction of maternal and infant morbidity and mortality and disparities in morbidity and mortality.

Module B Strategies and Activities Short-term Outcomes Intermediate Outcomes Long-Term Outcomes

Building stronger collaborative partnerships among state PQCs across the country to disseminate PQC resources nationally. The coordinating center will:

Coordinate the activities of the National Network of Perinatal Quality Collaboratives (NNPQC).

Keep track of existing resources from past and ongoing PQC projects.

Develop a speaker’s bureau of PQC experts to provide mentoring and technical support for states planning the development of a new PQC, or PQCs.

requesting consultation.

Field requests for information resources and technical support from state PQCs.

Advise Module A awardees on evaluation of projects.

Improved communication among PQCs across the country Increased capacity of state PQCs in early development Increased participation of partners and stakeholders

The development and sustainment of more fully functioning PQCs across the country

Improvements in perinatal measures Improvements in perinatal outcomes (e.g. reduced preterm birth, NICU admissions, racial/ethnic disparities) Reduction of maternal and infant morbidity and mortality and disparities in morbidity and mortality.

i. Purpose The purpose of this program is to enhance the ability of state-based PQCs in early stages of development (≤ 6 years) to actively conduct quality improvement projects, as well as expand current projects to address a broader range of neonatal and maternal health issues (Module A). In addition, this FOA will also facilitate the provision of technical assistance, formal mentoring, and capacity building for these newly developing PQCs and other state PQCs across the country through a coordinating center for the National Network of Perinatal Quality Collaboratives (Module B).

http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PQC.htm

ii. Outcomes As is presented in the logic model, short-term, intermediate, and long-term outcomes expected during the project period for Module A include increased participation of hospitals throughout the state in the collaborative, a fully functioning statewide PQC actively disseminating improvement projects, statewide service delivery improvements, and improvements in perinatal quality measures. For Module B, outcomes include improved communication among PQCs across the country, increased capacity of state PQCs that are in early development, increased participation of partners and stakeholders, and the development and sustainment of more fully functioning perinatal quality collaboratives across the country.

During this project period, we anticipate that successfully achieved short-term and intermediate outcomes will lead to sustainable ongoing perinatal collaboratives which use evidence-based interventions to demonstrate improvements in perinatal measures that indicate improvements in targeted perinatal outcomes. Examples include, but are not limited to, reduction of maternal morbidity and mortality, increase in use and documentation of use of antenatal corticosteroids, improvements in care for infants impacted by neonatal abstinence syndrome, and reduction of medically unnecessary cesarean deliveries.

iii. Strategies and Activities Module A: Funded PQCs should use program strategies for quality improvement (QI) that include the activities as outlined in the logic model and detailed below. Data for quality improvement metrics should be collected at the patient and hospital level, be analyzed, and then fed back to members of the collaborative in real time (aggregate and site-specific data, within days to several months of a birth, as applicable). Quality improvement science and methods should then be used to implement interventions to improve what is being measured by the data (e.g. Model for Improvement, Plan-Do-Study-Act Cycles). Quality improvement activities should also focus on improvement of completeness and accuracy of collected data.

Quality improvement requires "real time" data collection with rapid analysis and feedback to participants in the collaborative in an effort to change practice and improve outcomes. Although person-level data is collected, no personal identifiers are retained. All efforts to protect patient privacy will be made in compliance with HIPAA. Hospital-level data are reported back for the purpose of quality-improvement. CDC will not see any personally-identifiable information. Furthermore, the activities of the collaboratives will exist solely for the purpose of quality improvement in the state. To the degree that individual hospitals require IRB review, this will be done although not required because this is a quality improvement project and not research. Because this proposal is to fund existing collaboratives, there is a requirement for applicants that existing data management and analysis will be centralized and secure.

Identify and define perinatal quality measures to be used and how data will be collected.

Provide evidence of validation of data sources and perinatal quality measures or a plan of how they will be validated.

Use quality improvement science and methods to examine and improve data quality and identify opportunities for improvement of care;

including identification and documentation of evidence-based strategies that will be used to improve perinatal quality process and outcome measures, and the evaluation of the effectiveness of such strategies.

Do rapid-cycle collection, analysis, and feedback of perinatal data, including the following:

Develop a protocol for efficient and timely methods for data collection, analysis and implementation of evidence-based strategies to improve outcome measures.

Demonstrate ability to access the following required data sources: (1) mother’s prenatal and obstetric medical records and hospital discharge data (2) infant medical records since birth and hospital discharge (3) birth certificates (4) death certificates.

Provide a written manual of procedures for the Perinatal Quality Collaborative. These should include policies on confidentiality, HIPAA compliance, and member participation.

Following perinatal quality collaborative reviews, enter data to a centralized and secure web-based data collection system with an off-site backup storage system.

Develop and implement a quality assurance plan that includes methods to identify and resolve data collection problems, including missing or inaccurate data.

Communicate facility-level data to member institutions in a timely fashion.

Communicate aggregate-level data with the NNPQC Coordinating Center (Module B) to facilitate provision of technical assistance and evaluation of program progress.

Recruit additional institutions to the collaborative to make it statewide and representative of the entire state, and document efforts aimed at expanding participation of additional hospitals/medical institutions in the collaborative.

Regularly communicate information on project activities and results to partners and other state programs (e.g. quarterly newsletter), including preparing descriptive reports with state aggregated data and distributing them widely. These communications will assess the advantages and disadvantages of the collaborative, including a description of the problems encountered, potential improvements and lessons learned.

Share information learned from projects through presentations, webcasts, reports, and media events.

Participate in PQC “kick-off” meeting at CDC at the beginning of the performance period, and site visits by CDC staff to your state PQC.

Module B:The coordinating center for the National Network of Perinatal Quality Collaboratives will facilitate the provision of technical assistance, formal mentoring, and capacity building for newly developing PQCs funded through this cooperative agreement, and will also serve as a consultative resource for PQCs across the country.

Coordinate the activities of the National Network of Perinatal Quality Collaboratives, including:

Maintenance of a virtual work space for the Network for members to share, discuss and engage around perinatal quality improvement topics.

Planning of an annual summit of PQCs based on needs and issues identified by the Network.

Track existing resources from past and ongoing PQC projects, including maintenance of a resource library to include tools and resources gathered from member PQCs.

Develop a speakers’ bureau of PQC experts to provide mentoring and technical support for states planning the development of a new PQC, or PQCs requesting consultation.

Field requests for informational resources and technical support from state PQCs Advise and provide technical assistance for the evaluation of Module A grantee projects, including but not limited to:

Providing guidance on how to evaluate prevention effectiveness, including cost-benefit and/or cost effectiveness.

Provide guidance regarding the rigor of the scientific methods for awardee evaluation plans.

Development of standard evaluation practices across grantees.

Participate in PQC “kick-off” meeting at CDC at the beginning of the performance period, and site visits by CDC staff.

1. Collaborations

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

Module A: Although not required, if one or more funded collaboratives are in states with maternal-child health CDC state assignees, there may be opportunity to collaborate with the Division of Reproductive Health(DRH)/Field Support Branch and maternal-child health CDC state assignees to facilitate working with hospitals, agencies, and vital records departments/divisions. Additionally, state assignees may provide additional resources to facilitate the project and for capacity building. Collaboration with Pregnancy Risk Assessment Monitoring System (PRAMS) staff within the DRH/Applied Sciences Branch may also be useful; although PRAMS data are not real time, it may be used to help evaluate some components of the state perinatal quality collaborative.

Module A or Module B: Depending on the topic of the selected perinatal quality improvement projects within funded states, there may also be opportunity to collaborate with other CDC programs (e.g. Office for State, Tribal, Local and Territorial Support; National Center for Health Statistics; Division of Healthcare Quality Promotion).

b. With organizations not funded by CDC:

Applicants to Module A are required to provide documentation (memoranda of understanding (MOU)) of a working collaboration for the Perinatal Quality Collaborative with the state department of health, including the state division of vital statistics and maternal and child health programs; and evidence of participating medical facilities/hospitals that provide obstetric and neonatal services. In addition, although not required, applicants to Module A or Module B would also benefit from collaborations with other partners invested in perinatal quality improvement, including the local district/state chapters of the American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and the March of Dimes. Applicants should explain how each collaboration would assist them in implementing planned activities and achieving project period outcomes.

2. Target Populations The target population should include all recipients of maternal, perinatal, and neonatal care throughout the state. Applicants must define the target population within their state who will be impacted by proposed projects.

a. Health Disparities Applicants should describe how projects will include special populations who can benefit from program strategies, including populations disproportionately affected by selected perinatal outcomes based on geography, race, socioeconomic status, etc.

iv. Funding Strategy

NA

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Evaluation and performance measurement will determine an awardee’s success at implementing program strategies and reaching the desired outcomes. Key program activities for Module A include doing rapid-cycle collection, analysis, and feedback of perinatal data to collaborative members and using quality improvement science and methods to improve pregnancy and neonatal outcomes; Module B activities will focus on the coordination of the National Network of Perinatal Quality Collaboratives. CDC and awardees will evaluate and measure efforts during the project period by performing evaluations of process and outcome measures to determine the success of the program.

The following activities and performance measures outlined below should be implemented :

MODULE A:

Expanding early stage PQCs’ ability to actively conduct QI projects and disseminate data throughout the state.

Activities Process Measures

Identify and validate perinatal quality measures to be used and how data will be collected.

Number of clinical and general measures, with data sources documented with user guidance documentation.

Do rapid-cycle collection, analysis, and feedback of perinatal data.

Number of initiatives with active data collection, analysis and feedback to member facilities.

Time from data collection to feedback to member facilities

Use quality improvement (QI) science and methods to examine and improve data quality and identify service delivery issues and opportunities for improvement.

Number of initiatives contributing to the improvement of data quality (including medical records, administrative claims, and vital records data) Number of hospitals participating in in-person learning sessions Number of hospitals participating in action period calls Number of hospitals participating in webinar trainings

Do active recruitment of Number of hospitals invited to participate in QI initiatives hospitals across the state.

Outcomes Outcome Measures

Increased participation of hospitals throughout the state in the PQC.

Number and proportion of hospitals that are participating in statewide maternal QI initiatives Number and proportion of hospitals that are participating in statewide neonatal QI initiatives

Fully functioning statewide perinatal quality collaborative actively disseminating data and improvement projects.

PQC has implemented at least one continuous quality improvement initiative with statewide participation (all state regions represented, with at least 50% of maternity and/or neonatal units participating)

Service delivery improvements made statewide

Intervention-specific measures are to be incorporated as appropriate, based on the initiative and the interventions selected by the awardee.

Improvements in perinatal measures

Intervention-specific measures are to be incorporated as appropriate, based on the initiative and the interventions selected by the awardee.

MODULE B:

Building stronger collaborative partnerships among state PQCs across the country to disseminate PQC resources nationally through the National Network of Perinatal Quality Collaboratives (NNPQC)

Activities Process Measures

Coordinate the activities of the National Network of Perinatal Quality Collaboratives

(NNPQC).

Number and types of NNPQC activities conducted Annual participation/response rate of state PQCs, partners, and stakeholders in NNPQC self-assessments

Keep track of existing resources from past and ongoing PQC projects.

Number of resources identified and made available to PQCs

Develop a speaker’s bureau of PQC experts to provide mentoring and technical support

Number of unique sectors represented in the PQC speakers bureau (e.g. PQC directors, insurers, health systems, representatives of clinical organizations, patients/families, and others)

Module A awardees will also be expected to conduct an economic evaluation of at least one improvement project with assistance from CDC and the awardee of Module B (Coordinating Center for the National Network of Perinatal Quality Collaboratives). Key evaluation questions include:

Is the intervention effective?

What is the prevented fraction of poor outcomes? (E.g. neonatal morbidity and mortality, maternal morbidity and mortality, NICU admissions prevented, C-sections prevented, inductions prevented etc.)

What is the cost of the intervention?

What are the cost-effectiveness and/or cost-benefit of PQC interventions at the hospital and the state level?

for states planning the development of a new PQC, or for PQCs requesting consultation.

Number of requests for consultation/technical assistance and types of requests received.

Field requests for information resources and technical support from state PQCs.

Number of consultation/speaker requests fulfilled

Outcomes Outcome Measures

Improved communication among PQCs across the country

Number of PQCs reporting increased communication with PQCs in other states

Increased capacityof state PQCs in early development

Specific measures are to be incorporated as appropriate, based on the capacity of the PQC awardees of module A at the start of the project period.

Increased participation of partners and stakeholders

Number of partners and stakeholders engaged in NNPQC (e.g. CMS, HRSA, ACOG)

The development and sustainment of more fully functioning PQCs across the country

Number of states with functioning statewide PQCs, implementing at least one continuous quality improvement initiative across the state.

Improvements in perinatal measures

Specific perinatal measures are to be incorporated as appropriate, based on the specific initiatives of the PQC awardees in Module A.

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

How 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), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these FOA 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/additionalrequirements/ar-25.html.

Where the applicant chooses to, or is expected to, take on specific evaluation studies, they 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).

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

Module A Additional, intervention-specific measures will also need to be determined based on the selection of perinatal quality improvement projects by awarded states. Applicants should develop measures based on specific project objectives. Evaluation findings and performance measures will be used for continuous program quality improvement. These measures will also be used to demonstrate the value of this funding opportunity (e.g.

improved public health outcomes, effectiveness of the program, cost-effectiveness or cost benefit). It is important to note that data collection should be limited to data that will be analyzed and used for the purpose of PQC quality improvement projects. Awardees will be expected to disseminate information on project activities and results to collaborative participants, partners, and other state programs. Results will also be shared via the CDC website, presentations, reports, and media events.

c. Organizational Capacity of Awardees to Implement the Approach To ensure that applicants are able to execute CDC program requirements and meet project period outcomes, applicants must demonstrate relevant experience to implement the activities and achieve the project outcomes, experience and capacity to implement the evaluation plan, and a staffing plan and project management structure sufficient to achieve the project outcomes and which clearly defines staff roles.

Module A The anticipated level of organizational capacity in order to implement the award for Module A includes the following skill sets:

Pediatric/Neonatology and Obstetric/Perinatology leadership Quality improvement leadership https://www.cdc.gov/grants/additionalrequirements/ar-25.html

Quality improvement leadership Data management Partnership development Evaluation and Performance monitoring Budget management and administration Contract management

As stated in the section on Collaborations, applicants are required to provide documentation (MOU) of an effective working collaboration for the project with the state department of health, including the state division of vital statistics, maternal and child health programs, and evidence of membership medical facilities/hospitals that provide obstetric and neonatal services.

Module B The anticipated level of organizational capacity in order to implement the award includes the following skill sets:

Partnership development Capacity building Evaluation and Performance monitoring Data management Budget management and administration Contract management

Established experience in the following areas is also necessary for implementation of Module B of this award:

Participation and leadership in state-based perinatal quality improvement collaboratives Planning and convening of national meetings Development of virtual workspaces and resource libraries Content expertise in perinatal health, including maternal and newborn health issues Leadership of initiatives to improve birth outcomes Analytic expertise with a strong background in evaluation methodology, and/or health economics

d. Work Plan Applicants will be required to provide a detailed work plan that covers the first year of the project period and a high level plan for subsequent years.

The work plan assists the Project Officer in monitoring awardee activities and reflects activities supported by the annual budget award. The work plan should include how the outcomes, strategies, activities, timelines, and staffing/collaborations work together. Information on performance measures and data sources should also be included. The work plan must at a minimum include:

Activities and timelines to support achievement of FOA outcomes. These activities should be in alignment with the FOA logic model and should have appropriate performance measures for accomplishing tasks. Each element of the plan must contain the following components:

The overall goal of the intervention or activity, the target population, SMART* objectives (objectives that are Specific, Measurable, Achievable, Relevant and Time-based), data collection methods and sources.

Staff, contracts and administrative roles and functions to support implementation of the award.

Administration and assessment processes to ensure successful implementation and quality assurance.

See sample work plan template below:

Project Period 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.

6.

e. CDC Monitoring and Accountability Approach Monitoring activities include routine and ongoing communication between CDC and awardees, site visits, and awardee 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 awardee progress in achieving the desired outcomes.

Ensuring the adequacy of awardee 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 awardees are performing at a sufficient level to achieve outcomes within stated timeframes.

Working with awardees 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 grantees.

f. CDC Program Support to Awardees (THIS SECTION APPLIES ONLY TO COOPERATIVE AGREEMENTS) In a cooperative agreement, CDC and awardees share responsibility for successfully implementing the award and meeting identified outcomes.

CDC staff is substantially involved in the program activities, above and beyond routine grant monitoring. Substantial involvement refers to federal programmatic collaboration or participation that the awardee can expect in implementing the award. CDC program involvement may include:

Technical assistance in solving problems related to data sources, data collection, case review, data entry, quality assurance and evaluation.

Information sharing between Awardees through email, conference calls, webinars, and the development of guidance materials.

Dissemination of project findings through the CDC website, presentations, reports, success stories, publications, and media.

Facilitation of partnership building by connecting awardees to additional potential partners and resources.

Review of reports submitted by awardees and general assistance to awardees in developing these reports.

B. Award Information

1. Funding Instrument Type: Cooperative Agreement CDC's substantial involvement in this program appears in the CDC Program Support to Awardees Section.

2. Award Mechanism: U58 Chronic Disease Control Cooperative Agreement In cooperation with State and local public health agencies and other public or private organizations to assist in controlling and preventing chronic diseases. Efforts are directed at the integrated application of surveillance; applied epidemiology; laboratory sciences; evaluation; health education;

dynamic and productive relationships; training; and extensive applied management of effective disease control programs.

3. Fiscal Year: 2017

4. Approximate Total Fiscal Year Funding:

$1,200,000

5. Approximate Project Period Funding:

$6,000,000

This amount is subject to the availability of funds.

Estimated Total Funding: $6,000,000

6. Total Project Period Length: 5 year(s)

7. Expected Number of Awards: 6 Module A (5 awards) Module B (1 award)

8. Approximate Average Award: $200,000 Per Budget Period This is the estimated amount of funding for each anticipated individual award. This amount is for the first 12-month budget period and includes both direct and indirect costs.

9. Award Ceiling: $200,000 Per Budget Period

This amount is subject to the availability of funds.

This ceiling is for each budget period and includes both direct and indirect costs.

10. Award Floor: $100,000 Per Budget Period

11. Estimated Award Date: 07/31/2017

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 awardee (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 project period comprises the initial competitive segment and any subsequent non-competitive continuation award(s).

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

C. Eligibility Information

1. Eligible Applicants

Eligibility Category: State governments Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled "Additional Information on Eligibility"

Additional Eligibility Category:

Government Organizations:

State governments or their bona fide agents (includes the District of Columbia)

2. Additional Information on Eligibility

Module A: State health departments or other agencies with legal authority for the registration of births or their Bona Fide Agents. Applicants to Module A that are bona fide agents are required to provide documentation (memorandum of understanding ) of a working collaboration for the Perinatal Quality Collaborative with the state health department or referenced legal authority, including vital statistics and maternal and child health programs.

Module B. Unrestricted Depending on eligibility, applicants may apply to one or both Modules.

3. Justification for Less than Maximum Competition

NA

4. Cost Sharing or Matching

Cost Sharing / Matching Requirement:

No

5. Maintenance of Effort

Maintenance of effort is not required for this program.

D. Application and Submission Information

1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov.

a. Data Universal Numbering System:

All applicant organizations must obtain a Data Universal Numbering System (DUNS) number. A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements.

The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http:// fedgov.dnb. com/ webform/ displayHomePage.do. The DUNS number will be provided at no charge.

If funds are awarded to an applicant organization that includes sub-awardees, those sub-awardees must provide their DUNS numbers before accepting any funds.

b. System for Award Management (SAM):

The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as an awardee. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC.

If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov.

c. Grants.gov:

The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site.

Registration information is located at the “Get Registered” option at www.grants.gov.

All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete.

Applicants should start the registration process as early as possible.

Step System Requirements Duration Follow Up http://www.grants.gov/ http://fedgov.dnb.com/webform/displayHomePage.do http://fedgov.dnb.com/webform/displayHomePage.do https://www.sam.gov/portal/public/SAM/ http://grants.gov/ http://www.grants.gov/ http://www.grants.gov/

1 Data Universal Number System

(DUNS)

1. Click on http:// fedgov.dnb.com/ webform

2. Select Begin

DUNS

search/request process

3. Select your country or territory and follow the instructions to obtain your DUNS 9-digit #

4. Request appropriate staff member(s) to obtain DUNS number, verify & update information under DUNS number

1-2 Business Days

To confirm that you have been issued a new DUNS number check online at (http:// fedgov.dnb.com/ webform) or call 1-866-705-5711

2 System for Award Management

(SAM)

formerly Central Contractor Registration

(CCR)

1. Retrieve organizations DUNS number

2. Go to www.sam.gov and designate an E-Biz POC (note CCR username will not work in SAM and you will need to have an active SAM account before you can register on grants.gov)

3-5 Business Days but up to 2 weeks and must be renewed once a year

For SAM Customer Service Contact https://fsd.gov/ fsd-gov/ home.do Calls:

866-606-8220

3 Grants.gov 1. Set up an individual account in Grants.gov using organization new DUNS number to become an authorized organization representative

(AOR)

2. Once the account is set up the E-BIZ POC will be notified via email

3. Log into grants.gov using the password the

E-BIZ POC

received and create new password

4. This authorizes the AOR to submit applications on behalf of the organization

Same day but can take 8 weeks to be fully registered and approved in the system (note, applicants MUST obtain a DUNS number and SAM account before applying on grants.gov)

Register early! Log into grants.gov and check AOR status until it shows you have been approved

2. Request Application Package Applicants may access the application package at www.grants.gov.

http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://fedgov.dnb.com/webform http://www.sam.gov https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do https://fsd.gov/fsd-gov/home.do

3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this funding opportunity at www.grants.gov.

If Internet access is not available, or if the online forms cannot be accessed, applicants may call the CDC OGS staff at 770-488-2700 or e-mail OGS ogstims@cdc.gov for assistance. Persons with hearing loss may access CDC telecommunications at TTY 1-888-232-6348.

4. Submission Dates and Times If the application is not submitted by the deadline published in the FOA, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by OGS.

a. Letter of Intent Deadline (must be emailed or postmarked by) Due Date for Letter of Intent: 03/24/2017

b. Application Deadline Due Date for Applications: 04/24/2017 , 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov. If Grants.gov is inoperable and cannot receive applications, and circumstances preclude advance notification of an extension, then applications must be submitted by the first business day on which grants.gov operations resume.

Date for Information Conference Call

Date & Time:

Thu, Mar 16, 2017, 1:00 PM Eastern Daylight Time

Meeting Type:

Web & Audio

Audio Details:

Dial-In Number(s):

U.S. & Canada: 866.740.1260 Access Code: 4886003

Registration Link:

; ; ; ; ; ; ; ; ; ; ; https://cc.readytalk.com/r/dy9op8wa1aei&;eom

5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa)) /Homepage.aspx.

Applicants may follow either of the following processes:

Complete the applicable assurances and certifications with each application submission, name the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc.gov/ grantassurances/ (S(mj444mxct51lnrv1hljjjmaa))/ Homepage.aspx

Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply to all applications submitted to CDC by the applicant within one year of the submission date.

6. Content and Form of Application Submission Applicants are required to include all of the following documents with their application package at www.grants.gov.

7. Letter of Intent

A letter of intent (LOI) is requested but optional. The purpose of an LOI is to allow CDC program staff to estimate the number of and plan for the review of submitted applications. Please indicate whether applying to Module A or Module B.

LOI may be sent via U.S. express mail, delivery service, fax, or email to:

Zsakeba Henderson, MD, Project…