Project Charter: Pediatric Weight Management 862-04
Project Overview:
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Project Dates
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Year 1: 1/1/2019 – 7/31/2019
Year 2: 8/1/2019 – 7/31/2020
Year 3: 8/1/2020 – 7/31/2021
Year 4: 8/1/2021 – 7/31/2022
Year 5: 8/1/2022 – 7/31/2023 (Final Year)
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Funding Organization
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CDC
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Technical Project Officer
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Goodman, Alyson B. (CDC/DDNID/NCCDPHP/DNPAO)
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Executive Sponsor
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Kathy McNamara, Associate VP, Clinical Affairs, NACHC
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Project Lead
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Sarah Price, Deputy Director, Clinical Integration and Education, NACHC
Description:
Obesity is a major public health issue in the United States with 20 % of children and 40 % of adults obese in 2020, resulting in 150 billion dollars in health care spending annually. Childhood overweight and obesity affects 1 in 4 children ages 2-5 years, the rate of monthly BMI change almost doubled for children 6-10 during the COVID 19 pandemic and the US is expected to have 17 million obese children by 2030.
In Year 5, the National Association of Community Health Centers (NACHC) will continue work in 7 areas to improve health centers’ ability to respond to pediatric wellness and weight management in health centers and in their communities. NACHC’s proposal, to Pediatric Weight Management in Community Health Centers includes a package of responses mechanisms:
· Multi State Strategy using evidence- based programs such as Mind, Exercise, Nutrition and Do it (MEND) with new models of virtual curriculum and family engagement.
· A virtual evidence-based curriculum for health centers getting started in pediatric weight management in primary care from ages 0-18 and aligned with the new AAP new guidelines.
· Validation of a progressive childhood obesity metric beyond the BMI from prevention to treatment.
· Partner with CDC to initiate a clinical and community data initiative (CODI 2.0) in North Carolina.
· Use of FHIR technology to scale and spread evidence based pediatric programs such as Bright Bodies.
· An analysis plan to improve further understand anemia and Iron Deficiency screening practices
· A communication strategy to highlight promising practices to disparities of childhood obesity
NACHC Buy in: NACHC will guide and work with HCCNs and their participating health centers through a process to support intervention prioritization, assessment of interventions using an implementation science framework, learning, and best practice sharing. HCCNs and their participating health centers will also have access to virtual peer learning events, experts from the field, and additional training and resources to translate evidence-based and emerging successful strategies into practice.
Goals and Performance Measure:
Case for Change:
Clinical Rationale: Child obesity doubled since quarantine/COVID
Project Approach:
Phase 1 & 2:
Measures of Success? Maybe as an addendum - vs critical success - do we need both?
No learning community - not every project has one - PWM - legacy teams and national series
Intervention Framework: AAP guidelines/CDC (project dependent)
Project Scope:
Project Staff Resources Requirements:
HCCN
PCA
Health Centers
Role/Responsibilities (table)
Appendix:
Nita's (Alliance Chicago) work - feed in dashboards/data
Project Scope
Target Population:
Community Health Centers
Year 5 Deliverables (draft):
Implement 2-4 cohorts of families (10-week intervention could easily be done 4x by sites that have a good system in place now. And that helps increase reach). And funding could be scaled based on how many they say they are able to do?
Participate in data collection and evaluation efforts:
Reach and effectiveness (via patient- and family-level surveys and EMR pulls)
Implementation science metrics (via RE-AIM/PRISM)
Qualitative data from participants and/or staff (details TBD)
Participate in/ provide technical assistance PRN regarding sustainability and reimbursement opportunities
Participate in opportunities to disseminate best practices and lessons learned from COMMIT years 1-5 (conferences, workshops, posters, virtual presentations, etc)
Contribute to a facilitation guide that highlights best practices for implementation of intensive PWMI/FWMIs in health centers
Partner Responsibilities:
· CODI 2.0: NACHC will continue to work with CDC, Mitre, Duke and multiple state and community partners to advance clinical and community data capture, analytics and reporting.
· Curlew Consulting: Work with CODI 2.0 Data Partners on PPRL.
· Multi State Legacy Teams: NACHC will continue to collaborate primary care associations, and large health centers to continue to implement statewide evidence-based models for pediatric weight management include alternative payment models, use of health care team extenders.
· National Virtual Curriculum for health centers will include collaborative partnerships with AAP, health centers pediatricians who are members of AAP to implement pediatric weight management in primary care. Multiple strategies may be employed including leveraging national, state, and health center infrastructures.
· NQF Measure Development and Validation: NACHC will partner with national subject matter experts, health center pediatricians, academics, and seasoned informatists to advance the design and recommendation of a new measure to enhance the BMI. New recommendation will build on results of year 4 and address social drivers of health and referrals.
· Iron Deficiency Analytics Plan: NACHC will partner with one HCCN and member health centers and academic partners to explore the landscape for data available for pregnant women and children 6-23 months with recommendations for next steps.
· FHIR App for Scale and Spread of Bright Bodies. NACHC will continue to support the spread and scale of Bright Bodies in health centers through use of the FHIR app.
· McKinstry Consulting to share best practices through social media.
· Legacy Team Learning Collaborative and Coaching with Denver Health and Hospitals with Jessica Wallace as the lead.
· Multi-State Legacy Teams (COMMIT) engaged in learning community include: Borinquen, El Rio, IL PCA, MS PCA to advance and reimagine evidence based pediatric weight management interventions based on MEND.
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· AllianceChicago for validation testing of NQF measure and Iron Deficiency Data Analytic Plan.
· Yale University for scale and spread of Bright Bodies through FHIR app.
NACHC Offerings: NACHC will guide and work with HCCNs and their participating health centers through a process to support intervention prioritization, assessment of interventions using an implementation science framework, learning, and best practice sharing. HCCNs and their participating health centers will also have access to virtual peer learning events, experts from the field, and additional training and resources to translate evidence-based and emerging successful strategies into practice.
Goals and Performance Measures:
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Performance Measure
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Project Goal
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Stretch Goal
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Notes
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Activities*
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Process Measures*
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Outputs*
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Continue with the
Multi State strategy working with AZ, MS, IL, Fl using evidence based pediatric weight interventions such as MEND and innovations captured through COVID 19 Pandemic. This will include:
a. Virtual learning collaborative calls for participating primary care associations and legacy health centers.
b. One to one coaching calls to include evidence based best practices, dissemination and implementation science, business models and recommendations for scale and spread.
c. Highlight evidence based Best Practices from other sectors such as CORD, Bright Bodies, state initiatives and other health centers.
d. Standard data elements to measure improvement and evaluation.
Conduct two evidence based
National Virtual Curricula for health center getting started . This will include:
a. Working with AAP members and health center pediatricians.
b. Informing of new AAP Clinical Guidelines.
c. a virtual curriculum with expert faculty for health centers
d. Evidence based tools and resources
e. program evaluation
Validating a new
NQF Measure recommendation in HCCN, health centers and with multiple sector partners.
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PM 1. Number of Legacy Teams engaged in year 5.
PM 2. Number of national virtual curriculums conducted for health centers and number of health centers engaged.
PM 3. Number of NQF validation testing elements and the results.
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O 1. Summary report highlighting findings of Legacy Teams from Borinquen, El Rio, Il, and MS.
02. National virtual curriculum results and lessons learned.
O3. Results of NQF validation and final recommendation.
Project Approach:
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Project phases include readiness activities (Phase 1), implementation (Phase 2), and Harvest and Evaluation (Phase 3)
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TASK
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PHASE
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HCCN
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HC
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MEASURES OF SUCCESS
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Attend Launch Meeting
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1
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X
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X
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100% attendance and participation on Launch Call on August 9, 2022.
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Create a core project team
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1
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X
X
X
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X
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2 HCCN project leads identified (QI, data, etc.)
Identified 2-4 health centers
2-4 member health center project teams engaged: project lead, clinical champion, QI lead/care coordinator, data lead
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Complete Project Readiness Tasks
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1
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X
X
X
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X
X
X
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Reviewed BPAA Roadmap with participating health centers
Identified and documented priority roadmap interventions
Scheduled clinician training
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Attend required project calls
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1,2,3
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X
X
X
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X
X
X
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100% attendance and participation in virtual Learning Community:
Bi-monthly Town Halls and
Bi-monthly Check-in Calls,
Million Hearts® Learning Lab (at least 3 sessions: Sep ‘22 – May ‘23).
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Configure reporting systems to report monthly monitoring measures
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1
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X
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HIT systems (EHR and/or population health management system) ready to report
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Report monthly monitoring measures
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1, 2, 3
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X
X
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X
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Data validated and submitted by the 10th of each month (Aug ‘22 – Jun ‘23)
Key activities annotated monthly on run charts
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Set health center performance goals.
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X
X
X
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X
X
X
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Project goals reviewed
Current performance on project measures reviewed
Health center goals and stretch goals for 7/31/2023 established based on project goals and current performance
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Implement prioritized evidence-based intervention strategies to optimize care processes and improve outcomes.
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X
X
X
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X
X X
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Analyzed and redesigned workflows
Identified quality improvement activities using the BPAA roadmap
Identified and secured training, educational materials, and other resources to support implementation and scaling efforts.
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Implement spread and scale plan
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X
X
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Developed spread and scale plan for disseminating
Disseminated successful evidence-based strategies, implementation approaches, tools, resources, and tips for success to all member health centers.
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Use BPAA Roadmap to identify and prioritize interventions
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X
X
X
X
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X
X
X
X
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Reviewed information flows to implement prioritized roadmap interventions
Completed intervention testing, reporting and data-driven improvement
Submitedt/updated bi-monthly RE-AIM reports to assess interventions
Completed assessment
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Support NACHC in disseminating content to promote Million Hearts® strategies
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X
X
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Shared change packages, podcasts, videos with all health centers
Shared successes and best practices during Town Hall Calls, Learning Labs, SMBP Forums, etc
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Attend Harvest Meeting in June 2023 (date TBD) in Bethesda, Maryland
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X
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X
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Registered and made travel arrangements for max 2 HCCN Leads
Registered and made travel arrangements for max 1 HC representative
Submitted timely and complete pre-work for Harvest Meeting
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Complete final reporting
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X
X
X
X
X
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Submitted monitoring Data Report (through 6/30/2023)
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Submitted final run Chart (through 6/30/2023)
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Submitted limited Data Set of EHR patient-level data extraction for post-project evaluation (data elements will be specified on a separate data request) (through 6/30/2023)
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Submitted de-identified EHR patient-level data (through 6/30/2023)
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Project Charter: Supporting Health Centers to Reduce Disparities in Adult Immunizations 877-02
Table of Contents | ||||||
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Project Overview
Project Dates | 877-01 (Year 1): 1/1/2021 – 7/31/2022 877-02 (Year 2): 8/1/2022 – 7/31/2023 |
Total funding available per health center | 50k per phase (2 phases total) *not including any carry over money your health center may have from 877-01 (Year 1) |
Funding Organization | CDC |
Project Lead | Sarah Price, Deputy Director, Clinical Integration and Education, NACHC |
Project Manager | Naomi Smith, Manager, Clinical Integration and Education, NACHC |
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Contact Information
Name | Role | |
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Sarah Price | Deputy Director/Project Lead | sprice@nachc.com |
Naomi Smith | Project Manager/Point of Contact for all administrative concerns (non content related) | nsmith@nachc.com |
Nikki Navarrete | CCI Project Lead - for all content, schedule, live/async question comments or concerns | |
Hasna Soulhi Andrea Arthur Stacia Andre | NACHC Finance Team - for all budget/invoice/money concerns |
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Learning Series Dates and Resources
Please set aside Wednesdays from 12:00- 1:30pm PT from mid-October 2022 to January 2023 for LIVE and ASYNC sessions. · Participating teams are expected to attend LIVE sessions, which take place on Wednesdays from 12:00- 1:30pm PT. · Teams will watch several short video lessons and connect with their coaches on ASYNC weeks. | ||||
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Week 1 |
Week 2 |
Week 3 |
Week 4 |
OCT | 5th | 12th | – LIVE – START HERE: Zoom link Agenda: Welcome Back; Phase 2 plan Analogous Examples Recording: | – ASYNC Agenda: Creating Concepts Solution Directions Recording: |
NOV | – LIVE: Zoom link Agenda: Solution direction share & feedback Recording: | – ASYNC Agenda: Prototyping to test Brainstorm what you could try Recording: | – LIVE- Zoom link Agenda: Crate your prototype (a test idea) Recording: | 23rd – OFF Thanksgiving |
DEC | – LIVE - Zoom link Agenda: Prototype Test Feedback Test in community Recording: | – ASYNC Agenda: Office Hours Prototype & Testing advice Recording: | – LIVE - Zoom link Agenda: Prototype testing share & feedback Recording: | – ASYNC Agenda: Draft 7-part presentation Recording: |
JAN | 4th – OFF
| – LIVE -Zoom link Agenda: Get feedback on 7-part presentation Recording: | – ASYNC Agenda: Feedback on 7-part presentation Finalize 7-part presentation Recording: | – LIVE - Zoom link Agenda: Final presentation Recording: |
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Finance 101
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Important Finance Documents | |||||
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Vendor Information Form |
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Contract Redline Review |
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Budget Template Budget Tips |
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Invoice Instructions document |
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Scope of Work Template |
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Invoice Instructions
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Important links and resources
Health Center Name | Confluence Page | Miro Page |
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Scope of Work
Contractor: | ______________ |
Contact: | Name: ______________ Title: ______________ Email: ______________ Phone: ______________ |
Signatory | Name: ______________ Title: ______________ Email: ______________ Phone: ______________ |
Reports To: | Sarah Price, Clinical Affairs Division, NACHC |
Funding Source: | Centers for Disease Control and Prevention, 877-02 |
CFDA #: | 93.421 Strengthening Public Health Systems and Services through National Partnerships to Improve and Protect the Nation’s Health |
Time Period: | October 1st 2022, to July 31st, 2023 |
Project: | Supporting Health Centers to Reduce Disparities in Adult Immunization |
Fee: | ______________ |
Scope of Work
Overview
This scope of work addresses the significant disruption by COVID-19 to the nation’s public health and healthcare infrastructure. Community health centers serve as the safety net to the highest-risk patients and often serve as first responders to emergencies such as hurricanes, fires, and public health crises.
The National Association of Community Health Centers (NACHC) proposes to engage local health centers as trusted brokers to build the evidence base of effective interventions to reduce disparities in adult vaccination rates amongst diverse populations (homeless, mobile, rural, refugees, behavioral health, LGBTQ, farmworker, non-English speakers, immigrants etc.). NACHC’s approach will include a package of mechanisms to contribute to the evidence-based messaging and models:
· Grants to health centers who serve high risk patient populations to engage patients and community partners to co-create communication and interventions that add value to patients’ health and wellness.
· Establish a learning community of grantees to use human centered design and design thinking to engage patients and communities ensuring it is culturally responsible, scalable, and sustainable to implement strategies to increase vaccine rates amongst high risk and vulnerable populations.
· Engage public health, community-based organizations, faith-based groups, food banks, REACH, employers, barber shops, contractors to collaboratively address vaccine adoption across individual community eco-system for high-risk populations.
Deliverables
Deliverable 1: Participate in monthly learning sessions and coaching calls
Every month, participant attends 100% of all learning sessions and coaching calls
Tasks/Activities:
Administrative
a. Meet at least monthly with NACHC/CCI/coach to review strategy and progress against project goal(s).
b. Participate in scheduled learning session(s)
c. Share lessons learned, facilitators, barriers, and best practices with other health centers during learning sessions
Products
a. Monthly NACHC/CCI/Coach/Health Center meeting notes
b. All-participant workshops minutes and outcomes
c. Summary of lessons learned, challenges, and best practices
Due Date: February, 2023
Amount: ____________________________________________
Deliverable 2: Learning Session Activities
Tasks/Activities:
Administrative
a. Complete 100% of pre-and post-learning session activities
b. Monthly summary report using template
Products
A. At least one (1) designed prototype
B. Documented feedback and iteration of at least one (1) prototype
C. 7-part presentation to team sponsors
D. Participate in final summary evaluation
Due Date: February, 2023
Amount: ____________________________________________
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Project Approach
| Roadmap Planner | ||||||||||||
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TASK | PHASE | FQHC/Community Partner | MEASURES OF SUCCESS |
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Meet at least monthly with NACHC/CCI/coach to review strategy and progress against project goal(s). | 1 | X |
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Participate in scheduled learning session(s) | 1 | X |
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Share lessons learned, facilitators, barriers, and best practices with other health centers during learning sessions | 1 | X |
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Complete 100% of pre-and post-learning session activities | 1 | X |
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Monthly summary report using template | 1 | X |
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Phase 2 | |||
TASK | PHASE | FQHC/Community Partner | MEASURES OF SUCCESS |
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NACHC Offerings:
Activities* | Process Measures* | Outputs* |
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