CDC-RFA-DP21-2106.pdf

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Advancing Arthritis Public Health Priorities through National Organizations

CDC-RFA-DP21-2106

Application Due Date: 04/05/2021

Advancing Arthritis Public Health Priorities through National Organizations

CDC-RFA-DP21-2106

TABLE OF CONTENTS

Part I. Overview Information A. Federal Agency Name B. Funding Opportunity Title C. Announcement Type D. Agency Funding Opportunity Number E. Assistance Listings (CFDA) Number F. Dates G. Executive Summary

Part II. Full Text 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 Information 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- DP21-2106. 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:

Advancing Arthritis Public Health Priorities through National Organizations 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.govregs.com/regulations/title42_chapterI_part2_subpartD_section2.52. 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)).

New - Type 1

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP21-2106

E. Assistance Listings (CFDA) Number:

93.945 F. Dates:

1. Due Date for Letter of Intent (LOI): 03/12/2021

2. Due Date for Applications: 04/05/2021, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

February 2, 2021 A 60-minute informational call will be held on 2/2/2021 from 2:00 pm to 3:00 pm US Eastern Standard Time. To access call Dial: (888) 371-8141; Passcode: 8606471#.

In addition, an email address has been established to receive and respond to NOFO questions:

ArthritisDP21-2106@cdc.gov. NOFO questions and answers will be made available at https://www.cdc.gov/arthritis/funded/nofo/cdc-rfa-dp21-2106.html.

G. Executive Summary:

1. Summary Paragraph:

Arthritis is a general term for more than 100 conditions affecting joints or tissues around the joint, including osteoarthritis, rheumatoid arthritis, gout and fibromyalgia. The goal of this NOFO is to advance arthritis public health priorities to improve the quality of life for all adults https://www.grants.gov https://www.grants.gov https://www.govregs.com/regulations/title42_chapterI_part2_subpartD_section2.52 https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html https://www.grants.gov with arthritis. This NOFO will support:

Dissemination and delivery of arthritis-appropriate evidence-based interventions (AAEBIs);

Availability of tailored arthritis-specific consumer health information;

Collaborative public health action to address osteoarthritis and other forms of arthritis;

Provision of technical assistance to state partners; and Development of an evidence-informed healthcare provider approach to conduct function, pain and physical activity assessments, patient counseling on the benefits of physical activity, and referrals to arthritis appropriate physical activity and self-management programs.

Expected outcomes:

Increase in AAEBI participation.

Expanded access to arthritis resources and information.

Increase in Osteoarthritis:2020 Update priorities addressed.

Increase in effective strategies implemented by states to address arthritis.

Increase in function, pain and physical activity screening by healthcare providers.

Increase in physical activity counseling by healthcare providers.

Increase in referral of adults with arthritis to AAEBIs or other physical activity opportunities by healthcare providers.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 7

d. Total Period of Performance Funding: $10,185,595

e. Average One Year Award Amount: $350,000 Component 1: 5-7 awards of $150-500K each Component 2: 1 award of $300-$500K

f. Total Period of Performance Length: 5

g. Estimated Award Date: 09/15/2021

h. Cost Sharing and / or Matching Requirements: N While cost sharing is not required, the Component 2 applicant is encouraged to contribute, from non-Federal sources, a monetary or in-kind amount equal to 10 percent of the requested amount to carry out the activities supported by the cooperative agreement.

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Arthritis is a general term for more than 100 conditions that affect the joints or tissues around the joint, including osteoarthritis, rheumatoid arthritis, gout and fibromyalgia. Arthritis is an often overlooked, leading contributor to chronic disease burden and a top cause of morbidity, work limitations, and reduced quality of life. More than 54 million US adults have arthritis, half of whom are working aged; and 78 million are projected to have it by 2040. Arthritis is significant, not only because it limits physical function and quality of life, but because it commonly co-occurs with other chronic conditions that are leading causes of death, such as heart disease, diabetes, and obesity, and can interfere with management of these conditions through its effects on limiting physical activity. Arthritis-attributable activity limitations are higher among American Indian/Alaska Natives (51.6%), blacks (48.6%) and Hispanics (44.3%), as compared to whites (40.1%).

People with arthritis face barriers to physical activity such as fear of worsening arthritis pain and progression. However, arthritis and its limitations can be managed effectively, and symptoms improved, through routine physical activity and participation in self-management education (SME) programs. Low-cost, arthritis-appropriate, evidence-based interventions (AAEBIs) are shown to decrease arthritis pain and/or disability and improve quality of life. These AAEBIs are available in geographic pockets across the US, but do not reach all people who can benefit from them. Lack of awareness about AAEBIs, their benefits, and how to access them remain a challenge and a barrier to participation in these programs. More AAEBI offerings are needed, with greater geographic dispersion, and greater awareness to increase participation in them.

Evidence also suggests adults are more likely to attend an education program and engage in physical activity when recommended by a healthcare provider. Because physicians' advice is respected and physician-patient encounters can be frequent among adults diagnosed with arthritis, even if primarily for co-occurring conditions or age-related screenings or check-ups, these encounters and other opportunities can be used to: 1) counsel about the benefits of physical activity, including walking, and 2) refer adults with arthritis to AAEBIs for physical activity and self-management education.

The goal of this NOFO is to advance arthritis public health priorities to improve the quality of life for all adults with arthritis. This NOFO will support:

Dissemination and delivery of arthritis-appropriate evidence-based interventions (AAEBIs);

Availability of tailored arthritis-specific consumer health information;

Collaborative public health action to address osteoarthritis and other forms of arthritis;

Provision of technical assistance to state partners; and Development of an evidence-informed healthcare provider approach to conduct function, pain and physical activity assessments, patient counseling on the benefits of physical activity, and referrals to arthritis appropriate physical activity and self-management programs.

This five year funding opportunity has two Components. Applicants can apply for one or both http://www.cdc.gov/arthritis/interventions https://www.cdc.gov/arthritis/interventions/index.htm

Components. For Component 1, applicants may select only one strategy.

b. Statutory Authorities This program is authorized under the Public Health Service Act § 301(a) and 317(k)(2), 42 U.S.C. § 241(a) and 247b(k)(2), as amended.

c. Healthy People 2030 This funding opportunity will support a 5-year cooperative agreement program addressing the Healthy People 2030 focus areas of:

Arthritis;

Chronic Pain;

Health Care;

Health Care Access and Quality;

Health Communication;

Health IT;

Injury Prevention;

Neighborhood and Built Environment;

Nutrition and Healthy Eating;

Older Adults;

People with Disabilities; and Physical Activity.

d. Other National Public Health Priorities and Strategies This NOFO supports the following national and international strategies through the focus on evidence-based interventions related to adopting healthy behaviors associated with physical activity and chronic disease self-management:

National Partnership for Action to End Health Disparities National Physical Activity Plan 2018 Physical Activity Guidelines for Americans 2018 European League Against Rheumatism (EULAR) recommendations for physical activity in people with inflammatory arthritis and osteoarthritis 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Manag ement of Osteoarthritis of the Hand, Hip, and Knee A National Public Health Agenda for Osteoarthritis 2010 and 2020 National Pain Strategy: A Comprehensive Population Health Level Strategy for Pain The Community Preventive Services Task Force recommendations for increasing physical activity Step It Up! The Surgeon General's Call to Action to Promote Walking and Walkable

Communities 2019 Pain Management Best Practices Inter-Agency Task Force https://health.gov/healthypeople/objectives-and-data/browse-objectives https://minorityhealth.hhs.gov/npa/files/Plans/Toolkit/NPA_Toolkit.pdf https://www.physicalactivityplan.org/index.html https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf https://pubmed.ncbi.nlm.nih.gov/29997112/ https://pubmed.ncbi.nlm.nih.gov/29997112/ https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf https://www.rheumatology.org/Portals/0/Files/Osteoarthritis-Guideline-Early-View-2019.pdf https://oaaction.unc.edu/oa-agenda/ https://www.iprcc.nih.gov/national-pain-strategy-overview/national-pain-strategy-report https://www.thecommunityguide.org/topic/physical-activity https://www.thecommunityguide.org/topic/physical-activity https://www.cdc.gov/physicalactivity/walking/call-to-action/index.htm#:~:text=The%20goal%20of%20Step%20It,supports%20walking%20for%20all%20Americans.

https://www.cdc.gov/physicalactivity/walking/call-to-action/index.htm#:~:text=The%20goal%20of%20Step%20It,supports%20walking%20for%20all%20Americans.

https://www.hhs.gov/ash/advisory-committees/pain/index.html

e. Relevant Work This NOFO builds upon CDC-RFA-DP16-1606 Advancing Arthritis Public Health Approaches Through National Organizations, a 5-year cooperative agreement initiated on September 30, 2016 funding 5 national organizations. In combination with the currently funded 13 states (CDC-RFA- DP18-1803), AAEBIs have been offered in 49 states, Washington DC and American Samoa, and have reached more than 100K US adults. This NOFO is also relevant to the following key funding opportunities or initiatives:

CDC-RFA-DP18-1807: https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span- 1807/index.html

CDC-RFA-DP18-1809: https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop- 1809/high-obesity-program-1809.html

CDC-RFA-DP18-1813: https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach /index.htm

CDC-RFA-DP18-1815: https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1815.html

CDC-RFA-DP18-1817: https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1817.html

CDC-RFA-DP20-2004: https://www.cdc.gov/aging/funding/hbi/index.html CDC-RFA-DP20-2005: https://www.cdc.gov/aging/bold/index.html AHRQ's PCMH model addresses the needs of the patient at home: https://www.pcmh

.ahrq.gov/ AHRQ's Self-Management Support: https://www.ahrq.gov/ncepcr/tools/self-mgmt/self

.html CMS AHC Model addresses needs of its beneficiaries through screening, referral, and community navigation services: https://innovation.cms.gov/initiatives/ahcm/ ACL CDSME programming: https://www.acl.gov/programs/health-wellness/chronic-disea se-self-management-education-programs

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-DP21-2106 Advancing Arthritis Public Health Priorities through National Organizations

Strategies and Activities Short-Term Outcomes Intermediate Outcomes

Long-Term Outcomes

Component 1:

Choose 1 strategy from the Increased number of Increased number of https://www.grants.gov/view-opportunity.html?oppId=281507 https://www.grants.gov/view-opportunity.html?oppId=281507 https://www.cdc.gov/arthritis/partners/funded-national.htm https://www.cdc.gov/arthritis/partners/funded-states.htm https://www.cdc.gov/arthritis/about/nofo/2018/ https://www.cdc.gov/arthritis/about/nofo/2018/ https://www.cdc.gov/arthritis/interventions/index.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/span-1807/index.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/hop-1809/high-obesity-program-1809.html https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1815.html https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1815.html https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1817.html https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1817.html https://www.cdc.gov/aging/funding/hbi/index.html https://www.cdc.gov/aging/bold/index.html https://www.pcmh.ahrq.gov/ https://www.pcmh.ahrq.gov/ https://www.ahrq.gov/ncepcr/tools/self-mgmt/self.html https://www.ahrq.gov/ncepcr/tools/self-mgmt/self.html https://innovation.cms.gov/initiatives/ahcm/ https://www.acl.gov/programs/health-wellness/chronic-disease-self-management-education-programs https://www.acl.gov/programs/health-wellness/chronic-disease-self-management-education-programs options (A-D):

A. Increase access to and availability of proven arthritis interventions nationwide.

B. Expand national provision of consumer arthritis information and intervention referral services.

C. Facilitate partnerships and coordinate activities to address national osteoarthritis public health priorities.

D. Expand state capacity to address arthritis through technical assistance/support and leverage partners/networks to promote arthritis-appropriate evidence-based interventions (AAEBIs).

AAEBI courses offered, particularly in states not receiving CDC arthritis funding and under-served communities.

Enhanced infrastructure to support and provide arthritis-specific consumer health information.

Increased partnership capacity and collaborative action to address national osteoarthritis public health priorities.

Increased state policies and plans to address arthritis.

adults with arthritis who participate in AAEBIs.

Reduced disparities in access to interventions and services.

Increased number of priorities addressed as identified in A National Public Health Agenda for Osteoarthritis:

2020 Update.

Increased number of effective strategies implemented by states to address arthritis.

Component 2:

Develop and implement an evidence-

Increased healthcare

Increased number of

Improved arthritis management behaviors among adults with arthritis (Outcome Measure 1).

Decreased physical inactivity among adults with arthritis.

Improved social and physical environments for adults with arthritis (Outcome Measure 2).

Reduced pain, improved function, and limited arthritis progression.

informed healthcare provider approach to conduct function, pain and physical activity assessments, patient counseling on the benefits of physical activity, and referrals to arthritis appropriate physical activity and self-management programs.

provider capacity (self-efficacy) to promote physical activity among people with arthritis.

Increased clinical practice and healthcare system adoption of policies, technologies and procedures to support healthcare provider capacity to promote physical activity among people with arthritis.

Increased knowledge and awareness of reimbursement options for function, pain and physical activity assessment and counseling and/or referrals to AAEBIs.

healthcare providers conducting function, pain and physical activity assessments;

physical activity counseling;

and referring adults with arthritis to AAEBIs or other physical activity opportunities (Outcome Measure 3).

i. Purpose The purpose of this NOFO is to improve the quality of life for adults with arthritis, by:

Expanding AAEBI availability and access for adults with arthritis.

Providing arthritis-specific consumer health information.

Facilitating collaborative public health action to address OA and other forms of arthritis.

Providing technical assistance to state partners.

Developing a healthcare provider approach to conduct evidence-informed assessments, patient counseling on the benefits of physical activity, and referrals to arthritis appropriate physical activity and self-management programs.

ii. Outcomes The NOFO goals are to ultimately enhance the health, wellness, and quality of life of adults with arthritis, reduce health disparities, and improve arthritis management and health outcomes through evidence-based interventions. During the 5-year period of performance, the recipients are expected to contribute towards attainment of the following overarching outcomes:

Improved arthritis management behaviors among adults with arthritis (Outcome Measure 1).

Improved social and physical environments for adults with arthritis (Outcome Measure 2).

Increased number of healthcare providers conducting function, pain and physical activity screening; physical activity counseling; and referring adults with arthritis to AAEBIs or other physical activity opportunities (Outcome Measure 3; Component 2 only).

Component 1: This NOFO option will leverage and expand existing systems, technologies and networks with national reach and/or access into large segments of the adult population, including segments of the population that experience disproportionate burden, to increase awareness and availability of, and participation in, AAEBIs. It will also support technical assistance to state arthritis programs and state health departments, and provide arthritis-specific consumer health information to the public. Further, it will facilitate collaborative action to address osteoarthritis (OA) and other types of arthritis. Opportunities to address arthritis-related social determinants of health will be maximized.

Component 2: This NOFO option will develop and implement an evidence-informed healthcare provider approach to conduct function, pain and physical activity screenings, patient counseling on the benefits of physical activity, and referrals to arthritis appropriate physical activity and self-management programs. This strategic approach will enhance healthcare provider awareness, knowledge and skills to promote physical activity as an effective, drug-free way to relieve arthritis pain, improve function, and limit arthritis progression among adults with arthritis.

iii. Strategies and Activities

COMPONENT 1

Component 1 is focused on Building Capacity & Scaling Up non-research efforts to address arthritis. It comprises 5-7 awards of $200-$500K each. Applicants may apply for only one of the four strategies labeled A through D:

Strategy A- Increase access, availability and sustainability of proven arthritis interventions nationwide. One to two awards of $300-$500K will be supported annually. Recipient(s) will be expected to address the activities listed below:

Through affiliate sites (i.e. - an established, formally-affiliated, national network of chapters/sites that directly reach large segments of the US population), deliver physical activity and self-management programs nationwide, focusing primarily on states not curre ntly receiving CDC arthritis funding.

o Select at least two options from CDC's menu of recognized and promising arthritis -appropriate evidence-based interventions (AAEBIs) that promote quality of life for adults with arthritis.

At least one selection must be from the AAEBI recognized list.

Note: For purposes of this NOFO, Walk with Ease (WWE), regardless of delivery format (group, self-directed, etc.) is considered a single intervention selection.

Include a plan to strategically reach at least 50,000 people in 25 states.

Applicant has the option to expand/change interventions offered as

AAEBIs emerge that may better meet the needs of affiliates, delivery sites, or adults with arthritis.

o Using up to 10% of annual funding, the applicant has the option to offer one other self-management intervention (OSMI) in addition to the required AAEBIs. The selected OSMI must be recognized as evidence-based by at least one federal agency and must emphasize physical activity, weight-management, joint injury prevention and/or chronic disease self-management education. The applicant must provide a rationale for the selection of the intervention that clearly describes how the OSMI will contribute to attainment of arthritis related NOFO outcomes.

o Provide technical assistance (TA) to affiliate sites or partners to facilitate intervention delivery and data collection, and promote expansion of intervention delivery [e.g., increase the number of offerings and/or increase the number of sites/locations delivering the intervention(s)].

o Identify and share best practices to address challenges with AAEBI scaling-up;

recruitment, referrals and participation in AAEBIs; program flexibility as new standards and criteria are developed; and feasible and effective alternative formats for remote/virtual delivery, etc.

o Establish or maintain data collection methods to document AAEBI participation https://www.cdc.gov/arthritis/partners/funded-states.htm https://www.cdc.gov/arthritis/partners/funded-states.htm and delivery offerings. Track basic reach (e.g., number of participants enrolled and attending at least the first class) and delivery (e.g., number of courses offered, communities reached, etc.) of AAEBIs.

o Implement marketing and recruiting efforts to promote availability of interventions and increase participation in AAEBIs. Strategies should support referrals from a variety of sources, including community-based organizations, faith-based organizations and/or healthcare systems.

o Demonstrate affiliate site commitment to embedding AAEBI delivery, with the intent of continued impact beyond the cooperative agreement period (e.g., affiliate sites receiving funding or training agree to offer a minimum number of courses, or implement mechanisms or policies for ongoing AAEBI delivery, etc.).

Implementation of sustainable supports for expanding AAEBI dissemination, delivery, or referrals as evidenced by one or more of the following:

o Establishment of new financing system(s) to propel dissemination and support the delivery of AAEBIs (e.g., via the introduction and implementation of wellness benefits, reimbursement, insurer incentives or other financing supports).

o Increased AAEBIs embedded as permanent program offerings in a system or organization with the capacity to reach large numbers of people likely to have arthritis (e.g., via a national fitness organization, national park system, regional health care delivery system, etc.).

o Establishment of referrals of potential participants to AAEBIs (e.g., systematic referrals via state wide tobacco quit-lines or via regional or national health care provider systems or via a new network that facilitates referrals, etc.).

o Dissemination of systems approaches that result in increased referrals to or participation in AAEBIs.

Describe and implement plans to address social determinants of health (SDOH) by increasing AAEBI availability and accessibility to underserved/disproportionately affected populations and communities.

Strategy B - Nationally expand provision of tailored consumer arthritis information and arthritis-appropriate support service referrals. One award of $150-$250K will be supported annually. Recipient will be expected to address the activities listed below:

Host a national Arthritis Helpline to receive and respond to telephone and web-based consumer requests for arthritis-specific health-related information.

o Provide customized arthritis-specific health information and link consumers to available tools and resources for managing arthritis, including referrals to arthritis-appropriate support services, self-management education, and physical activity opportunities.

Identify and/or develop materials and information with a tailored focus on vulnerable populations that address barriers related to language, health literacy, socioeconomic status, social connectedness, physical activity opportunities and/or access to clinical care.

Develop and implement a marketing and communication campaign to increase public and healthcare provider awareness about the Arthritis Helpline.

Strategy C - Facilitate partnerships and coordinate activities to address national osteoarthritis public health priorities. One award of $400-$500K will be supported annually. Recipient will be expected to address the activities listed below:

Maintain and facilitate an active national alliance of organizations committed to addressing Osteoarthritis (OA) from a public health perspective.

o Address priorities and implement strategies outlined in A National Public Health Agenda for Osteoarthritis: 2020 Update (OA Agenda). Particular emphasis should be placed on the following strategies: 1) promotion of function, pain and physical activity screening to prompt healthcare provider counseling and referral as needed;

2) engagement of healthcare providers to embrace physical activity counseling and referral behaviors; and 3) creation or identification of new, evidence-based, programs effective for improving arthritis-specific health or behavior outcomes, including alternative, low-cost, flexible delivery options.

o Leverage partners, stakeholders, data, policy, and communication assets and other chronic disease resources and initiatives to address OA Agenda goals and strategies.

o Maintain and facilitate workgroups and activities of a multi-organization alliance committed to achieving OA Agenda goals and strategies, and work toward fiscal independence.

o Monitor and evaluate progress towards achieving OA Agenda goals and strategies.

Address the OA Agenda priority to expand the menu of recognized options for evidence-based, packaged, self-management education and physical activity programs, including alternative, low-cost, flexible delivery options (e.g., online self-directed guides, low-tech phone contact, self-help program books and tool kits).

o By the end of Year 1, develop evidence-based standards for the minimum elements and structure required for a packaged intervention to be recognized as effective for adults with arthritis (i.e. - similar to National Diabetes Self-Manag ement Education and Support standards).

o Develop and implement a process for managing recognition or revocation of recognition consistent with the new evidence-based standards. Standards should include the development of a framework which will reduce challenges associated with lack of program flexibility, cost and ownership of programs, alternate program formats/remote delivery, etc.

o Widely disseminate new evidence-based standards and menu of programs meeting criteria.

Establish a workgroup to provide recommendations to address social determinants of health related to arthritis such as social connectedness, access to physical activity opportunities, clinical community linkages (i.e. - access, provider mistrust, etc.) and AAEBI access/availability.

Promote the widespread adoption and use of pre-existing and newly identified AAEBIs that resulted from the AAEBI Review conducted by the OA Action Alliance in 2020/2021 as a part of DP16-1606 activities. Note: Results from the AAEBI Review will be made available to the recipient by CDC.

Create and maintain a national OA Resource Center for housing evidence-based tools and materials. Tools and materials should be aligned with 2019 ACR/AF OA Management Guideline, A National Public Health Agenda for Osteoarthritis: 2020 Update, and HHS https://oaaction.unc.edu/files/2020/05/OA-Agenda-Final_04302020.pdf https://oaaction.unc.edu/files/2020/05/OA-Agenda-Final_04302020.pdf https://www.cdc.gov/diabetes/dsmes-toolkit/standards/index.html https://www.cdc.gov/diabetes/dsmes-toolkit/standards/index.html https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.41142 https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.41142 https://oaaction.unc.edu/files/2020/05/OA-Agenda-Final_04302020.pdf https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Physical Activity Guidelines for Americans, 2nd edition and available free of charge.

Strategy D - Enhance the capacity of states to effectively address arthritis from a public health perspective through provision of technical assistance and support, and leveraging of partner networks to promote AAEBIs. One award of $200-$300K will be supported annually. Recipient will be expected to address the activities listed below:

Identify best practices and develop tools, resources and trainings as needed to address challenges/barriers associated with AAEBI scaling-up; program locators; feasible and effective alternate formats for remote/virtual delivery; and healthcare provider physical activity screening, counseling and referral.

o Create a central repository for the various tools and resources, so that they are easily accessible and available to CDC funded partners and others.

Coordinate with CDC recognized evidence-based program owners to offer various AAEBI leader training to state health agency arthritis program staff to enhance their ability to more effectively promote and market the program to partners.

Annually assess and identify additional technical assistance gaps and support needs of CDC funded state arthritis programs.

o In collaboration with CDC, develop tools, resources and trainings based on needs assessment findings to address identified needs.

Provide technical assistance and support to unfunded states to take advantage of opportunities to leverage organizational capacities, assets and opportunities to meet the HealthyPeople 2030 objectives related to this NOFO.

o Assess and address, at least twice during the period of performance, the arthritis-related needs, interests, capacities, and leverageable opportunities among states not receiving CDC arthritis funding.

o By Year 2, operationalize a sub-award program using these CDC funds to identify and work with interested unfunded states to add arthritis objectives to state public health priorities.

Identify opportunities to educate and partner with organizations and/or agencies which address chronic diseases that are co-morbid with arthritis such as diabetes, heart disease and obesity to promote evidence-based, arthritis-appropriate physical activity programs.

The recommended physical activity interventions are well aligned with goals of increasing physical activity among adults with multiple chronic conditions and are likely to help address the presence of arthritis as a barrier to physical activity. Thus, the intervention dissemination and delivery promotion and advancement that are expected as a result of the proposed NOFO are likely to positively impact the work of multiple chronic disease programs. For these reasons, collaboration is strongly encouraged.

o Promote evidence-based physical activity programs that benefit people with limited mobility and function, including people with arthritis and other chronic diseases, by encouraging adoption of recognized and promising AAEBIs as a complement to other lifestyle management programs/initiatives such as Diabetes Self-Management Education Programs/DPP, WISEWOMAN, Falls Prevention/Matter of Balance, Work@Health, etc.

o Leverage networks providing health and wellness opportunities to constituent members (i.e.- this might include networks such as State Health Department https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf https://www.cdc.gov/arthritis/interventions/index.htm#:~:text=Recognized%20and%20Promising%20Programs%20The%20CDC%20Arthritis%20Program,make%20them%20available%20in%20communities%20across%20the%20country.

Chronic Disease Units, Faith-Based Organizations, Area Agencies on Aging [AAAs], Employer Worksite Wellness Programs, etc.) to offer arthritis-appropriate physical activity programs in conjunction with lifestyle coaching/counseling or self-management programs.

Conduct 10-12 webinars per year and 2 CDC award recipient meetings during the 5-year period of performance to provide technical assistance, facilitate peer-to-peer sharing and enhance capacity among CDCs state arthritis recipients and others to effectively address arthritis public health priorities.

Convene national partners on a quarterly basis to share and inform ongoing planning and implementation efforts related to the cooperative agreement. Explore opportunities for leveraging and integrating activities and approaches to maximize impact.

COMPONENT 2

Component 2 is an Innovation Award. This component will support 1 award of $300-$500K annually to develop and implement an approach designed to support healthcare providers delivering clinical services to people with arthritis. The approach should incorporate evidence-informed best practices regarding:

function, pain and physical activity assessments;

counseling that emphasizes physical activity to address arthritis pain and symptom management; and referrals to AAEBIs and other appropriate physical activity opportunities.

A paradoxical relationship exists among inactive and insufficiently active adults with arthritis because pain is a potential barrier to physical activity and yet is also reduced by physical activity.

While fear of pain can serve as a barrier to physical activity among inactive or insufficiently active adults with arthritis, research has also shown that the benefits from physical activity in reducing arthritis pain may serve as a motivator for insufficiently active adults with arthritis to become physically active as a way to manage arthritis pain. Further, research indicates that health care provider counseling may play a critical role in addressing patient barriers, educating patients about the benefits of physical activity for managing arthritis pain and increasing the likelihood that patients become active and/or maintain a physically active lifestyle. These reasons underscore the importance of routinely assessing function, pain and physical activity to establish a baseline and monitor progression over time, as well as counseling and referring for physical activity.

Component 2 will enhance healthcare provider awareness, knowledge and skills to promote physical activity as an effective, drug-free way to relieve arthritis pain, improve function, and limit arthritis progression among adults with arthritis. Behavioral and health outcome goals include increasing physical activity, decreasing pain, increasing function and mobility, improving mental health, decreasing social isolation and increasing healthy self-management behaviors among adults with arthritis.The recipient is expected to address all of the activities listed below.

1. Develop an evidence-informed approach for arthritis related function, pain and physical activity assessments, counseling and referrals in partnership with CDC, Osteoarthritis Action Alliance (OAAA), American College of Rheumatology (ACR), Arthritis Foundation (AF) and others as appropriate (e.g., American College of Preventive

Medicine, American College of Lifestyle Medicine). At a minimum the approach should incorporate:

a. Strategies to promote the adoption and utilization of professionally recognized, accredited and/or validated tools by healthcare providers to conduct clinical assessments of patient function, pain and physical activity levels.

b. A coordinated strategy to increase healthcare provider physical activity counseling and subsequent referral of patients to arthritis-appropriate interventions and other appropriate forms of physical activity opportunities based on results of function, pain and physical activity assessments. The recipient is expected to leverage and/or engage appropriate partners to support adoption of healthcare provider counseling practices and referrals to AAEBIs and other physical activity opportunities. Healthcare providers include, but are not limited to, physicians, nurses, physical therapists and other recognized health practitioners whose advice and recommendations are likely to motivate patients to engage in physical activity.

c. Automated system prompts for conducting function, pain, and physical activity assessments; physical activity counseling and physical activity referral into electronic health records (EHRs) or healthcare system clinical flow processes for arthritis management and other joint pain or injuries. Such technologies are intended to remove/reduce healthcare provider barriers and burdens associated with conducting assessments and counseling (e.g., time limitations, knowledge, confidence, practical tools, and/or documentation of billable codes for reimbursement).

d. Strategies to leverage cross-cutting approaches related to falls prevention and aging goals, as well as physical activity goals associated with other co-morbidities to maintain independence and physical function.

e. Healthcare provider incentives and reimbursements for function, pain and physical activity assessment and physical activity counseling and referrals. Coding and reimbursement resources such as the Merit-based Incentive Payment System (MIPs) and the Advanced Alternative Payment Model (AAPM) created under Medicare Access and CHIP Reauthorization Act (MACRA) and Current Procedural Terminology (CPT) codes for reimbursement should be included, at a minimum.

2. Pilot implementation of the approach framework in at least one large health system setting to evaluate feasibility of utilization and identify areas for improvement.

a. Implementation in a large health system that serves a high percentage of Medicare/Medicaid eligible clients/patients such as those seen at Federally Qualified Healthcare Centers (FQHCs) or a Veterans Health Administration (VA) Medical Center is highly encouraged. FQHCs and VA facilities provide primary care services for underserved populations that frequently have co-morbidities and are often adversely impacted by arthritis, chronic pain, mental health issues (anxiety and depression) and injuries which contribute to health disparities. Other factors that may contribute to health disparities in the populations served by FQHCs and VAs include homelessness, social isolation, lack of transportation, low income, etc.

b. Evaluation findings, lessons learned, challenges and recommendations for addressing the identified issues should be documented and incorporated into the final version of the approach framework.

3. Support ongoing dissemination and adoption of the approach through:

a. Development and implementation of a national promotion/marketing plan with accompanying materials to reach healthcare providers, health systems, decision makers and other stakeholders. Engage national healthcare professional organizations, healthcare systems, health insurers and other stakeholders. Promotion strategies may include but are not limited to, peer-reviewed publications, social media, targeted correspondence, and presentations at professional conferences and meetings.

b. Development and implementation of training and education to promote and facilitate use of the approach framework. Training and education should incorporate relevant incentives such as Maintenance of Certifications (MOC), Continuing Medical Education units (CMEs), Continuing Education Units (CEUs) and others as appropriate.

i. MOC should be developed in partnership with American Board of Internal Medicine (ABIM), American Board of Medical Specialties (ABMS), American Board of Preventive Medicine (ABPM) and/or other organizations.

ii. Develop CMEs and CEUs and make them available to healthcare providers via national partners, and through conferences and other training opportunities.

iii. Propose other innovative training or education opportunities to encourage healthcare providers to adopt the approach framework.

4. Coordinate with other national partners funded through this cooperative agreement to share resources, tools developed, best practices and lessons learned. Findings will be used to inform ongoing planning efforts and be integrated into strategies related to:

o Increasing healthcare provider counseling for physical activity.

o Identification of evidence-based standards for recognition of new AAEBIs.

o Facilitating utilization of the approach framework.

o Establishing referral pathways between health systems and community information and referral exchange platforms.

o Providing bi-directional feedback about patient participation in recommended interventions, including AAEBIs.

1. Collaborations

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

Applicants are expected to identify and leverage opportunities with other CDC-funded public health programs with common interests and objectives related to arthritis, such as diabetes, heart disease, obesity, disabilities, aging, and injury (including falls prevention) programs. These collaborations might include, but are not limited to:

CDC's Arthritis Program conducts scientific research and collects data on arthritis, and funds state health departments and national organizations to expand the reach of evidence based physical activity and self-management education programs appropriate for arthritis.

https://www.cdc.gov/arthritis/about/index.html https://www.cdc.gov/arthritis/about/index.html

CDC's Alzheimer's Disease and Healthy Aging Program develops evidence-based, scientific information to educate, inform, and assist in translating its research into public health practice. https://www.cdc.gov/aging/about/index.htm

CDC's Falls Prevention Program provides information for organizations on the building blocks of effective fall prevention programs by providing examples, resources, and tips.

https://www.cdc.gov/homeandrecreationalsafety/falls/community_preventfalls.html

CDC's National Diabetes Prevention Program provides information for professionals on screening and referring patients to a lifestyle change program and provides information on how the program can be covered by a health benefit. https://www.cdc.gov/diabetes /prevention/index.html.

CDC's Division of Nutrition, Physical Activity and Obesity promotes physical activity, walking and walkable communities. https://www.cdc.gov/physicalactivity/index.html

CDC's Workplace Health Initiatives provide national leadership and support for employee health, safety, and well-being in the worksite setting. https://www.cdc.gov /workplacehealthpromotion/initiatives/index.html

CDC's Disability and Health Branch supports national organizations that work with people with mobility limitations and/or intellectual disabilities and have national reach through a network of 15 or more state/local programs, chapters and/or affiliates across the United States. https://www.cdc.gov/ncbddd/disabilityandhealth/national-programs.html

All recipients are expected to collaborate with other successful applicants funded through this NOFO, as well as organizations funded under CDC-RFA-DP18-1803 State Public Health Approaches to Addressing Arthritis.

b. With organizations not funded by CDC:

Applicants are expected to collaborate with state and national partners as appropriate to support the required strategies and activities. The following is a list of types of partners/organizations to consider that can help sustain project activities and improve outcomes for this NOFO:

Business (employers, retail organizations, trade associations, unions, etc.);

Healthcare Systems (managed care organizations, rural health clinics, accountable care organizations, Indian Health Service or tribal clinics, pharmacies, quality improvement networks, health plans, etc.);

Government (Administration for Community Living, Medicare, state Medicaid agency, the Veterans Administration, state/local transportation departments, SNAP-Ed, etc.);

Community based organizations (senior centers/area agencies on aging, health and fitness centers, local Park & Recreation agencies, etc.);

Education/Academia (colleges and universities, area health education centers, cooperative extension services, etc.);

Lifestyle management instructor/health coach networks that support client participation in evidence-based self-management education and physical activity programs;

Employee health and wellness benefit groups and coordinators that influence benefit packages for the general population as well as priority populations in underserved areas;

and https://www.cdc.gov/aging/about/index.htm https://www.cdc.gov/homeandrecreationalsafety/falls/community_preventfalls.html https://www.cdc.gov/diabetes/prevention/index.html https://www.cdc.gov/diabetes/prevention/index.html https://www.cdc.gov/physicalactivity/index.html https://www.cdc.gov/workplacehealthpromotion/initiatives/index.html https://www.cdc.gov/workplacehealthpromotion/initiatives/index.html https://www.cdc.gov/ncbddd/disabilityandhealth/national-programs.html https://www.cdc.gov/arthritis/partners/funded-states.htm

Insurers offering AAEBIs and/or other evidence-based interventions as part of the benefits package.

The following is a list of potential partners/organizations not funded by CDC whose strategies and activities align with and may help sustain NOFO project activities and improve outcomes. This is for your consideration and is not intended to be an endorsement or exhaustive list.

American Chronic Pain Association (ACPA): https://www.theacpa.org/pain-manag ement-tools/resource-guide-to-chronic-pain-treatments/resource-guide-to-chronic-pain-management/ ;

American College of Lifestyle Medicine (ACLM): https://www.lifestylemedicine.org American College of Preventive Medicine (ACPM): https://www.acpm.org/ American College of Rheumatology (ACR): https://www.rheumatology.org/ American College of Sports Medicine (ACSM): https://www.acsm.org/ Arthritis Foundation (AF): https://www.arthritis.org/ Agency for Health Resources and Quality (AHRQ): https://www.ahrq.gov/ncepcr/tools

/assessments/index.html ;

American Medical Association (AMA): https://www.ama-assn.org/ American Physical Therapy Association (APTA): https://www.apta.org/ CMS Innovation Center: https://innovation.cms.gov/ Federally Qualified Health Centers (FQHCs): https://www.hrsa.gov/opa/eligibility-and

-registration/health-centers/fqhc/index.html National Association of Community Health Centers (NACHC): http://www.nachc.org

/about-our-health-centers/ National Alliance of State Pharmacy Associations (NASPA): https://naspa.us/ National Center on Health, Physical Activity and Disability (NCHPAD): https://www

.nchpad.org/ National Council on Aging (NCOA): https://www.ncoa.org/center-for-healthy-aging

/cdsme-resource-center/cdsme-grantees/ and https://www.ncoa.org/healthy-aging/chronic-disease/

Component 2 applicants should include at least three letters of support from key partners who will be significantly involved in the activities proposed for this NOFO. Each letter of support should describe the partner's past history working with the applicant organization, details about their organization's role and commitment over the 5-year project, and how their organization supports applicant's proposed key activities. Name the file "Letters of Support" and upload it as a PDF at www.grants.gov.

2. Target Populations Component 1:

The primary target population is all U.S. adults, 18 and older, with arthritis, including those experiencing disproportionate burden. The secondary target audience includes state health departments, national organizations and other key stakeholders focused on improving the health and wellness of large numbers of adults with arthritis.

https://www.theacpa.org/pain-management-tools/resource-guide-to-chronic-pain-treatments/resource-guide-to-chronic-pain-management/ https://www.theacpa.org/pain-management-tools/resource-guide-to-chronic-pain-treatments/resource-guide-to-chronic-pain-management/ https://www.theacpa.org/pain-management-tools/resource-guide-to-chronic-pain-treatments/resource-guide-to-chronic-pain-management/ https://www.lifestylemedicine.org https://www.acpm.org/ https://www.rheumatology.org/ https://www.acsm.org/ https://www.arthritis.org/ https://www.ahrq.gov/ncepcr/tools/assessments/index.html https://www.ahrq.gov/ncepcr/tools/assessments/index.html https://www.ama-assn.org/ https://www.apta.org/ https://innovation.cms.gov/ https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html…