Thursday, November 21, 2024 11/21/2024

Diabetes and Heart Disease & Stroke Prevent Programs-Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke

Award Number: NU58DP006635
ORGANIZATION: NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION & HEALTH PROMOTION
OPDIV: CDC
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SOCIAL SERVICES

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PROJECT ABSTRACT SUMMARY North Carolina has chosen multiple innovative strategies to address the prevention and management of diabetes. Innovation is demonstrated with several activities implemented in conjunction with the NC Health Information Exchange Authority that oversees the NC Health Information Exchange (HIE). As of June 1, 2018, HIE connectivity is required for all health systems receiving Medicaid in North Carolina. By June 1, 2020, the HIE will also include health data for all health systems that serves NC State Health Plan for Teachers and State Employee members and local mental health entities. North Carolina’s interface with the HIE will increase the functionality of the diabetes patient registry and support bi-directional communication between clinical sites and community-based diabetes prevention and management programs and facilitate decision-support/electronic flagging for chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) in people with diabetes. We will partner with the NC Community Health Center Association, the member organization for 39 federally qualified community health centers and two look-alikes. They will establish diabetes care teams to implement telehealth screening for diabetic retinopathy, use SMS messaging and decision support/alert flags related to ASCVD and CKD staging to help providers manage patients with diabetes and reduce their risk for complications, and refer patients to the National Diabetes Prevention Program (NDPP). We will also increase community-clinical connections to lifestyle change programs and diabetes self-management education and support (DSMES) as well as other social resources. The NC Department of Health and Human Services (NC DHHS) is developing a standardized screening tool that identifies core elements of unmet social resource needs that can be used to screen patients in a consistent manner across healthcare organizations. For those that have resource needs, NC DHHS is joining partners to develop the NC Resource Platform. This robust statewide resource database features a call center as well as a referral platform that clinicians, social workers, care coordinators and others can use to identify resources in communities, connect patients to those resources, and track successful connections and outcomes. We will incorporate lifestyle change program and DSMES sites into this database. While it is being built our funded clinical sites will begin screening people at risk for and those with diabetes for unmet needs and referring them to currently available resources. Additionally, this application supports the testing of lifestyle coach credentialing for reimbursement and the creation of a healthcare provider referral network by automating notification of prediabetes results for providers through lab-based blood glucose testing. This notification will prompt providers to refer persons with prediabetes to diabetes prevention program (DPP) sites and alert DPP vendors of the need for additional sites. These innovative strategies will support safety net providers to increase access, participation, and retention in LCPs and DSMES while improving quality of clinical care in underserved areas for people with prediabetes and diabetes. This will be accomplished through systems-based changes that have broad reach and are sustainable, scalable and replicable.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$890,810 )
2024	2022	STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES	101 BLAIR DR	RALEIGH	NC	27603	WAKE	USA	The Innovative Cardiovascular Health Program	01	5	9/26/2024	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	-$654,626
2024	2021	STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES	101 BLAIR DR	RALEIGH	NC	27603	WAKE	USA	The Innovative Cardiovascular Health Program	01	5	9/26/2024	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	-$236,184
2024	2020	STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES	101 BLAIR DR	RALEIGH	NC	27603	WAKE	USA	The Innovative Cardiovascular Health Program	01	5	9/26/2024	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
2024	2019	STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES	101 BLAIR DR	RALEIGH	NC	27603	WAKE	USA	The Innovative Cardiovascular Health Program	01	5	9/26/2024	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
2024	2018	STATE OF NORTH CAROLINA DEPARTMENT OF HEALTH & HUMAN SERVICES	101 BLAIR DR	RALEIGH	NC	27603	WAKE	USA	The Innovative Cardiovascular Health Program	01	5	9/26/2024	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
														Subtotal = -$890,810

Issue Date FY: 2022 ( Subtotal = $654,626 )
2022	2022	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	00	5	6/23/2022	NON-COMPETING CONTINUATION	$654,626
2022	2021	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	02	4	5/31/2022	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
														Subtotal = $654,626

Issue Date FY: 2021 ( Subtotal = $1,000,000 )
2021	2021	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	01	4	9/24/2021	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
2021	2021	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	00	4	6/25/2021	NON-COMPETING CONTINUATION	$1,000,000
2021	2020	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	01	3	10/7/2020	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
														Subtotal = $1,000,000

Issue Date FY: 2020 ( Subtotal = $1,000,000 )
2020	2020	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	00	3	6/21/2020	NON-COMPETING CONTINUATION	$1,000,000
2020	2019	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	02	2	5/21/2020	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
2020	2019	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	01	2	11/19/2019	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
														Subtotal = $1,000,000

Issue Date FY: 2019 ( Subtotal = $1,000,000 )
2019	2019	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	00	2	6/26/2019	NON-COMPETING CONTINUATION	$1,000,000
2019	2018	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	01	1	12/13/2018	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
2019	2018	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	02	1	8/5/2019	ADMINISTRATIVE SUPPLEMENT ( + OR - ) (DISCRETIONARY OR BLOCK AWARDS)	$0
														Subtotal = $1,000,000

Issue Date FY: 2018 ( Subtotal = $1,000,000 )
2018	2018	Health & Human Services, North Carolina Department Of	2025 Mail Service Ctr	Raleigh	NC	27699	WAKE	USA	The Innovative Cardiovascular Health Program	00	1	9/18/2018	NEW	$1,000,000
														Subtotal = $1,000,000

Grand Total All Awards = $3,763,816

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Diabetes and Heart Disease & Stroke Prevent Programs-Innovative State and Local Public Health Strategies to Prevent and Manage Diabetes and Heart Disease and Stroke

Award Number: NU58DP006635

ORGANIZATION: NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION & HEALTH PROMOTION

OPDIV: CDC

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SOCIAL SERVICES

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