Foa_Content_of_CDC-RFA-DP22-2207.pdf

Centers for Disease Control and Prevention

NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH

PROMOTION

Statewide Perinatal Quality Collaboratives

CDC-RFA-DP22-2207

06/06/2022

Table of Contents A. Funding Opportunity Description

B. Award Information

C. Eligibility Information

D. Application and Submission Information

E. Review and Selection Process

F. Award Administration Information

G. Agency Contacts

H. Other Information

I. Glossary

Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Subscribe" button link to ensure they receive notifications of any changes to CDC-RFA- DP22-2207. 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:

Statewide 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 https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr- 46/index.html (See section 45 CFR 46.102(d)).

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP22-2207

E. Assistance Listings Number:

93.946 F. Dates:

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

The LOI date will generate once the Synopsis is published if Days or a Date are entered.

2. Due Date for Applications:

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

06/06/2022 11:59 p.m. U.S. Eastern Standard Time, at www.grants.gov.

3. Due Date for Informational Conference Call:

4/21/2022 2pm EST Call in (audio only) +1 404-498-3000,,301962266# United States, Atlanta

(888) 994-4478,,301962266# United States (Toll-free) Phone Conference ID: 301 962 266#

G. Executive Summary:

1. Summary Paragraph Statewide Perinatal Quality Collaboratives (PQCs) are recognized networks of multidisciplinary teams improving population-level perinatal outcomes in a state (or group of states) by implementing quality improvement (QI) initiatives, which advance evidence-based clinical practices within healthcare centers and systems across the state(s). PQCs facilitate collaborative learning; provide technical assistance to healthcare facilities in conducting QI initiatives; and disseminate statewide successful interventions, policies, and practice changes. The National Network of PQCs (NNPQC) provides comprehensive, coordinated technical support for PQCs nationwide and disseminates successful interventions, policies, and practice changes. The purpose of this NOFO is to enhance PQCs’ capacity to make measurable improvements in perinatal healthcare and health outcomes statewide. Component A will support increasing capacity of PQCs to rapidly conduct population-level perinatal QI initiatives, with a focus on ensuring an equitable distribution of benefits from QI initiatives. Component B will support the provision of technical assistance, trainings, and capacity building for all PQCs in the US to improve uptake of perinatal QI initiatives nationwide. Component B recipient will work with all interested PQCs to support the integration of a health equity perspective in all PQC QI initiatives to improve perinatal outcomes and ensure an equitable distribution of benefits from these initiatives.

a. Eligible Applicants:

Open Competition

b. Funding Instrument Type:

CA (Cooperative Agreement)

c. Approximate Number of Awards Component A=Approximately 22; Component B=1

d. Total Period of Performance Funding:

$34,000,000 Average total period of performance amount for Component A = approximately $30,250,000 and Component B = approximately $3,750,000.

e. Average One Year Award Amount:

$275,000 https://www.grants.gov/ tel:+14044983000,,301962266 tel:8889944478,,301962266

Average amount for Component A is anticipated to be approximately $275,000, Award for Component B is approximately $750,000

f. Total Period of Performance Length:

g. Estimated Award Date:

September 30, 2022

h. Cost Sharing and / or Matching Requirements:

No Part II. Full Text A. Funding Opportunity Description

1. Background

a. Overview Perinatal morbidity and mortality are key indicators of a nation’s health. Infant and maternal mortality rates are greater in the US compared with other high-income countries, with persistent disparities between subpopulations by race/ethnicity, income, insurance status, geography, preferred language, and other characteristics. Quality of care is an important factor affecting these outcomes and associated disparities.

The goal of this NOFO is to increase statewide Perinatal Quality Collaboratives’ capacity to conduct quality improvement (QI) initiatives which: 1) rapidly improve perinatal healthcare and outcomes statewide; and 2) reduce disparities in healthcare and outcomes between subpopulations within a state (or group of states).

Statewide Perinatal Quality Collaboratives (PQCs) are state or multi-state networks of multidisciplinary teams of perinatal care providers and public health professionals working to improve population-level maternal and infant outcomes statewide through use of QI methods.

PQCs have multidisciplinary steering committees representing diverse partners including hospitals, healthcare centers, health departments and patients/families/community. PQCs use QI science to rapidly implement intervention, policy, and practice changes in healthcare across the state, advancing evidence-based clinical practices and processes. A PQC facilitates collaborative learning within and among facilities, working through formal and informal networks in the state to rapidly disseminate successful interventions, policies, and practice changes. A PQC operates statewide, primarily in birthing facilities; however, as they expand to address prenatal and postpartum care and clinical-community care linkages, the participation in QI initiatives of other types of facilities that provide perinatal healthcare may be necessary.

Currently, all 50 states have a PQC in some stage of development. The integration of a health equity perspective in all PQC QI initiatives is needed to improve perinatal outcomes and ensure an equitable distribution of benefits from these initiatives. To ensure equitable benefits from QI initiatives, PQCs can prioritize engaging facilities that serve communities disproportionately impacted by adverse perinatal outcomes, and support data systems which collect, analyze, and report timely, accurate data that can be disaggregated across subpopulations. Increasing family and community engagement in QI initiatives and creating partnerships to enhance clinical-community linkages to address social determinants of health (SDOH) are necessary to achieve optimal outcomes from QI initiatives. There is also a need for continued comprehensive, coordinated technical support for PQCs in these efforts from the National Network of PQCs

(NNPQC).

This NOFO will fund two components. Component A will support increasing capacity of PQCs to rapidly conduct population-level perinatal QI initiatives that make measurable improvements in perinatal healthcare and outcomes statewide, with a focus on ensuring an equitable distribution of benefits from QI initiatives. Component B will support the coordinating center of the NNPQC to facilitate provision of technical assistance, training, and capacity building for all PQCs in the US to improve uptake of perinatal QI initiatives nationwide.

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)

c. Healthy People 2030 This program addresses the Healthy People 2030 focus area Maternal, Infant and Child Health, specifically the leading indicators of decreasing MICH-04 (maternal mortality), MICH-05 (severe maternal complications during delivery hospitalization), MICH-06 (C-sections among low-risk mothers), MICH-07 (preterm births), MICH-D02 (illicit opioid use during pregnancy).

Other focus areas include increasing: MICH-11 (abstinence from illicit substances among pregnant women), MICH-14 (back to sleep practices), MICH-D01 (postpartum screening for depression), MICH-D03 (safe sleep environment), HDS-05 (high blood pressure control).

d. Other National Public Health Priorities and Strategies This NOFO aligns with the HHS Action Plan to Improve Maternal Health in America: Healthy Women, Healthy Pregnancies, Healthy Futures, 2020, the 2020 Surgeon General’s Call to Action on maternal health, and the CDC’s Eliminating Disease Strategic Priority to address maternal health. It also aligns with National Quality Forum’s 2021 Maternal Morbidity and Mortality Recommendations Final Report.

e. Relevant Work This NOFO builds on previous work of CDC-RFA-DP11-1110, CDC-RFA-DP14-1404, and CDC RFA-DP17-1702, which resulted in improvements in perinatal healthcare and health outcomes by increasing the capacity of PQCs individually and through the NNPQC. (Perinatal Quality Collaboratives | Perinatal | Reproductive Health | CDC)

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA- DP22-2207

Logic Model for Statewide Perinatal Quality Collaboratives (PQCs)

PQC Strategies (Component A)

Short Term Outcomes (Component A)

Intermediate Outcomes (Component A)

Long Term Outcomes (Component A) https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth https://aspe.hhs.gov/sites/default/files/private/aspe-files/264076/healthy-women-healthy-pregnancies-healthy-future-action-plan_0.pdf https://aspe.hhs.gov/sites/default/files/private/aspe-files/264076/healthy-women-healthy-pregnancies-healthy-future-action-plan_0.pdf https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf https://www.cdc.gov/about/organization/strategic-framework/index.html https://www.qualityforum.org/Publications/2021/08/Maternal_Morbidity_and_Mortality_Measurement_Recommendations_Final_Report.aspx?utm_source=informz&utm_medium=email&utm_campaign=maternal+final+report https://www.qualityforum.org/Publications/2021/08/Maternal_Morbidity_and_Mortality_Measurement_Recommendations_Final_Report.aspx?utm_source=informz&utm_medium=email&utm_campaign=maternal+final+report https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm

Build and strengthen capacity of PQCs to improve the quality of perinatal care statewide

Engage facilities statewide to improve perinatal outcomes Support facilities to implement Quality Improvement (QI) initiatives

Build and strengthen data systems to improve identification and documentation of disparities

Engage patients/communities in QI initiatives

Build partnerships and conduct outreach and dissemination of QI results

Increase implementation of QI initiatives in facilities statewide including those that serve disproportionately impacted populations

Increase implementation of QI initiatives to reduce disparities

Increase patient/community engagement in planning & implementing QI initiatives

Improve health care practices equitably

Improve clinical-community linkages

Equitable improvement in population-level perinatal health outcomes

National Network of PQCs Strategies (Component B)

Short Term Outcomes (Component B)

Intermediate Outcomes (Component B)

Long Term Outcomes (Component B)

Build capacity of PQCs nationwide

Engage national partners & build relationships with key organizations

Disseminate resources and best practices to PQCs nationwide

Increase implementation of QI initiatives across the nation, including in facilities serving disproportionately impacted populations

Increase implementation of QI initiatives to reduce disparities across the nation Increase patient/community engagement with PQCs throughout the US

Improve health care practices equitably

Improve clinical-community linkages

Equitable improvement in population-level perinatal health outcomes

i. Purpose This NOFO will enhance PQCs’ capacity to make measurable improvements in perinatal care and outcomes statewide. Component A will support increasing capacity of PQCs to rapidly conduct population-level perinatal QI initiatives, with a focus on ensuring an equitable distribution of benefits from QI initiatives. Component B will support the coordinating center for the NNPQC to facilitate provision of technical assistance and capacity building for all PQCs in the US to improve uptake of perinatal QI initiatives nationwide.

ii. Outcomes Component A recipients are expected to achieve the following outcomes during the period of performance:

Increase implementation of QI initiatives in facilities statewide including those that serve disproportionately impacted populations.

Increase implementation of QI initiatives to reduce disparities.

Improve healthcare practices equitably.

Component B recipients are expected to achieve the following outcomes during the period of performance:

Increase implementation of QI initiatives across the nation, including in facilities serving disproportionately impacted populations.

Improve healthcare practices equitably.

iii. Strategies and Activities Strategies (Component A): Component A recipients will be expected to conduct the following strategies and activities during the period of performance:

1. Build and strengthen capacity of PQCs to improve the quality of perinatal care statewide: Strong applicants will:

Identify PQC capacity needs to conduct QI initiatives to improve quality of perinatal care statewide and develop a plan to address these needs including the following domains:

PQC organizational structure; PQC multidisciplinary advisory committee; engaged clinical, public health, data management, and QI methods leaders; patient, family, community engagement; measurement strategy and data systems for documenting QI initiative implementation and outcomes; ability to address health disparities; and dissemination of data to PQC members and partners.

Engage and participate in NNPQC-promoted or sponsored webinars, trainings, or other technical assistance for peer-to-peer collaborative information sharing.

For the remaining strategies (below) an applicant should propose a QI initiative for implementation during the first year of the period of performance. Applicants are expected to develop and implement other QI initiatives during the 5-year period of performance, in addition to the proposed QI initiative for Year 1. The applicant should describe plans to conduct as many strategies and/or outcomes of the logic model detailed below as possible in the context of the proposed QI initiative. The choice of the proposed initiative should be justified by a review of need. This review should include descriptive statistics on perinatal outcomes, identifying populations with disproportionate burden, gaps in clinical care or other community issues, within the state represented by the applicant, and any collaboration required for implementation from other state or local public health, clinical or community entities. For the proposed QI initiative, the applicant should clearly describe the goals and objectives, and address the required information outlined in the Logic Model and listed below relative to the proposed initiative.

2. Engage facilities statewide to improve perinatal outcomes: In order for an applicant to successfully improve perinatal healthcare and outcomes statewide through QI initiatives, it is important to engage facilities statewide. Thus, strong applicants will:

Actively recruit all birthing facilities in the state to participate in the proposed QI initiative, prioritizing those serving communities disproportionately impacted by adverse perinatal outcomes.

Expand participation of other types of healthcare facilities. PQCs operate primarily in birthing facilities; however, as a PQC expands to address prenatal and postpartum care and develop clinical-community care linkages, the participation of other types of facilities in the QI initiative may be desired. Participation of other types of healthcare facilities may also result in improved outcomes. For example, a QI initiative with a strategy to increase provider education (such as protocol development for pregnant or postpartum women presenting to emergency rooms for emergency care) may benefit from engaging providers at various types of healthcare facilities.

3. Support facilities to implement QI initiatives: PQCs achieve improvements in the quality of perinatal healthcare and outcomes statewide by supporting participating facilities to implement the QI initiative. Thus, strong applicants will:

Use QI methods to address high-burden or emerging perinatal issues identified in the initiative.

Use QI methods to identify and make needed changes in service delivery of quality care at the facility to improve perinatal healthcare and outcomes as part of the initiative.

Integrate health equity perspectives into the QI initiative, including identifying inequities in QI metrics and perinatal healthcare and perinatal health outcomes to ensure equitable distribution of benefits from the initiative. Example activities may include:

o Efforts to improve patient-centered outcomes by addressing factors that impact the quality of care (e.g., addressing respectful care, health literacy, and language barriers) o Efforts to develop clinical-community linkages to address SDOH that influence QI outcomes

Provide ongoing training/technical assistance in QI methods and in implementation of the QI initiative through a collaborative learning model across participating facilities statewide.

4. Build and strengthen data systems to improve identification and documentation of disparities: In order for PQCs to document the QI initiative implementation and outcomes, ensuring an equitable distribution of benefits from these initiatives, data systems must be supported. Thus, strong applicants will:

Identify and validate perinatal QI metrics to be used in the initiative and how data will be collected.

Support data systems to document QI metrics of the QI initiative, including to track progress of the initiative implementation, results, barriers encountered, and inequities in QI metrics, perinatal healthcare and outcomes, which can inform revisions in the QI implementation as needed

Ensure high-quality data that can be disaggregated across race/ethnicity and other subpopulations (e.g., geography, insurance, preferred language) to identify inequities in QI metrics, perinatal healthcare and outcomes.

Implement rapid data collection, analysis, and sharing results with members of the PQC (aggregate and site-specific if applicable) to monitor QI metrics at the facility and state level.

Share QI metrics and results with the NNPQC for broader dissemination to other PQCs across the country.

5. Engage patients/communities in QI initiatives: A strategy for PQCs to achieve optimal and equitable outcomes from QI initiatives is to comprehensively incorporate patient, family, and community perspectives into QI initiatives. Strong applicants will:

Identify and implement activities to improve patient, family, and community partnership in the proposed QI initiative, including having a patient representative on the PQC advisory committee, at a minimum. Activities should include engaging and partnering with patients, families, and community leaders in communities disproportionately impacted by the adverse perinatal outcomes.

Incorporate patient, family, and community input in aspects of the QI initiative cycle – including the choice of QI initiative, relevance to the community, implementation strategies, assessment and interpretation of progress, and patient-oriented outcomes.

Share results with and work with patients, families, and communities to obtain their perspectives on interpretation and dissemination of initiative results, appraise relevance to their community, and provide feedback on improvements or changes to future implementation of the proposed or additional QI initiatives.

6. Build partnerships and conduct outreach and dissemination of QI results: PQCs not only achieve improvements in perinatal healthcare and outcomes through implementing a QI initiative, but also play a key role in disseminating results and building partnerships for continued improvements. Furthermore, creating partnerships to support clinical-community linkages to address SDOH is key to achieving optimal, equitable outcomes in the state. Therefore, strong applicants will:

Disseminate QI initiative results to partners statewide highlighting perinatal healthcare changes leading to improved perinatal outcomes in the state. This can be through quarterly newsletters, listservs, presentations, consultations, webcasts, media events, briefs, success stories/descriptive reports, or published scientific manuscripts.

Assess the successes and challenges in implementing the QI initiative in facilities within the state, including a description of the difficulties encountered, potential improvements and lessons learned, based on the implementation, service, and patient outcomes.

Disseminate lessons learned and best practices resulting from the QI initiative to all facilities and other partners.

Partner with maternal and neonatal public health programs and committees affiliated with the state health department (e.g., Maternal Mortality Review Committees (MMRCs), perinatal risk appropriate care activities, Maternal Child Health (MCH) epidemiologists), with professional organizations related to perinatal care in the state (e.g., clinical membership organizations or chapters), and community-level organizations that support community engagement and address SDOH (e.g., Healthy Start programs, or community health workers). For example, partnering includes collaboration to translate recommendations from MMRCs to QI initiatives of PQCs.

Participate in a recipient “kick-off” meeting at CDC during the first year of theperiod of performance; attend virtual learning sessions hosted by the NNPQC, offer support in PQC peer-to-peer engagement activities, attend an annual NNPQC meeting (virtual or in-person) and annual site visits (virtual or in-person) by CDC staff to each PQC.

Strategies (Component B): Component B recipients will be expected to conduct the following strategies and activities during the period of performance:

1. Build capacity of PQCs nationwide: A strong applicant will:

Conduct an annual review of all PQCs nationwide addressing: 1) capacity needs for PQCs to improve quality of perinatal care statewide (described for Component A above);

2) implementation, completion, and outcomes of QI initiatives; and 3) participation of facilities in QI initiatives, with a focus on increasing participation in facilities that serve communities disproportionately impacted by adverse perinatal outcomes.

Based on the annual capacity review, identify and implement activities to build and strengthen capacity of PQCs to improve quality of perinatal care. This should include technical assistance to:

o Foster collaborative shared learning among PQCs to increase recruitment of facilities and support clinical-community linkages particularly in communities disproportionately impacted by adverse perinatal outcomes.

o Increase engagement of patients, families, and communities in QI initiatives particularly those in communities disproportionately impacted by adverse perinatal outcomes.

o Strengthen PQC skills in QI methods and implementation science, including:

Provide QI training opportunities, including those using a collaborative learning model, to all PQCs.

Provide technical assistance to funded PQCs in implementation science to:

Plan a well-defined implementation approach that is inclusive of implementation outcomes, such as acceptability, adaptability, adoption, feasibility, penetration, or sustainability of the QI initiative.

Support outcome evaluation of QI initiatives, including use implementation outcomes to assess and improve implementation of the QI inititative.

o Support data systems to report high-quality data that can be disaggregated across race/ethnicity and other relevant subpopulations (e.g., geography, insurance, preferred language) to identify inequities in QI metrics, perinatal healthcare and outcomes, and to document QI initiative implementation, and outcomes.

Work with PQCs nationally to ensure integration of health equity perspectives into all QI initiatives, including addressing disproportionately impacted populations to assure equitable distribution of benefits from these initiatives.

Provide technical assistance to funded PQCs in the statewide dissemination of QI initiative results, lessons learned and best practices which can lead to sustained improvements, including development of success stories, in Years 2 through 5 of the period of performance.

2. Engage national partners & build relationships with key organizations: A strong applicant will:

Work with PQCs throughout the US to develop effective partnerships with other perinatal clinical and public health partners, membership organizations, programs, and relevant organizations statewide and nationally.

Work with PQCs throughout the US to enhance clinical-community linkages to address SDOH. For example, by building partnerships between PQCs and community-based health centers (e.g., through National Association of Community Health Centers) or Healthy Start project's Community Action Networks (CAN) which have community connections and infrastructure.

Participate in a “kick-off” in-person or virtual meeting with the successful Component A applicants at CDC during the first year of period of performance.

Plan and convene an annual meeting of all PQCs in partnership with CDC and other identified organizations.

3. Disseminate resources & best practices to PQCs nationwide: A strong applicant will:

Develop a stand-alone website to compile and disseminate resources and best practices in QI to all PQCs, to promote PQC activities to PQCs and their partners throughout the US.

The website will include, but is not limited to:

o Resources from past and ongoing PQC QI initiatives, including maintenance of a resource library that includes toolkits and resources to support all PQC QI work.

o A list, updated annually, of QI initiatives completed, sustained, or being developed by PQCs across the nation, their impact on perinatal healthcare and outcomes as documented by reports, briefs or manuscripts, and the successes and challenges of implementation.

Respond to requests for information resources and technical support from PQCs throughout the US, including management of a speaker’s bureau of PQC experts to provide mentoring and technical support.

Use multi-modal communication methods (e.g., social-media, podcasts, listservs, and other communication innovations) to disseminate information about evidence-based practices relevant to all PQCs, foster peer-to-peer PQC collaborative sharing, promote PQC activities, and amplify PQC QI initiative successes to all PQCs nationwide and to partners.

1. Collaborations

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

Component A: All Component A applicants are required to provide the following:

Provide a Letter of Support (LOS) for collaboration with recipients of the CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) program if available in the applicant’s state/jurisdiction. If ERASE MM recipient is not available in applicant’s state/jurisdiction, applicant should provide a LOS of collaboration with the state Maternal Mortality Review Committee (MMRC). Applicants are required to collaborate with ERASE MM recipients or MMRC on the implementation of preventive strategies for reducing maternal mortality. The ERASE MM program or state MMRC has a component of translating clinical recommendations to prevent maternal mortality at the health system level by coordinating with PQCs. Applicant should describe in the narrative how collaboration with ERASE MM recipients or state MMRC will assist the implementation of the proposed QI initiative.

Additionally, when possible:

Applicants are encouraged to collaborate with the CDC Division of Reproductive Health (DRH) Maternal and Child Health epidemiology (MCH) program state assignees to facilitate working with state and local agencies. State MCH epidemiology assignees may provide additional resources to facilitate PQC capacity building for QI initiatives and data analysis.

Provide a LOS to collaborate with other state entities implementing perinatal risk-appropriate care activities, such as implementing the CDC LOCATe (Levels Of Care Assessment Tool), to improve levels of neonatal and maternal care in delivery facilities.

CDC LOCATe supports partnership-building activities to address the assessment of facility capabilities, equipment, and staffing needed to provide the most appropriate care.

This is encouraged but not required.

Applicants are encouraged to collaborate with Pregnancy Risk Assessment Monitoring System (PRAMS) recipients in their jurisdictions for additional sources of data to provide further contexts to QI initiatives. This is encouraged but not required.

https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/index.html https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/index.html https://www.cdc.gov/reproductivehealth/mchepi/index.htm https://www.cdc.gov/reproductivehealth/mchepi/index.htm https://www.cdc.gov/reproductivehealth/maternalinfanthealth/cdc-locate/index.html https://www.cdc.gov/reproductivehealth/maternalinfanthealth/cdc-locate/index.html https://www.cdc.gov/prams/index.htm https://www.cdc.gov/prams/index.htm

Component B:

Applicants are encouraged to develop and maintain collaborative relationships with other CDC-funded programs/partners to achieve the outcomes outlined in the Logic Model and detailed in this NOFO. Applicants may provide LOS of collaboration with previously CDC-funded programs or activities working to improve maternal and infant outcomes, which includes the role of applicant in the program or activity. Applicants should describe in the narrative how collaborations will facilitate provision of comprehensive, coordinated technical assistance and capacity building for all PQCs in the US. This is encouraged but not required.

Component B recipients are expected to collaborate with Component A recipients, as described in the strategies and activities section, to achieve the outcomes outlined in the Logic Model.

Where applicable, applicants are required to include LOS, as appropriate. These files should be uploaded as PDFs with the application and named “LOS_Collaborating Program Name_Applicant Name ". All PDFs should be uploaded to www.grants.gov. For example, Applicants must name the file “LOS_CDC-fund programs_Applicant Name” and upload it as a PDF file at www.grants.gov.

b. With organizations not funded by CDC:

Component A: All Component A applicants are required to provide the following:

Provide Letter of Support (LOS) of collaboration from the state’s hospital association, which is a key partner for PQCs to engage healthcare facilities in QI initiatives. Hospitals are the primary location of implementing PQC’s QI initiatives;

therefore, collaboration with the hospital association facilitates engagement of PQCs with hospitals to implement the QI initiatives.

If the state does not have an ERASE MM recipient, provide a LOS of collaboration with the state Maternal Mortality Review Committee (MMRC). Applicants are required to collaborate with the state MMRC on the implementation of preventive strategies for reducing maternal mortality. The MMRCs have a component of translating clinical recommendations to prevent maternal mortality at the health system level by coordinating with PQCs. Applicant should describe in the narrative how collaboration with the MMRC will assist the implementation of the proposed QI initiative.

Provide LOS of collaborations with other partners invested in perinatal health, QI and improving health equity in maternal and child health outcomes in the state (e.g., local district/state chapters of the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, the March of Dimes); with Institute of Healthcare Improvement (IHI); or with HRSA funded programs (e.g., Alliance for Innovation in Maternal Health (AIM), Healthy Start), or Centers for Medicare and Medicaid Innovation (CMMI) Center funded programs (e.g. Maternal Opioid Misuse (MOM) model). In their http://www.grants.gov

LOS, applicants should explain how each collaboration will assist applicant in implementing Component A activities and achieving period of performance outcomes.

LOS are encouraged but not required.

If available in the state/jurisdiction, provide a LOS for collaboration with recipients of the HRSA Maternal Health Innovation Projects. Applicants LOS should explain how each collaboration will assist the applicant in implementing Component A activities and achieving period of performance outcomes. This is encouraged but not required.

Component B: All Component B applicants are required to:

Describe their engagement with national partners invested in improving perinatal healthcare and outcomes and improving health equity, by providing LOS from one or more of these nationally operating partners: the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, the March of Dimes, and the Institute of Healthcare Improvement (IHI). The description should explain how each collaboration will assist in implementing planned activities of the Component and achieving period of performance outcomes.

Provide LOS from other national organizations and partners invested in perinatal health, QI and improving health equity (e.g., Association of Women’s Heath, Obstetrics, and Neonatal Nurses (AWHONN)) explaining how each collaboration will assist in implementing planned activities of the Component and achieving period of performance outcomes. This is encouraged but not required.

Applicants for both Components are required to include letters of support (LOS) and/or MOUs from partners who will be involved in the activities proposed for this NOFO. All applicants must file the LOS, and/or MOU as appropriate, as PDFs with the application. Name the file " LOS_Collaborating Program Name_Applicant Name”, (for example: “LOS_State Hospital Association Name_Applicant Name” etc.). All PDFs should be uploaded to www.grants.gov.

2. Target Populations The population of benefit should include all recipients of maternal, perinatal, and neonatal care throughout the state. Benefits should be equitably received by disproportionately impacted populations. Applicants should describe any disproportionately impacted populations using CDC Preferred Terms for Select Population Groups & Communities.

a. Health Disparities Applicants should describe disparities in perinatal healthcare and outcomes in their state based on geography, race/ethnicity, socioeconomic status, insurance type, preferred language, or other relevant factors. All QI activities conducted with funding from this NOFO should integrate a health equity perspective to improve perinatal healthcare or outcomes and to ensure an equitable distribution of benefits from these initiatives. Applicants should describe what strategies the proposed QI initiative will use to reduce identified disparities such as prioritizing facilities that serve disproportionately impacted populations; using high-quality data to identify disparities in care processes and outcomes to ensure equitable implementation of QI efforts; emphasizing https://www.cdc.gov/healthcommunication/Preferred_Terms.html standardized protocols for all patients across facilities; engaging patients, families, and communities in the PQC QI process; and developing partnerships to create clinical-community linkages to address SDOH affecting perinatal care and outcomes.

iv. Funding Strategy Approximately $6,050,000 is available in year 1 to support approximately 22 Component A recipients and approximately $750,000 to support one Component B recipient. Only one Component A award will be made within a state or jurisdiction. If multiple applicants are interested in applying for Component A of this NOFO within a state or jurisdiction, CDC encourages coordination on a single NOFO application. Applicants can apply to Component A OR Component B but not both and must identify which component they are applying for in their project abstract summary. Funding availability subject to change.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy

For both Component A and B, evaluation and performance measurement will examine a recipient’s success at implementing program strategies and reaching the desired outcomes. CDC and recipients will evaluate and measure efforts during the period of performance by conducting evaluations of process and outcome measures to determine program success. Applicant should provide information about data sources that will be used for evaluation and performance measures.

All recipients must collaborate with CDC. Component A recipients must also collaborate with the Component B recipient, as appropriate, to evaluate their work. To measure progress in strategies and activities, and short-term and intermediate-term outcomes, CDC will implement an evaluation approach that consists of:

1. Ongoing monitoring and evaluation of progress through the collection and reporting of performance measures by recipients.

2. Recipient-led evaluations, with support from CDC and the NNPQC, as appropriate.

Additional efforts to track progress include:

1. Assessing recipient annual continuation application.

2. Meeting with the recipients virtually during quarterly conference calls and providing feedback on quarterly progress.

3. Reviewing of recipient documentation and processes during site visits.

4. Participating in presentations and discussions during NNPQC meetings/calls and the annual NNPQC meeting.

Component A:

Each applicant’s evaluation plan should describe how the applicant will evaluate the implementation of the proposed QI initiative, which will be tailored to the recipient’s specific activities and intended outcomes. Description of the evaluation plan should be related to the proposed QI initiative for the first year; however, the applicant should also state how the following evaluation questions will be addressed for subsequent additional QI initiatives throughout the period of performance. The evaluation should assess the following:

1. The extent to which the activities increase the capacity of the applicant to implement the QI initiative.

2. The extent to which the applicant increases implementation of the QI initiative in facilities statewide.

3. The extent to which the implementation approach for the proposed QI initiative results in achieving the desired outcomes i.e., equitably improved perinatal healthcare and outcomes in the state.

Component A successful applicants are also expected to:

1. Submit at least one success story per year during years 2-5 of the period of performance demonstrating impact of the applicant’s initiatives in improving perinatal care and/or outcomes, with a focus on equitable distribution of the benefits from these initiatives.

2. Produce a final report on their evaluation of the implementation of the proposed QI initiative in facilities statewide by the end of Year 3, with progress reports at the end of years 1 and 2.

The applicant’s evaluation of the implementation of the QI initiative should describe facilitators and barriers to successful implementation of the proposed QI initiative in their state. Applicants should use rigorous QI methods to assess and improve their implementation of the proposed perinatal QI initiative statewide, including a well-defined approach inclusive of implementation outcomes, such as acceptability, adaptability, adoption, feasibility, penetration, or sustainability, of the QI initiative. Implementation outcomes should be linked to service outcomes, such as efficiency, safety, effectiveness, equity, or timeliness. The implementation outcomes should also be assessed with patient-oriented outcomes, such as patient satisfaction. All implementation outcome measures should be analyzed with consideration of the effects on QI outcomes and health outcomes relevant to the initiative. Additionally, implementation, service and patient-oriented outcomes should be evaluated with a health equity perspective, including consideration of facilitators and barriers to equitable implementation such as addressing SDOH and participation of facilities that serve disproportionality impacted populations. QI implementation, service, and patient-centered outcomes will be used for program quality improvement and to inform the broader evaluation to demonstrate the value of the NOFO.

Component B:

The evaluation plan should describe how the applicant will evaluate:

1. The extent to which the approach increased the capacity of all PQCs to implement QI initiatives nationally.

2. The extent to which the approach increased implementation of QI initiatives in facilities throughout the US.

3. The extent to which the approach increased the capacity of all PQCs to implement QI initiatives equitably to improve perinatal healthcare and outcomes among disproportionately impacted populations.

Outcome-related Performance Measures:

Key outcome-related performance measures for Component A and Component B are listed below. Additional performance measures for the strategies and activities in the logic model may be developed and refined in collaboration with recipients and then used by CDC and the recipients for monitoring progress and improving public health outcomes.

Outcome-related Performance measures include:

Component A:

Proportion of facilities statewide that are implementing the PQC QI initiative.

Proportion of facilities participating in the PQC that serve communities disproportionately impacted by adverse perinatal health outcomes.

Define and report the standardized intervention-specific measures being used to monitor change in perinatal healthcare and outcomes as part of the QI initiative (e.g., percentage of cesarean births among low-risk women, number of infants with neonatal abstinence syndrome identified and cared for, percentage of pregnant women with severe hypertension treated in under 60 minutes, etc.).

o Depending on the focus of the QI initiative and the interventions selected by the recipient to support consistency across states, CDC and the NNPQC will work with applicants, post-award, to provide feedback on specific measures selected.

o Data should be reported by race/ethnicity, at a minimum. Reporting by other indicators of disproportionately impacted sub-populations, such as income, insurance status, geography, or preferred language, is encouraged.

Component B:

Proportion of facilities nationwide that are implementing a PQC statewide QI project.

Proportion of PQCs nationwide engaged in initiatives that incorporate a focus on health equity.

Applications involving public health data collection or generation must include a Data Management Plan (DMP) as part of their evaluation and performance measurement plan unless CDC has stated that CDC will take on the responsibility of creating the DMP. The DMP describes plans for the applicant’s assurance of the quality of the public health data through the data’s lifecycle and any plans to deposit data in a repository to preserve and to make the data accessible in a timely manner. If a DMP is required, applicants should follow the guidance and fill out the template in the following weblink: DMP guidance and template. For additional information on DMPs visit: Additional Requirement – 25 | Grants | CDC.

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

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

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

https://www.cdc.gov/chronicdisease/programs-impact/nofo/index.htm https://www.cdc.gov/grants/additional-requirements/ar-25.html

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

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

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

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

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

Describe key evaluation questions to be addressed by these evaluations.

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

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

c. Organizational Capacity of Recipients to Implement the Approach The applicant’s organizational capacity statement must clearly demonstrate the applicant has the necessary skills and relevant experience to successfully implement the strategies and activities outlined in the Logic Model. For both Component A and Component B, organizational capacity is also demonstrated by collaborative ability, which is critical to successfully implement strategies and activities. Thus, for each component, organizational capacity has two parts: a structural capacity and a collaborative capacity.

Component A

Structural organizational capacity: A strong applicant for Component A will:

1. Describe their experience in leading QI initiatives to improve perinatal healthcare and outcomes. Description of experience leading QI work should demonstrate:

a. Experience in implementing QI initiatives to address disparities in perinatal healthcare or outcomes in the state. Identified populations experiencing disparities should be clearly defined and described in the proposed QI initiative, including potential benefits of the initiative for these groups.

b. Ability to use and disseminate QI data to provide information to relevant public health, clinical and community organizations, as well as patients and communities

2. Describe the existence of, or plan for, infrastructure to manage QI data collection and analysis for rapid cycle improvements, build best practices, and develop clinical evidence for perinatal practice changes. Applicants should also describe a QI data management and analysis system that is centralized and secure.

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

a. Highlight experience and ability to stratify data by populations disproportionately impacted.

3. Describe ability to identify a multidisciplinary steering committee that includes Obstetric/Perinatology, Pediatric/Neonatology and public health expertise, and family/community representatives particularly those from disproportionately impacted populations from the state.

4. Describe expertise in program evaluation for measuring the success of the QI initiatives, as demonstrated by an existing or planned on-staff evaluator, or existing or planned partnership with an external evaluator that has experience in public health evaluations and implementation science.

5. Describe ability to manage programs and resources ensuring the administrative, financial, and staff support necessary to sustain activities. This includes describing an adequate Staffing Plan, providing CVs/Resumes and position descriptions for proposed personnel, an Organizational Chart, and project management structure that clearly defines staff roles and reporting structure. Applicants must name these files "CVs/Resumes" and "Organizational Charts" and upload them with the application package at grants.gov.

Collaborative organizational capacity: A strong applicant for Component A will:

1. If applicant is not part of the state public health agency, provide Memoranda of Understanding (MOU) from the state health department (or all state health departments if a multi-state jurisdiction). If the applicant is part of the state public health agency, provide a Letter of Support from the state’s public health agency leadership. The MOU/LOS should detail the relationship between the applicant and the state public health agency.