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Home My WebLink AboutC08-324~~CI AGREEMENT BETWEEN THE EAGLE COUNTY PUBLIC HEALTH DIVISION AND THE VAIL VALLEY MEDICAL CENTER FOR COORDINATION OF THE CANCER, CARDIOVASCULAR, AND PULMONARY DISEASE GRANT This Agreement (the "MOA") is entered into on this ~ day of C, , 2008 by and between the BOARD OF COUNTY COMMISSIONERS OF THE 'OUNTY OF EAGLE, STATE OF COLORADO, a body corporate and politic ("The County") and the VAIL VALLEY MEDICAL CENTER, by and through its Board of Directors (the "Hospital"). RECITALS: WHEREAS, cardiovascular disease (CVD) is the leading cause of death in Eagle County, and; WHEREAS, 26 percent of Eagle County residents do not have health insurance, (a disproportionate amount of which are Spanish speakers), which creates barriers to early screening, diagnosis, and treatment for cardiovascular disease, and; WHEREAS, increasing the number of Eagle County residents who receive early screening, diagnosis and treatment for CVD is a goal of Eagle County Public Health, and; WHEREAS, the Hospital has been named as the fiscal and administrative agent of a Denver Health/Colorado Department of Public Health & Environment grant entitled "Community Cardiovascular Disease Prevention Program" (the "Grant"), which provides early screening, diagnosis and treatment to low income individuals, and; WHEREAS the Hospital desires to partner with Eagle County to operationalize this program within the community, using the expertise of the Public Health Division, and; WHEREAS, grant specifications require the Hospital to employ a para- professional, bicultural Community Health Outreach Worker (the "CHOW"), who will require day-to-day guidance in the area of community outreach and health promotion strategies and; WHEREAS, Eagle County's Public Health Division desires to use its expertise to provide such guidance in partnership with the Hospital, and; WHEREAS, the Hospital desires to delegate oversight of the day-to-day program operations (as described in number 7, 8, and 10 on Page 2) to Eagle County Public Health, but will maintain the role of administrative supervisor for the grant and employer for the CHOW position. NOW, THEREFORE, in consideration of the mutual conditions contained herein, the County and Hospital agree as follows: 1. The Hospital will employ a CHOW, in accordance with the grant requirements and job description, as set forth in Exhibit A, attached hereto and incorporated herein by this reference. 2. The Hospital shall identify an appropriate workstation for the CHOW. 3. The Hospital shall recruit and hire the CHOW. The County will assist in the selection of and training of the CHOW. 4. Upon hiring of the CHOW, all supervision, performance, and other personnel matters, including discipline, will be the duty of the Hospital, and will be accomplished at the sole discretion of the Hospital. The County will provide input, as solicited by the Hospital. 5. Upon hiring of the CHOW, the coordination, management, and quality assurance of the services performed by the CHOW will be led by the County, with solicited input from the Hospital. 6. The Hospital and County will work cooperatively on program goals and objectives. 7. The County will lead the outreach plan development, including the use of health promotion strategies, based on agreed upon goals and objectives, and will mentor the CHOW on activities related to these goals and objectives. 8. The County will provide oversight of the CHOW during outreach sessions, when the CHOW will perform a general CVD screening in the form of a questionnaire, provide general education, and give health care referral information. 9. The Hospital will assure an adequate medical resource base for referral of clients by the CHOW. 10. The County will take the lead in evaluating the program's effectiveness in terms of outreach strategies and the CHOW's screenings/education/referral process, with input on methodologies from the Hospital 11. The full time CHOW position shall be funded by the Grant, set forth in Exhibit B, attached hereto and incorporated herein by this reference. 12. The hospital will manage all administrative aspects of the grant including the fiscal reporting requirements and grant deliverables. The County will provide all information necessary to report on grant deliverables. This agreement shall be binding upon the respective parties hereto, their successors or assigns, and may not be assigned by anyone without the prior written consent of the 2 respective parties hereto. 7. Notices. Any notice required under this Agreement may be personally delivered or mailed in the United States mail, first class postage prepaid to the party to be served at the following addresses: a. County: Jill Hunsaker, MPH Public Health Manager . P.O. Box 660 Eagle, Colorado 81631 Facsimile: (970) 328-8809 b. Vail Valley Medical Center: Attention: Cacky Ryan P.O. Box 40,000 Vail, Colorado 81658 Facsimile: (970) 569-7720 Notices personally served shall be deemed served on the date of delivery. If mailed, such notice shall be deemed to be given when deposited in the United States mail, with postage thereon prepaid. If transmitted by teletype, electronic message, facsimile or other wire or wireless communication, such notice shall be deemed to be given when the transmission is completed. 8. Term. This Agreement shall commence upon execution by both parties and shall continue through the end of the CCPD Grant fiscal year (June 30, 2009). 9. No Assignment Contractor shall not assign any of its rights or duties under this Agreement to a third party without the prior written consent of County. County shall terminate this Agreement in the event of any assignment without its prior written consent of County. 10. Entire Agreement. The parties hereto agree that neither has made or authorized any agreement with respect to the subject matter of this instrument other than expressly set forth herein, and no oral representation, promise, or consideration different from the terms herein contained shall be binding on either party, or its agents or employees hereto. 11. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Colorado, and venue for any action arising out of any dispute pertaining to this MOA shall be exclusive in Eagle County, Colorado. 12. Third Party Beneficiary. Nothing herein expressed or implied is intended or should be construed to confer or give to any person or entity other than the County or the Hospital any right, remedy or claim under or by reason hereof of any covenant or condition herein contained. 13. Severability. If any portion of this Agreement is held invalid or unenforceable for any reason by a court of competent jurisdiction, such portion shall be deemed severable and its invalidity or its unenforceability shall not affect the remaining provisions; such remaining provision shall be fully severable and this Agreement shall be construed and enforced as if such invalid provision had never been inserted into this Agreement. 16. Amendments. This Agreement may be amended, modified, changed, or terminated in whole or in part only by written agreement duly authorized and executed by both County and the Hospital. This Agreement represents the full and complete understanding of County and the Hospital and supersedes any prior agreements, discussions, negotiations, representations or understandings of County and the Hospital with respect to the subject matter contained herein. 17. Independent Contractor Status. The Parties to this Agreement intend that the relationship between them is that of independent contractor. County, and any agent, employee, or servant of Eagle shall not be deemed to be an employee, agent, or servant of Hospital. Hospital, and any agent, employee or servant of Hospital, including the CHOW, shall not be deemed to be an employee, agent or servant of County. Hospital, the CHOW and any other agent, employee or servant of Hospital are not entitled to any Workman's Compensation benefits through the County and are responsible for payment of any federal, state FICA and other income taxes on their own behalf. 18. Indemnification. Hospital agrees to release, indemnify and save harmless the County, and its officers, agents, and employees, against any and all claims, damages, suits, costs, expenses, liabilities, actions, or proceedings of any kind or nature whatsoever, including Workman's Compensation claims, of or by any person, in any way resulting from or arising out of, either directly or indirectly, the operations and duties undertaken by the CHOW in performance of his or her duties under the terms of the Grant. 4 IN WITNESS WHEREOF, the parties hereto have executed this agreement the day and year first above written. COUNTY OF EAGLE, STATE OF COLORADO, By and Through its BOARD OF COUNTY CO MI IONERS ATTEST: ~~ ~~~~ ~ ~ ' B Jerk to th oar o * * Peter F. Runyon, Chai 1 ./~ ATTEST: By: VAIL VALLEY MEDICAL CENTER EAGLE, COLORADO By and Through its BOARD By: , ~~, /lam ~. 6 Title: [' i~ ~ ~ - Approved as to Form VVMC-Legal LTe rime RY l Emily Kaufman Oate EXHIBIT A VAIL VALLEY MEDICAL CENTER JOB DESCRIPTION TITLE: Community Health Worker DEPARTMENT: Occupational Health and Eagle County Public Health SUPERVISOR: Director and Eagle County Public Health Educator DATE: July 2008-2009 POSTION PURPOSE: Under supervision to perform a variety of paraprofessional community health worker duties related to community outreach. Provides health screening, education information, referrals to assist client to access programs and service to promote detection and treatment at local health centers. The Community Health Worker is a paraprofessional who is not licensed to provide direct health care. TYPICAL PHYSICAL DEMANDS: Require full range of body motion. Requires standing and walking for extensive periods of time. May require periods of prolonged sitting. Requires manual and finger dexterity and eye/hand coordination. Requires ability to distinguish letters and/or numbers. Requires use of office equipment, i.e., computer terminals, telephones, fax machines and copiers. Occasionally lifts and carries items weighing up to 25 lb. Requires corrected vision and hearing to normal range. Occasionally requires working under stressful conditions and/or working irregular hours. May require some exposure to communicable diseases or body fluids TYPICAL WORKING CONDITIONS: Work is performed in an office/clinic environment and community environment. All contact with clients will be strictly confidential. Exposure to blood and other body fluids is possible. Frequent contact with staff, physicians and the general public. Must have own transportation to interface with clients in the community. KEY RESPONSIBILITIES: • Support the work of the Community Voices Grant, Occupational Health Director (OHD), and Community Health Education Specialist (CHES) • Perform client screening and tracking and tracking/ordering of supplies under the guidance of the CHES or OHD • Maintain care of grant supplied technology, including pen-tablet, cell phone, and all screening machines • Provide appropriate client based interventions, including referrals to primary care for treatment and health education materials on subjects such as nutrition, physical activity, and tobacco usage, and follow up with moderate to high risk client within two weeks and as needed following initial screening to improve identified cardiovascular disease problems under guidance provided by the OHD and CHES • Facilitate community and client coordination of appropriate services including culturally competent follow up especially with high risk clients • Clarify professional and medical instructions to community and referred clients • Translate on behalf of clients when no alternative translator is available • Collaborate and effectively communicate with necessary community partners and supervisors/grantor of the Community Cardiovascular Disease Prevention Program • Participate in the design and implementation of community outreach • Adhere to VVMC policies and procedures. • Abide by National Patient Safety Goals • Abide by Service Excellence Standards • Comply with rules/regulations set forth by HIPPA regulations regarding patient confidentiality • Attend all required trainings for the program and all meetings with grantor and supervisors • Learn foundation for public health under guidance of CHES • Perform other duties as assigned ii PERFORMANCE CATEGORIES/STANDARDS: Standard Number Weight Performance Standard 1.0 100% Community Health Worker 1.1 25%Client Based Intervention-Demonstrate the ability to screen patients, enter data accurately and timely into pen tablet, participate in the design and implementation of community outreach, provide educational materials and/or referrals to local resources for nutrition, tobacco usage, and physical activity, plan and organize screening functions and supplies. Exceptional 5 points ~~ Exceeds Job Standard 4 points Fully Meets Job Standard 3 points ~~ Needs Improvement 2 points ~~ Does Not Meet Job Expectations 1 point ~~ 1.2 25%Case management-Demonstrate the ability to facilitate community and client coordination of appropriate services, follow up with moderate and high risk clients within 2 weeks of initial screening, refer at risk client to primary care physicians for further evaluation. Exceptional 5 points ~~ Exceeds Job Standard 4 points ~~ Fully Meets Job Standard 3 points ~~ Needs Improvement 2 points ~) Does Not Meet Job Expectations 1 point ~~ 1.3 25%Communication-Demonstrate the ability to communicate effectively both verbal and written to community partners, clients, supervisors, grantors, and iii demonstrate strong customer service skills, and bilingual abilities, if needed. Exceptional 5 points ~~ Exceeds Job Standard 4 points Fully Meets Job Standard 3 points Needs Improvement 2 points Does Not Meet Job Expectations 1 point 1.4 15%Administrative Duties-Attends monthly phone conference call with grantor, attends required trainings throughout the year, achieves goals set by CHW. Exceptional 5 points ~~ Exceeds Job Standard 4 points Fully Meets Job Standard 3 points Needs Improvement 2 points Does Not Meet Job Expectations 1 point 1.5 5% Safety- Demonstrate personal safety such as using Personal Protective Equipment ,practices universal precautions, wearing seat belt will driving, and no use of cell phone while driving. Exceptional 5 points ~~ Exceeds Job Standard 4 points Fully Meets Job Standard 3 points Needs Improvement 2 points Does Not Meet Job Expectations 1 point iv EMPLOYMENT STANDARDS: Any combination of education and experience sufficient to directly demonstrate possession and application of the following: Knowledge of: Health beliefs and potential health delivery barriers of target population; community outreach and organizing; the culture of target population. Ability to: Learn Public Health principles of disease control including health practices related to cardiovascular disease, nutrition, physical activity, and tobacco prevention and cessation; to speak Spanish or other appropriate language applicable to Eagle County; communicate Public Health principles in culturally appropriate manner to target populations; work well with the Medical community and Public Health professionals; and work well with community members of target population. SKILLS, KNOWLEDGE AND ABILITIES: Position requires ability to deal successfully communicate both verbally and written with hospital personnel, patients, co-workers, agencies/companies and their employees. Requires organizations skills, priority management and problem solving. Also requires computer skills, good math skills, organization and accuracy. Knowledge and practice of universal precautions. Bi-lingual skills preferred. EQUIPMENT/LAB SKILLS Pen Tablets/Computer Cholestech Machine Finger Stick HT/ WT Basic Office Equipment Blood Pressure CERTIFICATE/LICENSE: Current CPR card is encouraged Valid Colorado Drivers License EDUCATION: High School or Equivalent One year experience in related area I have read and understand my position description. Employee Occupational Health Manager Date Date v Community Cardiovascular Dise___e Prevention Program EXHIBIT B Cancer, Cardiovascular Disease and Pulmonary Disease Competitive Grants Program 2008 ~ Continuation Application 2009 Agency Name: Denver Health Principal Investigator or Project Director: Elizabeth Whitley, Ph.D., R.N. Project Title: Community Cardiovascular Disease Prevention Program Contract Number: FLA PPG0800287 B Check one: ^ I am requesting continuation funding for year 2 of my CCPD requesting continuation funding for year 3 of my Part 1: Applicant Information Form Part 2: Work Plan Part 3: Evaluation Plan Part 4: Budget and Budget Narrative Part 5: Financial Assessment Questionnaire Community Cardiovas~_.ar Disease Prevention Program Executive Director Patricia A. Gabow, MD ' Name and Official CEO and Medical Director Title: Phone: 303-436-6611 Fax: 303-436-5131 Email: patricia.gabow@dhha.org Address: 660 Bannock St., MC0278 City, State, Zip: Denver, CO 80204 Please identify the primary applicant's agency type. 1. Public Health Agency 2. College or University ^ 3. Worksite ^ 4. Health Care System 5. Community Health Center 6. Non-governmental or nonprofit organization ^ 7. Public or Private School K-12 ^ 8. Other ^ Is this amulti-agency project? (check if yes) Please check one: 1. One-time project (one year request) ^ 2. Two-year request ^ 3. Three-year request ii Agency Name: Denver Health Community Cardiovas~_.ar Disease Prevention Program Please enter the total dollar amount. Requested funding for FY 08/09 (July 1, 2008 -June 30, 2009) $1,216,182 Principal Elizabeth M. Whitley, Ph.D., R.N. Investigator Name: Title: Director Community Voices Phone: 303-436-4071 Fax: 303-436-4069 Email: Iwhitley@dhha.org Address (if different 777 Bannock St., MC 7779 from above): City, State, Zip: Denver, CO 80204 Project Manager Pedro Arevalo Rincon Name: Title: Program Manager Phone: 303-436-4182 Fax: 303-436-4069 Email: pedro.arevalorincon@dhha.org Address (if different from above): City, State, Zip: Please list key staff people (if known) who should receive email correspondence (information on training, networking and technical assistance opportunities) from the CCPD Program. Name: Email: Name: Email: Name: Email: iii Community Cardiovas~_.ar Disease Prevention Program Fiscal/Contracts Manager Name: Title: Phone: Email: Address (if different from above): City, State, Zip: Julie Potocnik Director Sponsored Programs and Research Office 303-602-7061 Fax: 303-602-7078 julie.potocnik@dhha.org 655 Broadway Denver, CO 80204 Please indicate which funding priority your project addresses. Cancer ^ Other: this application does not address a specific funding priority Cardiovascular Disease Pulmonary Disease ^ Crosscutting (project addresses more than one ^ priority area) Will any of the funds in this proposal be allocated to treatment? Yes: ^ No: If yes, please list the dollar amount devoted to treatment for FY 08/09. iv Community Card Program Please indicate whether you are currently receiving funding from any of the following CDPHE Grant programs. (check alf that apply) ® Cancer, Cardiovascular Disease and Pulmonary Disease Amount: $953,757 Competitive Grants Program (CCPD) ^ Health Disparities Grants Program (HDGP) Amount: ^ State Tobacco Education and Prevention Partnership (STEPP) Amount: ^ Colorado Physical Activity and Nutrition Program (COPAN) Amount: ^ Women's Wellness Connection (WWC) Amount: ^ LiveWell Colorado Amount: ^ Other Amount: Do you intend to apply for funding from any of the CDPHE Grant programs listed above in FY08/09? If so, which programs? yes, Office of Health Disparities Provide the following demographic information about your target population. (check aN that apply) Gender: Male ®% 47 Female ®% 53 Other ^ Age range: School-Age ^ 19 -29 ® 30-39 ® 40-49 ® 50 - 59 ® 60-64 ® 65+ Race: White Black Hispanic Asian American, Pacific Islander Native American Other Sub-population: Residents of 14 Colorado communities Socio-economic: ^ Free/Reduced Lunch (school-age children who are eligible for free or reduced-lunch programs based on financial need). ® Medicaid (individuals who are eligible for Medicaid benefits) ® Medicare (individuals who are eligible for Medicare benefits) ® Uninsured (Individuals who do not have any health insurance and who are not eligible for Medicaid or Medicare benefits) ® Under-served (Those who have limited access to clinical preventive or treatment services due to socioeconomic, geographic and/or other barriers to services which adversely affect access) ^ Other: v Community Cardiovascular Disease Prevention Program Check the geographic area of your project below. Rural or frontier counties are those outside of Denver, Boulder, Broomfield, Jefferson, Arapahoe, Larimer, Adams, Douglas, Weld, Mesa, Pueblo, Elbert, and EI Paso counties. Note that statewide reach means that programs/services are locally available in the eastern plains, western slope, central mountains, Front Range, and each corner of the state. Additional guidance is available in the CCPD Application Guidelines. 9. Rural or frontier counties 10. Regional 11. Statewide Please indicate which counties your project will serve. Statewide projects also must indicate the counties in which pro rams/services are locally available. Adams County ~ Denver County ® Lake County ^ Phillips Countv ^ Alamosa County ^ Dolores County ^ Larimer County ® Pitkin County ^ Arapahoe County ® Douglas County ^ Las Animas County ^ Prowers County Archuleta County ® Eagle County ® Hinsdale County ^ Pueblo County Baca County ^ EI Paso County ^ Huerfano County ^ Rio Blanco County ^ Bent County ® Elbert County ^ Lincoln County ^ Rio Grande County ^ Boulder County ® Fremont County ^ Logan County ® Routt County Broomfield County ^ Garfield County ® Mesa County ® Saguache County ^ Chaffee County ^ Gilpin Countv ^ Mineral County ^ San Juan County ^ Cheyenne County ^ Hinsdale County ^ Moffat County ® San Miguel County Clear Creek County ^ Huerfano County ^ Montezuma County ^ Sedgwick County ^ Coneios County ^ Jackson County ® Montrose County ® Summit County ^ Costilla County ^ Jefferson County ® Morgan County ® Teller County ^ Crowley County ^ Kiowa County ^ Otero County ® Washington County ^ Custer County ^ Kit Carson County ^ Ouray County ^ Weld County Delta County ^ La Plata County ® Park County ^ Yuma County ^ Have you contacted the local public health deaartments and/or county nursina services in the counties your project will serve? Yes: ® No: ^ Some: ^ vi Community Cardiovascular Disc. Prevention Program vii Community Cardiovascular Disease Prevention Program viii Community Cardiovascular Disease Prevention Program Community Cardiovascular Di se Prevention Program. Please provide ahalf-page description of your proposal, purpose, key objectives and target population, including age group and geographic focus, and expected outcomes. The goal of this program is to reduce the risk of cardiovascular disease (CVD) among adult residents in 14 Colorado communities in 2008-09. Specifically, the Community Cardiovascular Disease Prevention Program will provide screening, CVD risk assessment, health information and education and referrals to primary care and other resources for 1200 residents of Denver County, 600 residents of Lamar in Prowers County, 600 residents of Glenwood Springs in Garfield County, 600 residents of Pueblo County and 600 residents of Grand Junction in Mesa County, 600 residents of Larimer and Weld Counties served by Sunrise Community Health Center, 600 residents of Logan and Morgan Counties served by Salud Family Health Centers, 600 residents of Routt, Jackson and Moffat Counties served by Northwest Colorado Visiting Nurse Association, 600 residents of Adams, Arapahoe and Jefferson Counties served by Metro Community Provider Network, 600 residents of San Migue! and Montrose Counties served by Uncompahgre Medical Center, 600 residents of La Plata and Archuleta Counties served by San Juan Basin Health Department, 600 residents of Eagle County served by Vail Valley Medical Center and Eagle Public Health Department, and 600 residents of Boulder County served by the Salud Clinic in Longmont for a total of 9,000 individuals by June 30, 2009. The expected benefit is that individuals will be aware of their numbers (blood pressure, cholesterol, glucose, BMI) and risk of developing CVD and will be offered health education and additional resources to assist them in changing modifiable behaviors related to nutrition, physical activity, and smoking. Additionally, individuals at moderate and high risk for CVD will be identified and linked to primary care for treatment. This program will also reduce health disparities related to CVD risk management in residents of participating Colorado counties. Part 2: Work Plan FY08/09 Reduce the risk of CVD of adult residents in 14 Colorado communities. ix Community Cardiovascular Disease Prevention Program • ~ - • • ~ Reduced risk of CVD for participants as demonstrated by decreased blood pressures, decreased BMIs, decreased dyslipidemia, and decreased tobacco use b June 30, 2010. Community Health Worker (CHW) follow up with all participants at moderate to • ~ - high risk within 2 weeks and as needed following initial screening by June 30, 2009. • • - Provide community-based screening, CVD risk assessment, health information and education and referrals to primary care and other resources for 9,000 residents b June 30, 2009. - •~ - • • • • -~ • ~. ~~ 1) Provide free screening opportunities for 9,000 X X X X adult Coloradans to "know their numbers" and risk of CVD b June 30, 2009. 2) Provide information, guidance and support to X X X X assist 9,000 adult Coloradans in reducing their modifiable cardiovascular risk factors by June 30, 2009. 3) Engage participants at moderate and high risk X X X X with local primary care, (enrolling them in health coverage, if eligible and locating a rovider if needed b June 30, 2009. 4) Train and educate 4 new CHWs to provide X X X X screening, health information and education and referrals throu h June 30, 2009. A. Evidence-based justification There is considerable evidence supporting the positive impact of Community Health Workers (CHWs) on the health of diverse populations with hypertension and other chronic conditions.'~2.s.a,s Community-based blood pressure measurement programs improve hypertension awareness and control. Up to one-third of persons whose blood pressures are assessed in community blood pressure programs have elevated levels, and about one third of these are unaware that they have high blood pressure. In addition, community based blood pressure measurement programs identify persons with treated hypertension who have poorly controlled blood pressures. CHWs have contributed to significant improvements in community members' access to and continuity of care, as well as adherence to treatment for the control of hypertension. for over forty years, CHWs have been successful in both screening and detecting hypertension in churches, supermarkets, schools, community based organizations and people's homes.s In fact, employing CHWs for reducing CVD risk and improvin~q outcomes, especially in high risk, minority populations, is considered a best practice. A review of the CHW literature provides support for their role in increasing access to care, particularly in underserved and minority populations.a The Institute of Medicine's x Community Cardiovascular Di se Prevention Program Report on Unequal treatment: confronting racial and ethnic disparities states that CHWs "offer promise as a community based resource to increase racial and ethnic minorities' access to healthcare and to serve as a liaison between healthcare providers and the communities they serve."9 The report recommends supporting CHWs as a strategy for enhancing risk reduction, improving care delivery and implementing prevention strategies. These successful interventions that employ CHWs are culturally relevant, community-based and considered key to public health efforts to address health disparities.10~'~ In addition, CHWs have been shown to improve access to care through the provision of health screening, patient navigation, and referrals to pcps,12,'3.'a promote client knowledge and behavior change, primarily through health education,15.'s and, contribute to improved health status of patients with chronic diseases, such as diabetes and hypertension." Relative to Denver's target population, there is also literature on success in reaching African Americans through beauty and barbershops for nutrition, HIV/STD, cancer and cardiovascular disease education and screening.18~'9~2o.z, An abundance of literature is available supporting the use of the Framingham risk assessment to improve primary prevention of CVD.2 .23.24 Additionally, the program uses the evidence based clinical guidelines for Adult Cardiovascular Disease and Stroke Prevention and Adult Obesity developed by the Colorado Clinical Guidelines Collaborative.25 Evidence-based justification is also available from the previous year and one-half that this project has been operational. To date, the Community Cardiovascular Disease Prevention Program provided screening, CVD risk assessment, health information and education and referrals to primary care and other resources to 4326 individuals in 10 communities. Almost 44 percent of participants were Caucasian, nearly 45 percent were Hispanic and 21 percent African American. An analysis of the screening/assessment data indicates that we are indeed targeting a population at risk for chronic conditions. Over 47 percent of participants were uninsured and 40 percent did not have a medical home. Although over 26 percent of participants had a family history of heart disease, almost 96 percent had never been advised that they were at risk for, or had heart disease. And, 80 percent of participants claimed to have no knowledge of their risk of heart disease. CVD risk factors are evident in this population. Over 39 percent of participants were overweight and almost 36 percent obese. One-fifth of participants reported that they had hypertension and indeed, 12 percent of the participants had blood pressures indicating mild hypertension, 4.2 percent were in the moderate hypertension range and .3 percent had readings indicating severe hypertension. Almost 31 percent had borderline total cholesterol and 15.6 had high cholesterol readings. Using the Framingham risk assessment, 72 percent of participants were at low risk, 21.4 percent were at medium risk and 6.6 percent were at high risk. Of the participants with risk factors, 595 received referrals to primary care providers. Additionally, three individuals were sent directly to an emergency department, and two were sent to urgent care. B. How diagnosis and treatment services will be integrated and coordinated xi Community Cardiovascular Disease Prevention Program Community monitoring programs are, effective only if clients with increased risk for CVD receive appropriate clinical follow-up. In all participating counties, participants with abnormalities in screening andlor at moderate and high risk are referred to primary care services at their community health centers or other local health care agencies for further evaluation and treatment. The CHWs assist those individuals without a medical home in locating a primary care provider (pcp) and also provide coordination and follow up to ensure that these patients get the recommended care. It is estimated that up to 50 percent of participants (4500) may be referred for further evaluation and treatment services. C. Collaboration with other agencies The Community Cardiovascular Disease Prevention Program demonstrates collaboration between community health centers, public health departments, local visiting nursing services, hospitals and community based organizations to share resources, coordinate efforts and avoid duplication of resources. For example, in communities where the subcontract resides in the local public health department or visiting nursing service, collaboration occurs with the community health center in order to refer individuals to a medical home. D. Selected past successful collaborative projects Denver Health Community Voices (CV): The CV project serves as the foundation for the present proposal. The two goals of CV are to increase access to healthcare for the underserved and to change public policy. Primary CV initiatives include Community Outreach, Facilitated Enrollment, Case Management and Men's Health. CV has served as a learning laboratory for creating linkages, leveraging resources, innovation and transformation of healthcare systems, and policy development. CV is currently engaged in numerous successful collaborative projects, including outreach in school-based health centers, pregnancy outreach, men's health outreach and the family/neighborhood health assessment program (described below). The Family/Neighborhood Health Model.• Most recently, The Family/Neighborhood Health Model was implemented by CV in 5 underserved West Denver neighborhoods through a grant from the Office of Health Disparities. CHWs visit each household in their neighborhoods and conduct a brief risk and health assessment for adult family members. Blood pressure, height, weight and BMI are done for each individual. Appropriate health education and referrals to screening and primary care also take place. The CHW follows up with individuals to monitor the completion of screening and reassess for health issues. The main conditions that CHWs assess and monitor include CVD, diabetes, and cancers and associated risk factors. Of note, at the conclusion of the funding from the Office of Health Disparities in 2007, the City and County of Denver, Office of Economic Development, funded the continuation of the program. Currently the results of the first 1200 surveys are being presented to groups of residents in the 5 neighborhoods to spark conversation about future actions to improve health. Community College of Denver (CCD) CHW Education Program: Through CCD, we are providing CHWs with the basic transferable skills necessary to succeed in today's professional work force and to be effective within their individual communities.26 The xii Community Cardiovascular Dis a Prevention Program . existing certificate program has successfully educated and certified four cohorts of CHWS between 2002 and 2007. A fifth cohort of students began the program in the fall of 2007. We are also partnering with UCDHSC on a CCPD grant to expand and enhance the existing CHW curriculum and create a Patient Navigator curriculum (Risendal, PI). Other relevant Federal grants and programs at DH include a USPHS 330 funded Community Health Center Services grant, participation in the BPHC Health Disparities Collaboratives for diabetes, asthma, depression and finance, an NHLBI funded CVD prevention partnership, LUCHAR, and a HRSA Healthy Community Access Program (HCAP) grant. Additionally, a previously funded CDC Phase I REACH grant resulted in community collaborations among 11 health institutions and 6 Community Based Organizations to address diabetes rr~eltitus and CVD in African American and Latino communities. E. List of New Partners This application reflects strong collaboration between numerous organizations. New partners include Uncompahgre Medical Center, San Juan Basin Health Department, Vail Valley Medical Center and Eagle County Health Department and Salud Clinic in Longmont. Each new partner has identified a target, hard to reach, underserved population and will participate fully in the program and evaluation described herein. Letters of participation and support are in the attachments. F. Involvement in the design and implementation Each site solicits participating community involvement. For example, in Denver, the design and implementation of the project is guided by the barbers and beauty shop operators and results of focus groups that were conducted with underserved African American men. In Pueblo, the Neighborhood Associations guide the design and implementation of their program. Additionally, the CHWs employed for this program are community members and advise each community on the best way to reach the selected target population(s). Note: at the request participants and year 1 and 2 sites, we are adding glucose to the screening for year 3. G. Cultural, linguistic and educational appropriateness DH and our partners aim to provide quality health care to our patients with diverse values, beliefs and behaviors, tailoring the delivery of services, information and education to respectfully meet patients' social, cultural and linguistic expectations and preferences. We recognize that race, ethnicity and culture determine the manifestation of illness, coping styles, provider patient interactions, and willingness to seek treatment. DH seeks to employ culturally and linguistically diverse staff: Of 4600 employees, over 40 percent are members of an ethnic minority group and 35 percent of our peps are people of color, the majority Hispanic. Linguistic competency is an important component of cultural competency and interpreters and translation services are available. A majority of the peps and CHWs are fluent in Spanish. All patient education material is available in Spanish and English at a sixth grade reading level. xiii Community Cardiovascular D,~.,ase Prevention Program Significant disparities exist relative to mortality from cardiovascular disease in Colorado.27 Prevalence of associated risk factors of hypertension, overweight and obesity also demonstrate disparities. Barriers to care that influence these disparities include financial barriers, particularly the lack of health insurance, low literacy, fear, and system barriers, including hours of service, language, racial/ethnic congruency and cultural competency, and fragmentation of services.2a,2s Culturally appropriate, community based screening, education and referral to care and other services by CHWs is making progress in reversing these disparities. xiv Community Cardiovascular Di ~e Prevention Program , Part 3: Evaluation Plan FY08/09 Program evaluation is essential to determine effectiveness and to inform and guide ongoing learning, improvement and expansion of the Community Cardiovascular Disease Prevention Program. The evaluation is led by Dr. Deborah Main, Associate Director of the Colorado Health Outcomes Program (COHO) at the University of Colorado Denver Health Sciences Center (UCDHSC). The evaluation uses mixed methods to determine program effectiveness. Program effectiveness is defined as the extent to which the program (1) reaches target populations within participating communities, (2) identiffes people with or at risk for CVD, and (3) improves individual access to needed preventive, early detection and treatment services at local health centers. A. Evaluating Reach Program reach is determined by analyzing data to describe how well the program reaches the target population within each of the sites. Through an analysis of the CWH database, we are able to summarize the number and demographics of people screened, the number provided assistance for accessing health services, the number referred to other community programs or services, and the number referred to primary care. B. Evaluating short-term and intermediate outcomes We will use both descriptive and multivariate analyses to determine the impact of the program. Through an analysis of CHW data and available clinical and administrative data from community health centers, we will determine whether and how the program increased the identification of people at risk for CVD, and increased access to needed preventive, early detection and treatment services for these at-risk populations. We employ quantitative and qualitative methods and include process and outcome measures to address evaluation aims. Data Sources: This evaluation uses primary data routinely collected by CHWs and entered into an electronic database and, when possible, secondary data available through each counties community health center to examine whether those participants identified by CHWs as having moderate or high risk actually accessed health care services. Measures: Primary data are collected by CHWs using a combination of biological measures and self-report measures as part of a health screening and assessment. The assessment includes questions about personal health, health habits, CVD risk factors and presence of CVD. We also collect data on each participant's blood pressure, total and HdL cholesterol, height and weight, with a combination of these data used to identify CVD risk factors (overweight, inactivity, smoking, hypertension, and diabetes mellitus). From these data we calculate a 10 year Framingham Risk score for each participant, which is also shared with participants on their personalized report. For each participant, the CHW writes down their values and Framingham Risk Score on the personalized report form; the report includes a brief description of these values and is available in English and Spanish. CHWs collect data on whether those participants at risk for CVD knew their risk status prior to the screening/assessment - an important indicator for our program. Secondary data entered by CHWs into the database include xv Community Cardiovascular Disease Prevention Program several process measures for tracking participants served: number and demographics of individuals and families participating; number of referrals to primary care; number of screenings for BP, BMI, and cholesterol; and identification and treatment of individuals with CVD. By linking this database with community health center clinical data, we will also gain an account of whether referrals to primary care actually happened and what other services were provided in the DH system, and other community health centers if possible. Evaluation staff from the COHO analyze all data on an ongoing basis to address evaluation aims. Our evaluation is designed to address key questions about program effectiveness and describe the following indicators of program success within and across sites: • Number and description of participants who have never had their risk factors for CVD assessed • Number and description of those screened with identified risk factors. (Id patients at moderate or high risk for CVD using the Framingham of >10 percent) • Number and description of people with risk factors who were referred for healthcare serdices. • Number and description of people with risk factors who received care. • Number and description of people with risk factors who were linked with other community programs and services (e.g., referral to Quitline) • Number and description of people screened who had did not have access to healthcare. • Number and description of people who received help in accessing healthcare, including facilitation of enrollment in publicly sponsored coverage. • Number and description of people who actually sought primary care. Evaluation data are not only used to address primary aims but also for (1) improving our program and (2) providing quarterly customized reports to all participating sites. (1) Program Improvement: Because pen-tablet computers allow us to immediately download screening and contact information, we have been able to identify and track patterns of clinical values, patient demographic information, etc. that we review within the project team and with our community partners to change/improve what we do. For example, we learned in our first year that we were not targeting as many people without insurance as expected -- and shared this in monthly meetings with partners and brainstormed how to increase screening in this important target group. Another example of how we are able to use our data: we noticed that people who reported being told by a doctor that they had high blood pressure had actual BP readings that were inconsistent with their self-reports. In talking with CHWs, we decided to switch to digital blood pressure cuffs. Consequently, our findings have changed in the second year with blood pressure readings more in line with client self-report measures. (2) Quarterly Customized Feedback Reports: During monthly product meetings among all project partners, sites expressed an interest in receiving more information about the screenings, including a more detailed description of their clients. The COHO evaluation team now develops and sends reports to all sites on a quarterly basis, with this information customized based on site xvi Community Cardiovascular Disease Prevention Program needs and requests. These reports are used by partner sites for internal use (for quality improvement) and for sharing/disseminating this information more broadly in the community via newspaper articles, presentations etc. C. State strategic plan objectives This project is consistent with Colorado's state plan relating to CVD, in that it supports efforts to eliminate health disparities in CVD risk management, trains and educates public health workers in CVD prevention and addresses several Healthy People 2010 objectives, such as increasing cholesterol screenin~q, reducing total cholesterol, controlling hypertension and reducing tobacco use.3 Additionally, recommendations for healthy eating and physical activities are consistent with the Colorado Physical Activity and Nutrition Program (COPAN) and Colorado STEPS to a Healthier US grant. D. Tracking and reporting process objectives The process evaluation will determine the extent to which the program is implemented as intended, lessons learned and changes made to the program as a result of lessons learned. For example, the evaluation of year 1 led us to increase referrals to primary care for individuals at moderate and high risk and engage in a quality improvement process for blood pressure measurement. Program implementation is described by collecting a number of process data about our screenings. Through an analysis of the CWH database, we are able to summarize the number of people screened, the number provided assistance for accessing health services, the number referred to other community programs or services, and the number referred to primary care; the CHW database will also include text fields where they can provide more detailed, qualitative notes on their interactions with program participants. In years 2 and 3, we will use qualitative software (Atlas ti) to analyze this information. We will use both descriptive and multivariate analyses to determine the impact of the program. Through an analysis of CHW data and clinical and administrative data from community health centers, we will determine whether and how the program increased the identification of people at risk for CVD, and increased access to needed preventive, early detection and treatment services for these at-risk populations. xvii Community Cardiovascular Disease Prevention Program Part 4: Budget and Budget Narrative FY08/09 r~....e. !`erdfn,mcr~Jn. rliennm nnrl Dulmnnnni nimom (`nmrofffiva (;rnnfc pmn/AT FY90nR-n9 Continuation Budget {July 1, 2008 - Junc 30. 2009) APPLICANT: Denver Health 8 Hospital Authority Community Cardiovascular Disease Prevention Project PROJECT TITLE: SOURCE OF FUNDS Other o u rce' R uested Sauce' Other S ~~ ~p - . V~p}2: a ~ .g, ,' .;~ 4 'x.o- :' ..,+~'`:;:,x° pr+"{Y x: ., ro, - a." r`~.:t~~lY~~~ l " y° §vv"~~9 .nth. - ~~¢¢ ~~ - :~~w i ~"~:.~~~i f ~"~:%~ }: H.',~'~' ~!.•-Y y~c} _~ew.,$~, ~nFl'y°.!i%YK :aSR~. -_ ~hw.~,~t'' ~5 ~ ~te~J".d`,$t~'1V"~tYSi.i 4a Aa r.~. °.. ,~ ~y ~•S m Mouthy Monthly # of Enber name Enter name here PERSONAL SERVICES Position FTE Salary Benefits Months here if if applicable applicable Liz Whitley PI 0.15 $7,259.17 51,793.01 12.0 16,294 50.00 $0.00 Rebecca Hanra Co-PI 002 $12,803.92 S3,162.57 12.0 3,832 $0.00 $0.00 Pedro Arevalo Rincon Pro' r 0.83 $4,52158 51,116.83 12.0 56,159 $000 $0.00 M. Hooker, S. Thomas Comm Hlth Wrkrs 2.00 $2,382.00 $588.35 12.0 71,288 $0.00 $0.00 TBN Research Assist 0.50 $4,167.50 $1,029.37 12.0 31,182 $0.00 $0.00 Subtotals: 178,755 80.00 $0,00 Total Personal Services 178,755 $0.00 x.00 - „ .w' ya:" .~, ..dd.. ~ ~ _ :,. .tub,.. ' 4~~i. .K~j" x-da^"~~" .-e7~ »;: ~"n; '~;r.€:; csJ .. ~+'~" ~f`.3a' «#$,.u. 3SD`-• a ,~:. " ~ ~ ~• -:~ ,;,~. ,,~F-:. ~_. _ z , : ~, ;i+`.*~:i. :wR~; <~t:. . ~ -3.. DIRECT OPERATING COSTS DESCRIPTION Prlntin /Co i 0 $0.00 $0.00 Posta elShi i 1,000 $0.00 $0.00 Tele hone, Fax, IntemetAccess CHW Cell Phones 1,200 $0.00 $0.00 Com uter E ui maul 4 la to com users for CHWs 6,000 $0.00 $0.00 Staff Deveb ant 0 $0.00 $0.00 Meetf Ex uses 750 $0.00 $0.00 Other P ram Cost Office Su lies, Translation 1,570 $0.00 $0.00 Total 0 rata Cost: 10 520 50.00 $0.00 `.,~:. . ._ ., -=;$r£ ctS B e°"; ~.= ~' i •:.._ ;i `~ ~g~-'-$ °''~'~ei~'fi'~ 't $~ ; ( } ""r`.~+,n`~ .,`{'_: ~~~` '~4 ~ ~F `~i -"r'~„•~.;_ ° `"'t,." ,~`"~ gir ~ v , y e . ,?.. . . m.s; ~ ~~ tN', . ~ 1t, {-1=~' ~:,, f ~ i'. A~.Y~.. , A S. . •.Tb:~.<~; „ +$ / i.J - . a trby^4t TRAVEL DESCRIPTION In-State On CHW Conference and Education, Local Milea a 14,747 $0.00 $0.00 Total Travel Costa 14,747 50.00 $0.00 _ " } .'i i :'y">+~g" mss' ". • a~ •`.4,~*''-~ -,,,. ._, siw~; .,f"' !.` " CONTRACTUAL DESCRIPTION Consultant 0 $0.00 $0.00 ConVad Trainers/S akers 0 $0.00 $0.00 XVill Community Cardiovascular Disease Prevention Program subcontractors ns,142 $0.00 $o.oo Togl Contractual Coats 776142 $0.00 $0.00 - ~ ~" ~~.~'~ ~.`~ '' - ~ :~~ ,~r ~- ~. gyp.,. ' 'p: ~5.s ,r '~' "Fi:~~i~r .~ ~,X;p•.• "5x ~'r~. '.Y "y....~,m~yyY.tt ~ a r° , s', ~;f•~~yY t~~r~,~.'~+ d" t :... ' ~ Y „=; ~ `:+,' ,sac - . =" % p ~ ~..-, '~•x a°.~~`~t ~ , :. ,r..,, ,~ ~, R3 ;~'~"~!~ J";'i~-. 4 , _i Y,:,,~. .~,*, s ~ .n. ~' ,wJ"~ Xq .~~x8, _ -•M"4,'•w „~a-~'yD: e.y ~'e°af „r°4M'.'e .'~s d+~L ~ A ~,.a ~s; ~ . a , :,•p.. ,-n ~54'~ina OTHER COSTS DESCRIPTION Marketin (Media General Marketi and Promotional Materiab 12,000 $0.00 $~•~~ OutreachlEducetional Materials AHA, General General Health Materials 6,250 $0.00 $~•~~ Evaluation 0 $0.00 $0.0~ Screeni 131,492 $0.00 $Q•~ Treatment 0 ~•~ ~~'~~ Total Other Coats 149 742 $0.00 S~•~~ - ~x.-v~,a r^;y;r ~ , ~, ~ "~: ~ . 1;'+e .~e.a•'+F• ye ••`y~„•:U. ; s5~.,' «~ ~r ~+," ~.-. 1.'t'« ~'»y ": ~..: `.7 ,.f, ,yam ri ~ .w,._w,` <s: ~ t~.~ ~ f • ,~pti .. Y " ` •("' f~` ~ Fi >.a ~9d N'~ # f "6~~w ~ .. ! ° ~ 5'~ ' ~ * ~~ s ~ , z., a~^~"~'~ ,'~c _ ^~~ Y' p.:~",4;#~3 ~ •,Z} <•, '' • ' f.x ~: p ~i=` . ' ~^. , e .( f ~ r ,, d ~ E N i `e~,, a c «:1 4:t7 ,, tr :`•.z : ,~ °y°s± r,,zl^ ; L3, ~ ~ d,„$ i $' SUBTOTALS 1129,906 SO.00 ~~•~Q ''' d"' ac°n ~' ~ ' ^~ " ~ ~I ~ ~#~ ~ EC " ~ ~l j '~'.t~ aa rv . a 4*r N7 4 ,.~ INDIRECT COSTS: 2% Contractual 15,523 INDIRECT COSTS: 20% Personal Services, 0 rati ,Travel and Other 70,753 Total Indirect Cost Cskulated on Amount nested from CDPHE On 86,276 •g. 'gym= < "a ^ .•9' ey,.` .~' i ` ~ ~,rY..". ,~ h z i 38~ ~d TOTAL AMOUNT REQUESTED FROM COPHE $1,216,182 ~ ~~~ ~ ~~ 'Other. Please indicate additional revenue ff applicable, Rev. Signature of Authorized Re resentafive Date 12.11.07 xix Community Cardiovascular Disease Prevention Program Budget Narrative Year 3: Julv 1.2008 through June 30.2009 Principal Investigator Elizabeth Whitley, Ph.D., RN (:15 FTE) will provide oversight for the program and coordination of the CHW orientation and CCD education program. Salary calculation is $1,0891month or $13,0671year. Medical Director Rebecca Hanratty, MD (.02 FTE) will provide clinical consultation to the project. Salary calculation is $256.08/month or $3,073/year. Program Manager Pedro Arevalo Rincon (.83 FTE) will manage the proposed program statewide and implement the Denver intervention. Salary calculation is $3,753/month or $45,035/year. CHWs Stanley Thomas and Mark Hooker (2 FTEs) will deliver the proposed intervention in Denver. Salary calculation is $2,382/month or $28,584/year each. Research Assistant To be named (.50 FTE) will be responsible for review of system utilization data and cost effectiveness determination. Salary calculation is $2,083.75lmonth or $25,005/year. Fringe Benefits Fringe benefits at DHHA are calculated at negotiated fringe benefits rate of 24.7% of salaries, $36,345. • Postage, for mailing equipment and correspondence, $1,000 • Local Cell Phone: service for CHW connectivity with CV and clients, 2 phones @ $50/month/phone @ $1,200. • Tablet computers: for data entry for each new CHW: 4 @$1,500, for a total of $6,000. • Translation: for Spanish translation of promotional and educational materials @ $70 • Office supplies to: support administration of program @ $1,500 • Local Meeting Expenses: for facility charges and food for community meetings, $750 Annual 2 day conference in Denver: 4 sites: 4 CHWs and 4 supervisors Lodging, Town Place, 16 units @ 99/night, $1,584 Meals at conference, 16 units @ $51/day, $823 Mileage: for individuals to carpool to Denver, 2,564 miles @ $.39/mile @ $1,000. xx Community Cardiovascular Disease rrevention Program CCD classes: 2 weeks in Denver for 4 CHWs: Lodging Town Place: 40 units @ $99/night $3,960 Meal per Diem: 40 units @ $51/day, $2,040 Mileage: 6,000 miles @ $.39/mile @ $2,340 Local Mileage visiting barbershops and site visits: 7,692 miles @ $.391mi1e @ $3, 000. 2. University of Colorado Denver Health Sciences Center; $49.101 /vear ^ Debbi Main, Ph.D., (.10 FTE) Dr. Main will be responsible for the evaluation. $19,530 ^ Greg Higgins: (.08 FTE) computer programmer for tablet computers. $ 5,414 ^ Quantitative Analyst, to be named, (.15 FTE) to analyze program data $9,734 • Qualitative Analyst, fo be named, (.10 FTE) to analyze program data $6,240 ^ Indirect Costs @ 20 % of direct costs, $8,182 3. Community College of Denver: $14,200/vear ^ Tuifion, books and fees for 4 CHWs X $2,300/17 credit hours, $9,200 ^ Coordination fee to work with local community colleges: $5,000. 4. Mountain Family Health Center: $ 56,323/year ^ Supervisor, (.05%) to oversee implementation of intervention $4, 368 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $38,480 ^ Mileage, for local travel, 7405 x .39, $2,888 ^ Cell Phones for connectivity with community health centers and patients, $600 • Office/Medical Supplies, $600 ^ Indirect Costs @ 20 % of direct costs, $9,387 xxi 1. Barber Gonswtancs tuenver~: ~ ~~,~.,~~~~~a~ • 20 Barber Shops @ 1, 000 each = $ 20, 000/year Community Cardiovascular Disease Prevention Program 5. High Plains Community Health Center: $ 48,410/year ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $5,991 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $31,150 • Mileage, for local travel, 2051 x .39, $800 ^ Cell Phones, for connectivity with community health centers and patients, $600 • Office/Medica/ Supplies, $600 ^ Postage/shipping to promote program, $200 ^ Advertising/marketingto promote program $1,000 ^ Indirect Costs @ 20 % of direct costs, $8,068 6. Mesa County Health Department: $ 51,072/year ^ Supervisor, (.25 FTE) Supervisor will oversee implementation of intervention $6,760 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $33,280 ^ Mileage, for local travel, 3384 x .39, $1, 320 ^ Ce/1 phone, for connectivity with community health center and clients, $600 ^ Office/Medica/ Supplies, $600 ^ Indirect Costs @ 20 % of direct costs, $8,512 7. Pueblo City/County Health Department: $ 61,7821year ^ Supervisor, (.20 FTE) Supervisor will oversee implementation of intervention $7,008 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $39,178 ^ Mileage, for local travel, 5128 x .39, $2000 ^ Cell Phones, for connectivity with community health centers and patients, $2,000 ^ Local meeting expense, $500 ^ Olfice/Medica/ Supplies, $600 ^ Postage/shipping to promote program, $200 ^ Indirect Costs @ 20% of direct costs $10,297 8. Sunrise Community Health Center: $52,155/year ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $5,824 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,538 ^ Mileage, for local travel, 4615 x .39, $1800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 xxii Community Cardiovascular Disease Prevention Program ^ Indirect Costs @ 20% of direct costs $8,692 9. Salud Family Health Centers: $ 51,918/year . ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,006 ^ Community Healfh Worker, (1.0 FTE) will deliver the proposed intervention $34,159 ^ Mileage, for local travel, 4615 x .39, $1,800 • Cell Phone, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 • Indirect Costs @ 20% of direct costs $8,653 10. Northwest Colorado VNA: ~. 60.216/near • Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,760 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $40,560 ^ Mileage, for local travel, 4615 x .39, $1800 ^ Cell Phones, for connectivity with community health centers and patients, $360 ^ Office/Medical Supplies, $700 ^ Indirect Costs @ 20% of direct costs $10,036 11. Metro Community Providers Network: $ 51,918/year • Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,006 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,159 ^ Mileage, for local travel, 4615 x .39, $1,800 ^ Cell Phone, for connectivity with community health centers and patients, $600 ^ Oflice/Medical Supplies, $700 ^ Indirect Costs @ 20% of direct costs $8,653 12.Otero County Health department: $ 51,860/year ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,006 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,111 ^ Mileage, for local travel, 4615 x .39, $1, 800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 • Indirect Costs @ 20% of direct costs $8,643 xxiii • . `~ Community Cardiovascular Disease Prevention Program 13.Uncompahgre Medical Center: $ 51,797/year • Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,064 • Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,000 ^ Mileage, for local travel, 4615 x .39, $1,800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 ^ Indirect Costs @ 20°l0 of direct costs $8,633 14. San Juan Basin Health Department: $ 51.797/year ^. Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,064 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,000 ^ Mileage, for local travel, 4615 x .39, $1,800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 ^ Indirect Costs @ 20% of direct costs $8,633 15. Salud Clinic in Longmont: ~51,797/year ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,064 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,000 ^ Mileage, for local travel, 4615 x .39, $1, 800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 ^ Indirect Costs @ 20% of direct costs $8,633 16. Vail Valley Medical Center: $ 51,797/year ^ Supervisor, (.10 FTE) Supervisor will oversee implementation of intervention $6,064 ^ Community Health Worker, (1.0 FTE) will deliver the proposed intervention $34,000 ^ Mileage, for local travel, 4615 x .39, $1,800 ^ Cell Phones, for connectivity with community health centers and patients, $600 ^ Office/Medical Supplies, $700 ^ Indirect Costs @ 20% of direct costs $8,633 xxiv Community Cardiovascular Disease Prevention Program ' -• 1. Screening 5uppues: ~s~,4a~ • Meter Cassettes: 988 boxes @ $113.09 each, $111,732 • Other supplies for cholesterol checks, $13,000 • Cholesterol Meters: 2@ $2,000, $4,000 • Stadiometers 4 @ $150 each, $600 • Blood Pressure Kit: regular adult, 8 @ $50 for blood pressure measurement, $400 • Blood pressure cuffs large: 8 @ $25 for blood pressure, $200 • Stethoscopes: 4 @ $ 50, $ 200 • Scales:4 @ $40 for measurement of weight, $160 • General Medical Supplies @ $1,200 2. Outreach/Education Materials: $ 6,250/near. • Brochures, from AHA, NHLBI, NCEP in English and Spanish @ $25./250: $6,250 3. Marketing/Media: ~ 12,000/near. Marketing, for development and production of promotion materials for all 14 sites: $12,000 Funding to cover grants management, administrative support and other indirect expenses is calculated @ 20% of total direct costs ($353,765 x 20% _ $70,753). Funding to Cover Contractual Costs - 2% of Contractual Costs ($ 776,142 x 2% _ $15,523). xxv Community Cardiovascular Disease Prevention Program References ~ Krieger, J., Collier, C., Song, L., Martin, D. Linking Community-based Blood Pressure Measurement to Clinical Care: A Randomized Controlled Trial of Outreach and Tracking by Community Health Workers. AJPH (1999): 6(89) 856-861. 2 Fedder, D., Chang, R., Curry, S., Nichols, G. 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Circulation, (1998); 97:1837-47. 24 Grundy, S., Pasternak, R., Greenland, P., et al. Assessment of cardiovascular risk by use of multiple risk factor assessment equations: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation, (1999): 100:1481-92. 25 2006 Guidelines for Adult Obesity and 2007 Adult Cardiovascular Disease and Stroke Prevention Guidelines, Colorado Clinical Guidelines Collaborative. Zs Whitley, E.M., Drisko, J., Everhart, R.M., Samuels, B.A. Standardized academic education prepares competent community health workers. (2007). American Journal of Health Studies. 22(2), 121-126. 27 Racial and Ethnic Disparities in Colorado 2005. Colorado Department of Public Health and Environment. 28 Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington D.C., 2002. 29 Whitley, E., Samuels, B., Wright, R, et al. Identification of barriers to healthcare access for underserved men in Denver. (2005). Journal of Men's Health & Gender. 2(4):421-428. 30 Colorado Heart Healthy and Stroke Free: Reaching the Future 2005-2010. Colorado Department of Public Health and Environment, May 2005. xxvii