Center for Health Promotion and Disease Prevention

描述(由申请人提供)：这项建议将继续北卡罗来纳大学现有的PRC(健康促进和疾病预防中心-HPDP)的工作，但新的重点是社区和医疗保健努力之间的联系，以预防和控制疾病(CDC领域4)，通过开发和测试技术辅助的社区卫生工作者心血管疾病预防实施战略，最初重点是低收入、农村社区和服务不足的少数民族人口众多。为了支持中心通过高质量研究加强公共卫生实践的这一努力和更广泛的工作，HPDP将在传播和实施(D&I)研究方面建立新的能力，增加系统动态建模和卫生服务研究方面的教师专业知识。此外，在健康信息技术和以患者为中心的医疗之家具有研究和实践经验的教师将加入团队。该中心将与全州的利益攸关方合作，传播EBI，并建设公共卫生从业人员的能力，以实施针对所有级别的社会生态模型的EBI。该中心将在过去25年的社区合作基础上，解决与心血管疾病预防和治疗最相关的可赢的战斗--营养、体育活动、肥胖和烟草。我们的努力将以美国疾病控制与预防中心(CDC)的战略优先事项(健康公平、研究转化、系统解决方案和可持续性)和国家预防战略(健康的社区环境、优质的预防服务、增强个人健康选择能力)为指导。目前，人们普遍认识到初级保健和公共卫生之间的协调存在差距。社区卫生工作者已经证明了显著影响慢性病风险因素的潜力，但诊所和公共卫生部门之间与社区卫生工作者合作的协调计划尚未得到充分测试。这项提议的应用研究项目被称为Change(卡罗莱纳心脏联盟网络促进更大公平)，旨在创建和测试新的结构，以利用通过技术援助的社区卫生工作者协调的诊所和公共卫生部门的互补优势，从而扩大临床和社区多层次循证干预的覆盖范围和有效性。研究设计包括形成性数据收集，以完善变化策略；事前比较，以评估实施和有效性；配对对照，事前比较，以评估变化策略对诊所总高危人群中胆固醇和血压得到控制的比例的影响，与三个匹配的对照诊所相比；最后，计划采取变化策略以扩大规模，在另一个社区复制它，确定其核心组成部分，创建并传播复制工具包，并通过NC的多个临床、公共卫生和研究网络促进该策略的采用。

DESCRIPTION (provided by applicant): 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.