This proposal is to continue the work of UNC's existing PRC (Center for Health Promotion and Disease Prevention - HPDP) but with a new focus on the link between community and health care efforts to prevent and control disease (CDC Domain 4), by developing and testing a technology-assisted community health worker implementation strategy for cardiovascular disease prevention with initial emphasis on low income, rural communities with large populations of underserved minorities. To support this effort and the broader work of the Center in its role to enhance public health practice through high quality research, HPDP will build new capacity in dissemination and implementation (D&I) research, adding faculty expertise in systems dynamic modeling and health services research. In addition, faculty with research and practice experience in health information technology and patient centered medical homes will join the team. The Center will collaborate with statewide stakeholders to disseminate EBIs and build public health practitioners' capacity to implement EBIs that target all levels of the socio-ecologic model. The center will build on community collaborations over the past 25 years to address the winnable battles -- nutrition, physical activity, obesity, and tobacco --that are most relevant to CVD prevention and treatment. Our efforts will be guided by NCCDPHP (CDC) strategic priorities (health equity, research translation, systems solutions, and sustainability) and the National Prevention Strategy (healthy community environments, quality preventive services, empowering personal health choices). Currently there is a widely recognized gap in coordination between primary care and public health. Community Health Workers have demonstrated the potential to significantly impact chronic disease risk factors, but coordinated programs between clinic and public health departments that collaborate with community health workers have not been adequately tested. The applied research project for this proposal, referred to as CHANGE (Carolina Heart Alliance Networking for Greater Equity) is designed to create and test new structures to leverage the complementary strengths of clinics and public health departments coordinated through technology-assisted community health workers, thereby expanding the reach and effectiveness of both clinical and community multi-level evidence-based interventions. The research design includes formative data collection to refine the CHANGE strategy; a pre-post comparison to assess implementation and effectiveness; a matched-control pre- post comparison to assess the CHANGE strategy's effects on the proportion of the clinic's total at-risk population that have cholesterol and blood pressure under control as compared to three matched comparison clinics; and finally planning for taking the CHANGE strategy to scale by replicating it in one additional community, identifying its core components, creating and disseminating a replication toolkit, and promoting the strategy's adoption through NC's multiple clinical, public health, and research networks.
Heart disease is the leading cause of death in the US. Evidence-based clinical and public health interventions are available but are not reaching those in greatest need. We propose the continuation of an existing Prevention Research Center with added infrastructure to support a core research project that links clinical care and public health through technology-assisted community health workers to reach the most vulnerable with effective and sustainable heart disease risk reduction strategies.
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