PKG00246094-instructions.pdf

Centers for Disease Control

National Center for Chronic Disease Prevention and Health Promotion

Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S. Affiliated

Pacific Islands, U.S. Virgin Islands, and Puerto Rico

CDC-RFA-DP19-1901

Application Due Date: 01/11/2019

Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S. Affiliated

Pacific Islands, U.S. Virgin Islands, and Puerto Rico

CDC-RFA-DP19-1901

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 "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-DP19-1901. 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:

Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S. Affiliated Pacific Islands, U.S. Virgin Islands, and Puerto Rico 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)).

New-Type 1: Cooperative Agreement

D. Agency Notice of Funding Opportunity Number:

CDC-RFA-DP19-1901

E. Assistance Listings (CFDA) Number:

93.377 F. Dates:

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

2. Due Date for Applications: 01/11/2019, 11:59 p.m. U.S. Eastern

Standard Time, at www.grants.gov.

3. Date for Informational Conference Call:

November 14, 2018 at 10:00 AM to 12:00 PM Eastern Daylight Savings Time. This conference call can be accessed by calling 1-800-857-9730. The leader for this call is Stacy De Jesus and the passcode is 2982408

November 14, 2018 at 7:00 PM to 9:00 PM Eastern Daylight Savings Time. For eligible applicants in the U.S. Affiliated Pacific Islands. This conference call can be accessed by calling 1-800-857-9730. The leader for this call is Stacy De Jesus and the passcode is 2982408. If operator assistance is needed, email 1901Islands@cdc.gov, at least 24 hours in advance of the call, and the operator will assist you in joining the call.

G. Executive Summary:

1. Summary Paragraph:

This NOFO works to prevent and control tobacco use, diabetes, and cardiovascular disease in 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.grants.gov mailto:1901Islands@cdc.gov the U.S. Affiliated Pacific Islands (USAPIs), the U.S. Virgin Islands, and Puerto Rico. This funding opportunity is comprised of two components: the Core Component and an optional Oral Health Component.

Core Component: This competitive component is required of all applicants and will support the implementation and evaluation of a core set of evidence-based strategies designed to address tobacco use and secondhand smoke exposure, diabetes management, type 2 diabetes prevention, and cardiovascular disease prevention and management. Applicants must propose a comprehensive work plan that addresses each of these areas in alignment with the four strategies indicated in the NOFO.

Oral Health Component: This competitive component is optional and will support the implementation and evaluation of a focused set of activities designed to improve oral health capacity and better address the oral health needs of Island communities. All applicants must apply for the Core Component in order to be considered for the optional Oral Health Component via a single application that clearly identifies the Core and Oral Health Components. Only successful applicants under the Core Component will be eligible for Oral Health Component funding.

a. Eligible Applicants: Open Competition

b. NOFO Type: Cooperative Agreement

c. Approximate Number of Awards: 8 8 recipients for the Core Component and up to 2 of them are anticipated to be funded for the Optional Oral Health Component

d. Total Period of Performance Funding: $22,000,000

e. Average One Year Award Amount: $450,000 Average One Year Award Amount for the Core Component: $450,000

Average One Year Award Amount for the Optional Component to address oral health needs:

$75,000

f. Total Period of Performance Length: 5

g. Estimated Award Date: 02/27/2019

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

Part II. Full Text A. Funding Opportunity Description

Part II. Full Text

1. Background

a. Overview Chronic diseases are responsible for 7 out of 10 deaths each year, and treating people with chronic diseases accounts for most of our nation's health care costs. In recent decades, progress has been made in chronic disease prevention and control in the U.S. However, similar progress is lagging in the U. S. Affiliated Pacific Islands (USAPIs), U.S. Virgin Islands (USVI), and Puerto Rico, often resulting in higher rates of chronic diseases and associated risk factors. The combination of high disease burden, broadly dispersed populations, lack of infrastructure, multiple cultures, languages, and traditions, susceptibility to natural disasters, and high health expenditures, makes it challenging for these islands to address this public health problem.

Cardiovascular disease (CVD), cancer, and diabetes are among the leading causes of death in these islands. Tobacco use is a significant cause/contributor to these diseases. Average adult smoking prevalence in the USAPIs is estimated at 30% while the median smoking prevalence among high school students is estimated at 31%. These rates are significantly higher than the average rates in the U.S., where 15% of adults and 11% of high school students were current smokers in 2015. Estimates of diabetes are as high as 47% in some islands. High blood pressure and high blood cholesterol are primary risk factors for CVD. In the Islands, estimates of high blood pressure and high blood cholesterol are 56% and 42% respectively.

This NOFO builds on DP14-1406 by concentrating on major risk factors for diabetes and CVD (i.e. tobacco use, hypertension, cholesterol), while also working to strengthen the capacity of the public health workforce to more effectively monitor and address other key concerns, including oral health. The purpose of this NOFO is to reduce the rates of disability and death associated with chronic disease in the USAPIs, USVI, and Puerto Rico. Cross-cutting and unified approaches using the Four Domains of Chronic Disease will be supported. Specifically, this NOFO aims to: a) prevent and reduce tobacco use and secondhand smoke exposure; b) improve the prevention and management of diabetes and diabetes-related complications; c) prevent persons with prediabetes from developing type 2 diabetes; d) improve the prevention and management of high blood pressure and high blood cholesterol; and e) better address oral health needs.

b. Statutory Authorities This program is authorized under sections 301(a), 317(k)(2), and 317(m) of the Public Health Services Act [42 U.S.C. Sections 241(a), 247(b)(k)(2), and 247(b-14)].

c. Healthy People 2020 This NOFO addresses the following Healthy People 2020 focus areas and leading health indicators including: educational and community-based programs,health communication and health information technology, health-related quality of life and well-being, diabetes; heart disea se and stroke; maternal, infant and child health; nutrition and weight status; older adults; oral health; physical activity; public health infrastructure; and tobacco use.

https://www.healthypeople.gov/2020/topics-objectives/topic/educational-and-community-based-programs https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology https://www.healthypeople.gov/2020/topics-objectives/topic/health-communication-and-health-information-technology https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health https://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity https://www.healthypeople.gov/2020/topics-objectives/topic/public-health-infrastructure https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use

d. Other National Public Health Priorities and Strategies This program supports the following national public health priorities and strategies:

National Tobacco Control Program https://www.cdc.gov/tobacco/stateandcommunity/tobac co_control_programs/ntcp/index.htm Million Hearts https://millionhearts.hhs.gov/ National Diabetes Prevention Program https://www.cdc.gov/diabetes/prevention/index.html Diabetes Self-Management Education and Support (DSMES) http://care.diabetesjournals .org/content/diacare/early/2017/07/26/dci17-0025.full.pdf

e. Relevant Work This NOFO builds on efforts to improve public health infrastructure and expands the work accomplished and outcomes achieved through CDC-RFA-DP14-1406: Public Health Actions to Prevent and Control Diabetes, Tobacco Use, Heart Disease, and Associated Chronic Disease Risk Factors and Improve Health in the U.S. Affiliated Pacific Islands, Virgin Islands, and Puerto Rico.

2. CDC Project Description

a. Approach

Bold indicates period of performance outcome.

CDC-RFA-DP19-1901 Logic Model: Prevention and Control of Chronic Disease and Associated Risk Factors in the U.S. Affiliated Pacific Islands, U.S Virgin Islands, and Puerto Rico Bold indicates period of performance outcome

STRATEGIES SHORT-TERM

OUTCOMES

INTERMEDIATE

OUTCOMES

LONG-TERM

OUTCOMES

CORE COMPONENT

Systematically collect, share, and use NCD clinical and population-based data to drive local public health action and evaluate impact.

Routine collection, analysis, and use of NCD clinical and population-based data

Increased availability and use of NCD clinical and population-based data

Implement environmental approaches that promote tobacco use

Increased number of evidence-based strategies implemented that reduce access to

Increased number of smokefree environments

Decreased tobacco use prevalence

Reduced rates of tobacco-related morbidity and mortality

Eliminate non-smoker https://www.cdc.gov/tobacco/stateandcommunity/tobacco_control_programs/ntcp/index.htm https://www.cdc.gov/tobacco/stateandcommunity/tobacco_control_programs/ntcp/index.htm https://millionhearts.hhs.gov/ https://www.cdc.gov/diabetes/prevention/index.html http://care.diabetesjournals.org/content/diacare/early/2017/07/26/dci17-0025.full.pdf http://care.diabetesjournals.org/content/diacare/early/2017/07/26/dci17-0025.full.pdf prevention and cessation, healthy eating, and physical activity.

tobacco and change social norms

Increased awareness of the dangers of tobacco use, and benefits of cessation

Increased awareness about benefits of, and increased support for, smokefree environments

Increased availability of healthier food and beverage choices and physical activity opportunities

Reduced access to tobacco and social norms accepting of tobacco use

Decreased tobacco use initiation rates

Increased consumption of healthy foods and beverages

Increased physical activity

Improve the quality of clinical care related to preventing and treating tobacco use and cardiovascular disease (CVD), and managing diabetes.

Increased quality improvement practices in health systems to improve diabetes and cardiovascular disease care

Increased use of EHRs and HIT to identify and manage patients with high blood pressure and high blood cholesterol

Increased implementation of team-based care in managing patients with high blood pressure and high blood cholesterol

Improved processes and effective delivery of quality preventive services

Increased reporting, monitoring, and tracking of clinical data for improved identification, management, and treatment of patients with diabetes, high blood pressure, and high blood cholesterol

Increased engagement in self-management among persons with diabetes, high blood pressure, and high exposure to secondhand smoke

Decreased number and percent of adults with diabetes with an A1C level >9

Increased control among adults with known high blood pressure and high blood cholesterol

Increased number of people with prediabetes enrolled in a CDC-recognized type 2 diabetes prevention program

Reduced proportion of children who are overweight or obese

Reduced prevalence of obesity

Increased number of birthing facilities with ideal breastfeeding practices

Increased awareness and implementation of PHS guidelines for treating tobacco use and dependence blood cholesterol

Increased number and percent of adults with diabetes with at least 2 A1C tests measured annually, at least 3 months apart

Improved medication adherence and lifestyle change for adults with high blood pressure and high blood cholesterol

Increased proportion of infants ever breastfed

Increased tobacco use quit attempts

Improve awareness of, access to, and participation in prevention and disease-management programs and services.

Increased opportunities for chronic disease prevention, risk reduction or management

Increased use of health-care extenders for the support of diabetes, high blood pressure, and high blood cholesterol.

Increased availability of evidence-based tobacco cessation services

Increased community-clinical linkages to support prevention, self-management, and control of chronic disease and related risk factors

Increased number of people with prediabetes who are referred to a CDC-recognized type 2 diabetes prevention program

Increased number of people educated about prediabetes

Increased awareness and use of available cessation resources

Increased use of diabetes self-management education and support programs

(DSMES)

Increased use of evidence based self-management programs for chronic disease

Increased self-measured blood pressure monitoring tied to clinical support

Increased cessation rates

OPTIONAL COMPONENT: ORAL HEALTH

Develop and implement an oral health surveillance plan

Maintain an oral health surveillance plan

Develop and maintain an oral health surveillance system

Utilize actionable information for program and policy decision

Conduct oral health surveillance to monitor prevalence and inform program and policy decisions to improve oral health

Disseminate oral health surveillance data on oral disease, risk factors and use of preventive oral health services

Promote, coordinate, implement, and evaluate dental sealant programs within elementary and middle schools

Expand school dental sealant program

Increase the number of children ages 6-14 receiving sealants on one or more of their permanent molars through school sealant programs

Monitor, promote, and provide education

Expand community Increase the percentage of adjusted water

Decrease in dental caries

Decrease in oral health disparities about water fluoridation water fluoridation systems that maintain optimal fluoridation level

Increase proportion of people served by community water systems who receive optimally fluoridated water

i. Purpose This NOFO has two components:

1. A competitive Core Component that is mandatory for all applicants.

2. A competitive Oral Health Component that is optional.

The Core Component is designed to prevent and reduce tobacco use and secondhand smoke exposure, improve the prevention and management of diabetes and diabetes related complications, high blood pressure, high blood cholesterol, and to prevent persons with prediabetes from developing type 2 diabetes. The optional Oral Health Component is designed to improve the capacity of the applicants to address oral health needs.

ii. Outcomes The program activities are expected to demonstrate measurable progress towards addressing the bolded outcomes depicted in the NOFO logic model.

Outcomes (Core Component):

Intermediate Outcomes:

Increased number of smokefree environments Improved processes and effective delivery of quality preventive services Increased reporting, monitoring, and tracking of clinical data for improved identification, management, and treatment of patients with diabetes, high blood pressure, and high blood cholesterol

Increased engagement in self-management among persons with diabetes, high blood pressure, and high blood cholesterol

Increased number and percent of adults with diabetes with at least 2 A1C tests measured annually, at least 3 months apart

Increased number of people educated about prediabetes

Long-term Outcomes

Decreased tobacco use prevalence Decreased number and percent of adults with diabetes with an A1C>9

Increased control among adults with known high blood pressure and high blood cholesterol

Increased number of people with prediabetes enrolled in a CDC-recognized type 2 diabetes prevention program

Outcomes (Oral Health Component):

Those applying under the optional Oral Health Component should use the logic model to identify priority program outcomes based on documented oral disease burden, infrastructure and capacity needs, and the selected strategy or strategies. During the period of performance, recipients are expected to achieve all proposed Oral Health activities and make progress towards the outcomes in the logic model associated with the selected strategy or strategies.

iii. Strategies and Activities Note: All attachments referenced can be located on the DP19-1901 NOFO website: https://www .cdc.gov/chronicdisease/about/foa/islands/index.htm

This NOFO has two components:

1. A competitive Core Component that is mandatory for all applicants.

2. A competitive Oral Health Component that is optional.

The Core Component is designed to prevent and reduce tobacco use and secondhand smoke exposure, improve the prevention and management of diabetes and diabetes related complications, high blood pressure, high blood cholesterol, and to prevent persons with prediabetes from developing type 2 diabetes. The optional Oral Health Component is designed to improve the capacity of the applicants to address oral health needs.

1. Core Component: The Core Component is mandatory for all applicants. Applicants are expected to implement all four strategies in the Core Component during the 5-year period of performance. For strategy 1, applicants should select a minimum of two activities. For strategy 2, applicants should select a minimum of three activities, inclusive of required activities.

Required activities are marked with asterisks. For strategies 3 and 4, applicants are expected to select a minimum of 3 activities per strategy, with at least 1 activity related to tobacco use, at least 1 activity related to diabetes, and at least 1 activity related to CVD. However, applicants may propose additional strategies and activities (beyond what is included in the logic model) to achieve the outcomes.

Strategy 1: Systematically collect, share, and use Non Communicable Disease (NCD) clinical and population-based data to drive local public health action and evaluate impact.

Activities - Select a minimum of 2 1.1: Develop and/or update NCD surveillance plan and NCD data dashboard.

1.2: Implement surveys, such as hybrid survey, Behavioral Risk Factor Surveillance System (BRFSS), Youth Risk Behavioral System (YRBS), Global Youth Tobacco Survey (GYTS), and https://www.cdc.gov/chronicdisease/about/foa/islands/index.htm https://www.cdc.gov/chronicdisease/about/foa/islands/index.htm

Global Adult Tobacco Survey (GATS).

1.3: Collect data on National Quality Forum (NQF) clinical quality measures (e.g., NQF0018:

blood pressure control, NQF0059: A1C).

1.4: Disseminate and use data to implement local public health action and evaluate impact.

Strategy 2: Implement environmental approaches that promote tobacco use prevention and cessation, healthy eating, and physical activity.

Activities - Select a minimum of 3. Required strategies are marked with asterisks.

**2.1: Educate the public, partners and decision makers about the evidence base for tobacco use prevention and cessation using data, earned media and culturally appropriate paid media, specifically focused on the:

2.1a: Dangers of tobacco use, including betel nut with tobacco as well as emerging tobacco products; benefits of and resources for quitting.

2.1b: Health effects of secondhand smoke exposure and the evidence-based environmental change strategies that prevent exposure in workplaces, public places, bars, restaurants, and multi-unit housing.

2.1c: Science supporting evidence-based tobacco prevention interventions, including increasing the price of tobacco products and retail environment policies.

**2.2: Develop and/or maintain a jurisdiction NCD coalition that includes diverse members with an interest in tobacco use, diabetes, cardiovascular disease, and oral health prevention and control, to annually update and work together to implement environmental change priorities.

**2.3: Collaborate with partners to develop and implement procedures/protocols and systems that implement evidence-based policies, including smokefree air, retail, price and other tobacco control policies.

2.4: Collaborate with partners to improve the food system to increase access to healthier foods.

2.5: Collaborate with partners to connect sidewalks, paths, bicycle routes, and public transit with homes, schools, worksites, parks, or recreation centers through implementing master plans and land use intervention.

Strategy 3: Improve the quality of clinical care related to preventing and treating tobacco use and cardiovascular disease (CVD), and managing diabetes.

Activities - Minimum requirement: Select at least 1 activity related to tobacco use, at least 1 activity related to diabetes, and at least 1 activity related to CVD. Required strategies are marked with asterisks.

3.1: Train, educate, and monitor health care providers and health care systems to follow Public Health Services (PHS) guidelines for treating tobacco dependence, including assessing and documenting tobacco use, and providing tobacco users a brief tobacco intervention (BTI).

3.2: Implement practices supportive of breastfeeding in birthing facilities.

3.3: Promote reporting of high blood pressure, high blood cholesterol, A1C measures, and tobacco use data.

**3.4: Implement quality improvement processes, such as the NCD Collaborative, in health care systems to improve diabetes and cardiovascular disease care.

3.5: Promote electronic health records (EHR) adoption and the use of health information technology (HIT) to improve provider outcomes and patient health outcomes for diabetes, high blood pressure and high blood cholesterol.

3.6: Facilitate the institutionalization and monitoring of aggregated/standardized quality measures at the provider level, such as National Quality Forum (NQF) measures: NQF0018 -blood pressure control; NQF0059 - A1C.

3.7: Support engagement of non-physician team members (i.e. nurses, pharmacists, nutritionists, physical therapists and patient navigators/community health workers) in diabetes, high blood pressure, and high blood cholesterol management in community health care systems.

3.8: Build local consensus, and promote the implementation of evidence-based guidelines for the prevention and control of chronic disease and associated risk factors.

Strategy 4: Improve awareness of, access to, and participation in prevention and disease-management programs and services Activities - Minimum requirement: Select at least 1 activity related to tobacco use, at least 1 activity related to diabetes, and at least 1 activity related to CVD.

4.1: Work with NCD/tobacco control coalition and other partners to increase availability of culturally appropriate evidence-based tobacco cessation services throughout the jurisdiction.

4.2: Promote use of tobacco cessation services by educating health care professionals and promoting services to patients and providers.

4.3: Promote use of self-measured blood pressure monitoring tied with clinical support.

4.4: Support the inclusion of health-care extenders in the community to support the self-management of high blood pressure and high blood cholesterol.

4.5: Improve access to, participation in, and sustainability of diabetes self-management education and support (DSMES) programs.

4.6: Improve access to, participation in, and sustainability of evidence-based self-management programs for chronic disease.

4.7: Implement activities that increase awareness of prediabetes in the general population and among health care providers/health care professionals (PSAs, community education events, social media, health care provider training, and other communication strategies as appropriate) and enrollment in CDC-recognized type 2 diabetes prevention programs, where available.

4.8: Implement activities that promote the awareness of high blood pressure and high blood cholesterol in the general population and among health care providers/health care professionals.

2. Oral Health Component: This competitive component is optional and will support up to two recipients to improve their capacity to address the oral health needs of their communities. All applicants must apply for the Core Component in order to be considered for the optional Oral Health Component via one single application that clearly identifies the Core and Oral Health Components. Only those successful applicants under the Core Component will be eligible for the Oral Health Component. Upon award, recipients will have an opportunity to review the findings from an assessment of jurisdiction oral health program infrastructure and capacity, which will be conducted by a separate recipient funded under DP18-1811: Partner Actions to Improve Oral Health Programs (awarded on September 1, 2018). These findings will inform recipients to:

Identify the priority infrastructure and capacity needs for the recipient jurisdiction's oral health program.

Implement appropriate strategies for building an effective territorial oral health program.

Implement selected actions to address the essential components of an oral health program that include oral health surveillance, sealant programs (includes CDC infection prevention and control guidelines), and water fluoridation.

Evaluate strategies and activities to implement essential components of an oral health program, and actions to strengthen oral health program infrastructure and capacity.

Three Oral Health program activities are listed below. Based on documented oral disease burden and infrastructure and capacity needs, applicants are expected to implement at least one of the three listed activities:

1. Oral Health Surveillance:

Recipients will develop and maintain an oral health surveillance system. In addition, recipients will monitor the burden of oral diseases and access to preventive services (for example, dental sealants and community water fluoridation) and disseminate findings to inform program and policy decisions. Specifically, recipients are expected to:

Identify and leverage opportunities and resources to develop or maintain surveillance capacity. Opportunities might include (but are not limited to) collaborating with other programs to address oral health related priority issues or cost sharing to support qualified staff (such as an epidemiologist or evaluator) with other programs.

Develop and maintain an oral health surveillance system that includes a surveillance plan, surveillance indicators, and timely data dissemination to monitor burden of oral disease and inform program and policy decisions.

2. Sealant Programs Recipients are expected to promote, coordinate, implement, and evaluate dental sealant programs within elementary and middle schools. In addition, recipients will promote the adherence to the CDC's infection prevention guidelines in school sealant programs, including the Guidelines for Infection Control in Dental Health-Care Settings - 2003, and the Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.

Specifically, recipients are expected to:

Foster and sustain relationships with public and private organizations whose missions align with improving child health or oral health outcomes, including developing partnerships with community, non-traditional, and national partners that may assist with reaching priority populations.

Convene a sealant work group of key partners to develop strategies for improving sealant program outcomes, such as quality control efforts, expanding program reach, and establishing a plan for program sustainability

3. Water Fluoridation Recipients are expected to monitor and report water fluoridation activities including documentation of public water systems that adjust fluoride and proportion of people served.

Recipients will provide education on the benefits, safety, and effectiveness of maintaining recommended fluoride levels for community water fluoridation. They will also maintain an awareness of policy changes and actions that support and promote quality control and management of fluoridated water systems. Specifically, recipients are expected to:

Foster and sustain partnerships with community leaders, water treatment professionals, coalitions and others whose mission aligns with promoting and strengthening water fluoridation.

Use qualitative data to determine levels of knowledge or public opinion of the benefits of water fluoridation.

Develop and implement a communication plan that identifies the goals, strategies and priority audiences for information about the benefits of water fluoridation.

Collect, analyze, and report on the proportion of people served by fluoridated water systems or sources.

1. Collaborations

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

For both the Core Component and Oral Health Component, recipients are encouraged to collaborate with other related CDC-funded programs that have a role in achieving the NOFO outcomes. Collaborations could center on strengthening/improving health systems and surveillance and building capacity through training, technical assistance and consultation, as well as collaboration on implementing evidence-based interventions and strategies.

Collaborations could also center on shared data, coalition development and maintenance, intervention settings/locations, marketing approaches/messages, and/or EHRs or other electronic clinical decision support, and referral systems. Opportunities/collaborations may also include cost sharing to support a shared position, such as a chronic disease epidemiologist, health communication specialist, program evaluator, or policy analyst, to support collaboration and activities across units or departments.

Related CDC-funded programs include but are not limited to CDC-RFA-DP17-1701: Cancer Prevention and Control Programs for State, Territorial, and Tribal Organizations (Core and Oral Health Components); CDC-RFA-DP15-1513: Behavioral Risk Factor Surveillance System (BRFSS) (Core and Oral Health Components); national organizations funded under CDC-RFA-

DP17-1705: Scaling the National Diabetes Prevention Program in Underserved Areas (Core Component); and other CDC-funded chronic disease prevention and management programs.

Applicants should also link strategies and collaborations described in the jurisdiction's Chronic Disease Plan, as applicable. Letters of support and MOAs/MOUs, with these potential partners, are not required but should be considered where appropriate and helpful in demonstrating and supporting collaborative efforts.

b. With organizations not funded by CDC:

Collaborations with a variety of public and private organizations, international organizations such as the World Health Organization (WHO) or the Pan American Health Organization (PAHO), and other federally funded programs, are encouraged to leverage resources and maximize reach and impact for the strategies and selected activities. Applicants should describe collaborations proposed with organizations relevant to both the core and competitive component in the NOFO. These organizations may include employers, community based organizations/coalitions, commercial or government health plans, hospitals, and federally qualified community health centers, non-profit agencies, other federal, state, or local government agencies, professional associations, quality improvement organizations, CDC-recognized type 2 diabetes prevention programs, and others. Letters of support and MOAs/MOUs, with these potential partners, are not required but should be considered where appropriate and helpful in demonstrating and supporting proposed collaborative efforts.

2. Target Populations The target populations are persons living in the six USAPI jurisdictions, U.S. Virgin Islands, and Puerto Rico.

a. Health Disparities Eliminating health disparities is one of the four Healthy People 2020 Foundational Health Measures. This NOFO will work to address the public health and healthcare challenges in the island jurisdictions that contribute to the reduction of health inequities related to the morbidity and mortality associated with chronic diseases and associated risk factors. Even with relatively small populations there are certain segments of the population that are disproportionately impacted by high rates of tobacco use, are at increased risk for diabetes, prediabetes, cardiovascular disease (CVD), and oral health issues. Many jurisdictions are constrained by the lack of adequate resources or options for prevention and/or treatment.

Along with implementing NOFO strategies and activities to improve the health of the general population, applicants should strive to identify and tailor activities that reach and engage disproportionately burdened populations. Disproportionately burdened populations may be defined by sex, race, ethnicity, disability, culture, sexual orientation, gender identity, geographic location, or socioeconomic status.

Additionally, Healthy People 2020 and the HHS Action Plan to Reduce and Eliminate Health Disparities calls for enhancing collaboration and coordination of health disparities activities.

Each applicant should initiate and maintain activities to address health equity

iv. Funding Strategy Multiple funding streams support the tobacco, diabetes, cardiovascular disease, and oral health activities in the USAPIs, U.S. Virgin Islands, and Puerto Rico. Award amounts are subject to change based upon availability of funds. Tracking by categorical line is not required as long as the appropriate strategies and activities are being reflected in the budget and work plan, as allocated by topic area. Below are descriptions of how anticipated funding levels are determined.

1. Tobacco Prevention and Control The USAPIs, U.S. Virgin Islands, and Puerto Rico are not included in the current funding formula for the National State-Based Tobacco Prevention and Control Programs. The Office on Smoking and Health (OSH) expects to the fund recipients with a total award of approximately $1,752,654, with a floor of $100,000 and a ceiling of $700,000.

2. Diabetes Prevention and Management As with tobacco, the USAPIs, U.S. Virgin Islands, and Puerto Rico are not included in the funding formula for diabetes. The Division of Diabetes Translation expects to fund recipients with a total award of approximately $1,500,000, with a floor of $80,000 and a ceiling of $350,000.

3. Cardiovascular Disease Prevention and Management As with tobacco and diabetes, the USAPIs, U.S. Virgin Islands, and Puerto Rico are not included in the funding formula for cardiovascular disease. The Division of Heart Disease and Stroke Prevention expects to fund recipients with a total award of approximately $1,000,000, with a floor of $50,000 and a ceiling of $200,000.

4. Oral Health The Division of Oral health expects to fund 1-2 recipients with a total award of $150,000, with a floor of $75,000 and a ceiling of $150,000.

Throughout the period of performance, CDC's commitment to continuation of awards will be dependent on the availability of funds, evidence of satisfactory progress by the recipient (as documented in required reports) and the determination that continued funding is in the best interest of the Federal Government.

b. Evaluation and Performance Measurement

i. CDC Evaluation and Performance Measurement Strategy Evaluation and performance measurement help demonstrate the implementation and effectiveness of NOFO strategies and activities and highlight program accomplishments. CDC will use performance measures and evaluation findings for continuous program quality improvement.

Throughout the five-year period, CDC will work individually and collectively with recipients to track and evaluate the implementation of recipient strategies and activities for both the Core and Oral Health components, if applicable. The process and outcome evaluation will seek to answer the following questions:

To what extent has implementation of strategies resulted in the NOFO outcomes?

What factors were associated with effective implementation of strategies?

How will implemented strategies be sustained after the NOFO ends?

How did collaboration increase among those working on chronic diseases and associated risk factors and did those connections facilitate strategy implementation?

CDC will use an evaluation approach that will consist of (1) ongoing monitoring and evaluation through the collection and reporting of performance measures, (2) a CDC-led jurisdiction wide evaluation, and (3) recipient-led evaluations (described below under Applicant Evaluation and performance measurement plan).

Performance measures are an important source of data to help recipients monitor their progress and to help CDC evaluate the effectiveness of NOFO activities and demonstrate improved health outcomes. Performance measures developed for this NOFO correspond to the strategies and outcomes described in the logic model (as indicated in the table below). Recipients will be responsible for collecting and reporting on the performance measures listed in the table below.

Tier 1 measures are required by all recipients and Tier 2 measures are required based on the specific strategies selected. CDC will work with recipients to select performance measures, operationalize the performance measures, and help identify available and feasible data sources for each performance measure. CDC will provide recipients with performance measure definitions and templates to report performance measures annually. CDC and recipients will have six months after the award to work together to finalize the performance measures and definitions. Recipients will report their performance measure data annually and, for the purposes of evaluation, will only have access to their data. Over the 5-year performance period, data will be secured with limited access to authorized CDC program and evaluation staff to the extent allowed under applicable Federal law. CDC will aggregate data across all recipients to publish annual and summative reports.

CDC will provide recipients with data related to the prevention of diabetes, specifically data on enrollment of participants in CDC- recognized type 2 diabetes prevention programs.

For the jurisdiction-wide evaluation, CDC will lead the design, data collection, analysis and reporting. Recipients will be asked to participate in jurisdiction-wide evaluation activities such as surveys, interviews, case studies, and other data collection efforts. An appropriate level of guidance and support will be provided to recipients to ensure effective participation in the jurisdiction-wide evaluation. CDC will use findings from this evaluation to refine its technical assistance, which will help maximize and sustain program outcomes.

CDC will provide evaluation technical assistance and ongoing evaluation guidance on recipient-level evaluation and performance measures. Evaluation technical assistance will be tailored to the needs of the recipients. All information will be stored using a secure system. All evaluation findings produced by CDC and recipients, where appropriate, will contribute to (1) continuous improvement of quality and effectiveness of program strategies, (2) documentation and sharing of lessons learned to support replication and scaling of these program strategies, (3) the evidence base, and (4) future funding opportunities supported by CDC.

The performance measure and evaluation data collected by CDC are directly related to the implementation of the strategies and/or the desired outcomes of the logic model. The data collected for this NOFO for evaluation and performance measurement does not include any personally identifiable information.

Strategy 2: Implement environmental approaches that promote tobacco use prevention and cessation, healthy eating, and physical activity.

Associated Outcomes Tier 2 Performance Measures (recipients will report on measures that correspond to the strategies they select)

Tier 1 Performance Measures (all recipients must respond)

Increased number of smokefree environments

Number and percent of people and/or settings covered by evidence-based tobacco control strategies (e.g., smokefree, pricing, retail environment)

Cigarette smoking prevalence in adults

Tobacco use (including e-cigarettes) prevalence in adolescents

Decreased tobacco product prevalence

No Tier 2 Measure Cigarette smoking prevalence in adults

Tobacco use (including e-cigarettes) prevalence in adolescents

Strategy 3: Improve the quality of clinical care related to managing diabetes and treating and preventing tobacco use and cardiovascular disease.

Associated Outcomes Tier 2 Performance Measures (recipients will report on measures that correspond to the strategies they select)

Tier 1 Performance Measures (all recipients must respond)

Decreased number and percent of adults with diabetes with an A1C

Number and percent of people with diabetes in clinics/hospitals participating in the NCD

Number and percent of adults with diabetes and A1C level>9 level >9 Collaborative (or equivalent clinical care improvement project) with at least two A1C levels measured annually, at least three months apart*

Increased engagement in self-management among patients with diabetes, high blood pressure, and high blood cholesterol

Number and percent of people with diabetes in clinics/hospitals participating in the NCD Collaborative (or equivalent clinical care improvement project) who have a diabetes self-management goal*

Number of patients with high blood pressure in publicly funded health care clinics and hospitals that are engaged in self-measured blood pressure monitoring tied to clinical support

Number and percent of adults with diabetes and A1C level>9

Increased control among adults with known high blood pressure and high blood cholesterol

No Tier 2 Measure Percentage of patients who had a diagnosis of hypertension and whose blood pressure was adequately controlled during the measurement period.

Increased proportion of health care systems reporting standardized clinical quality measures for the management and treatment of patients with high blood pressure (e.g.

NQF0018)

Proportion of health care systems reporting on National Quality Forum (NQF) measure 0018

No Tier 1 Measure

Strategy 4: Improve awareness of, access to, and participation in prevention and disease-management programs and services.

Associated Outcomes Tier 2 Performance Measures (recipients will report on measures that correspond to the selected strategy)

Tier 1 Performance Measures (all recipients must respond)

Increased number of people educated about prediabetes

Number of people reached through prediabetes awareness events

No Tier 1 Measure

Increased number of people with prediabetes enrolled in a CDC-recognized type 2 diabetes prevention programs

No Tier 2 Measure Number of people with prediabetes or at high risk for type 2 diabetes enrolled in CDC-recognized type 2 diabetes prevention programs**

Increased engagement in self-management among persons with diabetes

Number and percent of people with diabetes in clinics/hospitals participating in the NCD Collaborative (or equivalent clinical care improvement project) who have a diabetes self-management goal*

Number and percent of adults with diabetes and A1C level >9

OPTIONAL ORAL HEALTH COMPONENT

Associated Outcomes Tier 2 Performance Measures

(recipients will report on measures that correspond to the selected strategy)

Tier 1 Performance Measures (all recipients must respond)

Disseminate oral health surveillance data on oral disease, risk factors and use of preventive oral health services

Prevalence of dental caries experience, untreated decay, and dental sealants among 3rd grade children***

No Tier 1 Measure

Expand school dental sealant program

Number of eligible schools with dental programs***

No Tier 1 Measure

Increase proportion of people served by community water systems who receive optimally fluoridated water

Number of population served by optimally fluoridated community water systems***

No Tier 1 Measure

*If participating in the NCD Collaborative, CDC will provide these data, and recipients will not be asked to supply these data.

**CDC will provide these data, and recipients will not be asked to supply these data.

***These data will be collected by project officer reports.

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

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

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

Plans for updating the Data Management Plan (DMP), if applicable, for accuracy throughout the lifecycle of the project. The DMP should provide a description of the data that will be produced using these 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/additionalrequirements/ar-25.html.

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

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

Describe key evaluation questions to be addressed by these evaluations.

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

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.

CDC will assist recipients in developing and implementing evaluation plans, based on CDC guidance, that are useful for recipient-level program improvement and for the overall evaluation of the program. CDC will provide recipients with additional guidance, evaluation plan and report templates, including a Data Management Plan (DMP) and will work with recipients during the first six months to revise and finalize the evaluation and performance measurement plans. Any anticipated issue with data collection should be highlighted in the plan, along with options to remedy it. Additionally, the plan should address how the information generated by the performance measures will be used for program improvement by the recipient.

Recipients are encouraged to work with professional evaluators (either internal or external) to meet the evaluation and performance reporting requirements of this NOFO. Therefore, CDC encourages allocating 10% of total funding to award to evaluation and performance monitoring and to consider both development and implementation costs.

c. Organizational Capacity of Recipients to Implement the Approach Applicants must describe their organizational capacity to carry out the strategies and activities included in the Core Component and optional Oral Health component, if applicable.