The Kansas Department of Health and Environment (KDHE) requests CDC-RFA-DP-23-0004 The National Cardiovascular Health Program funds to expand on current momentum and existing efforts to impact cardiovascular disease outcomes in Kansas, including lessons learned from managing CDC-RFA-DP18-1815 Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke grant program. As the state health department, KDHE has the ability to implement strategies on a statewide level by leveraging internal capacity and a vast list of partnerships throughout the state. Our established partnerships and existing momentum will allow us to serve all populations and communities that are proposed in this project. Through this funding opportunity, KDHE will build the public health infrastructure by implementing evidence-based hypertension and high cholesterol strategies with an emphasis on reducing health disparities for priority populations. Priority populations of focus will be Kansas adults aged 18 years and older, low-income adults (less than $25,000), and those adults living in rural, urban, and frontier areas. The following criteria will be used to select target areas to implement the selected strategies: 1) population reach and burden of chronic conditions (i.e., hypertension and high cholesterol); 2) sociodemographic characteristics associated with these conditions; and 3) community/partner capacity for implementing the proposed strategies. By implementing strategies, KDHE will strengthen and expand acceptability and quality of care for priority populations with hypertension and high cholesterol, infrastructure for CDC-recognized lifestyle change programs to prevent and manage hypertension and high cholesterol including expanding availability of Healthy Heart Ambassador (HHA) and other Self Measured Blood Pressure (SMBP) programs currently in use or being developed/adapted by partners. This work will also include suppo
rting pharmacy networks in implementing and sustaining HHA and other SMBP programs. Kansas will support participating healthcare systems to improve quality of care for hypertension and high cholesterol, by 1A) advance the adoption of EHR or HIT to identify, track, and monitor measures for clinical and social services and support needs to address health care disparities and health outcomes for patients at highest risk of cardiovascular disease (CVD), with a focus on hypertension and high cholesterol; 1B) promote the use of standardized processes or tools to identify the social services and support needs of patient populations at highest risk of CVD, with a focus on hypertension and high cholesterol, and monitor and assess the referral and utilization of those services, such as food assistance, transportation, housing, child care, etc.; 2A) advance the use of health information systems that support team-based care to monitor population health with a focus on health disparities, hypertension, and high cholesterol; 2B) assemble or create multidisciplinary teams to identify patients’ social services and support needs and to improve the management and treatment of hypertension and high cholesterol; 2C) build and manage a coordinated network of multidisciplinary partnerships that address and identify barriers to social services and support needs within populations at highest risk of CVD; 3A) create and enhance community-clinical linkages to identify SDoH and respond to social services and support needs of populations at highest risk of CVD with a focus on hypertension and high cholesterol; 3B) identify and deploy dedicated CHWs to provide a continuum of care and services which extend the benefits of clinical interventions and address social services and support needs leading to optimal health outcomes; 3C) promote use of SMBP monitoring with clinical support within populations at highest risk of hypertension.