Hypertension and Diabetes Improvement Project Subgrant Solicitation Application 2017-2018

Hypertension and Diabetes Subgrant Solicitation Application

Organization: / Tax ID Number:
Contact Name: / Contact Title:
Address: / City & Zip:
Contact Phone: / Contact Email:
Person Completing Application: / Role:
D-U-N-S Number:
(Dun & Bradstreet (D&B) provides a D-U-N-S Number, a unique nine-digit identification number, for each physical location of your business. D-U-N-S Number assignment is FREE for all businesses required to register with the US Federal government for contracts or grants.)

Applications must be received by 5:00 p.m. M.T., Friday, August 11, 2017.

Only one application per eligible health system will be accepted.

Please respond to each prompt below; demonstrating your organizational readiness and capacity to successfully meet the project goals and priorities.

Organizational Capacity:Briefly describethe organizational structure, how it supports improved delivery of hypertension and diabetes care and services, and your clinic’s experiences and approaches in implementing quality improvement processes specific to hypertension, diabetes and prediabetes. Please include any potential barriers or challenges to implementation (e.g., staff buy-in, competing priorities, data validation, limited staff time, etc.) and how you plan to overcome them.(15 points)
Roles and Responsibilities of Practice Improvement Team: Identify key people (practice improvement team) who will assist in the development and implementation of this project.(15 points)

Role / Name and Job title
Provider Champion (may overlap with another role below)
Quality Improvement/Data Lead
Health Information Technology
Clinical Representative (e.g. Nurse, Medical Assistant or Care Coordinator)
Organizational Decision Maker
Grant Coordinator or similar position
Other key staff optional (e.g. patient navigators)

Supporting Goals and Measures: Please identify at least two (2) specific practice goals and measures that will be prioritized and accomplished by your practice due to receiving this funding (in addition to the one (1) project measure your program has chosen). Practice goals must align with project priorities. Make sure to use the “SMART” methodology when describing your program’s goals. Goals should be: Specific, Measurable, Achievable, Relevant, and Time Bound. (total of 50 points possible)

Please indicate which project goal your practice will be working on during this funding period (check one):

Patient Care: By June 29, 2018 subgrantees will demonstrate the ability to successfully report on quality measure 18, developed by the National Quality Forum (NQF) through a nationally recognized quality improvement initiative or program (NCQA – HEDIS, MU, PQRS, UDS)

Community-Clinical Linkages: By June 29, 2018 subgrantees will demonstrate the ability to successfully screen, test, and refer patients at high risk for prediabetes to an appropriate lifestyle intervention program.

Performance Improvement:By June 29, 2018 subgrantees will implement a standardized training for all appropriate providers on SMBP best practices and techniques

The priorities of this funding opportunity (project) are to:

Promote reporting of blood pressure and A1C measures and initiate activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure
Promote awareness of high blood pressure among patients
Increase implementation of quality improvement processes in health systems
Increase team-based care in health systems
Increase access, referrals, and reimbursement for AADE-accredited, ADA-recognized, State-accredited/certified, or Stanford-licensed DSME programs
Increase use of lifestyle intervention programs in community settings for the primary prevention of type 2 diabetes

Please Complete the tables below for your practice’s supporting goals:

*Required

Project Priority Area (from list above):
Target Goal (SMART):
Activity/Goal Description (what work will be done to achieve the goal):
Practice Improvement Team (list who will be involved):

*Required

Project Priority Area (from list above):
Target Goal (SMART):
Activity/Goal Description (what work will be done to achieve the goal):
Practice Improvement Team (list who will be involved):

*Optional

Project Priority Area (from list above):
Program Target Goal (SMART):
Activity/Goal Description (what work will be done to achieve the goal):
Practice Improvement Team (list who will be involved):

Letter of Support: Please include a letter of support from the administration of the applicant organization (i.e., CEO, CFO, Executive Director, etc.). (10 points)

Proposed Budget:Please provide proposed costs (up to $15,000.00) related to project priorities and required activities for personnel and operating.

Also, please provide contact information for your organization’s point of contact for invoicing and billing: ______(10 points)

Proposed Budget

Personnel Budget for Project Activities

Activity / Name, Position / Hourly Rate / Number of Hours / Amount Requested
Data Collection and Submission: baseline/pre and post project data, ACIC completion
PDSA Reporting
Project Coordination (includes project measure reporting)
Other (describe):

Operating Budget: marketing, patient education, facility rental, etc.

Expense / Cost / Amount / Total Requested

Other: travel, trainings, etc.

Expense / Cost / Amount / Total Requested

Applications should be sent electronically to:

Nicole Stickney, Idaho Diabetes, Heart Disease, and Stroke Program Specialist

This funding opportunity supported by Grant No. CDC-RFA-DP13-1305 from the Centers for Disease Control and Prevention through the Bureau of Community and Environmental Health, housed in the Division of Public Health, Idaho Department of Health and Welfare.