Center for Health Promotion and Disease Prevention

描述（申请人提供）：这一建议是为了继续联合国现有的审查委员会的工作，（健康促进和疾病预防中心- HPDP），但新的重点是社区和卫生保健工作之间的联系，以预防和控制疾病（CDC域4），通过开发和测试一种技术-协助社区保健工作者执行预防心血管疾病战略，最初重点是低收入、有大量得不到充分服务的少数民族人口的农村社区。为了支持这一努力和更广泛的工作中心在其作用，以提高公共卫生实践通过高质量的研究，HPDP将建立在传播和实施（D&I）研究的新能力，增加教师在系统动态建模和卫生服务研究的专业知识。此外，在健康信息技术和以患者为中心的医疗之家方面具有研究和实践经验的教师将加入该团队。该中心将与全州的利益相关者合作，传播EBI，并建立公共卫生从业人员实施EBI的能力，这些EBI针对社会生态模型的各个层面。该中心将建立在过去25年的社区合作基础上，以解决与CVD预防和治疗最相关的可赢得的战斗-营养，体育活动，肥胖和烟草。我们的努力将遵循NCCDPHP（CDC）战略优先事项（健康公平，研究翻译，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，赋予个人健康选择权）。目前，人们普遍认识到初级保健与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对慢性病风险因素产生重大影响的潜力，但与社区卫生工作者合作的诊所和公共卫生部门之间的协调计划尚未得到充分测试。该提案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，以利用诊所和公共卫生部门的互补优势，通过技术辅助的社区卫生工作者进行协调，从而扩大临床和社区多层次循证干预的范围和有效性。研究设计包括形成性数据收集，以完善CHANGE策略;前后比较，以评估实施情况和有效性;匹配对照前后比较，以评估CHANGE策略与三个匹配对照诊所相比对胆固醇和血压得到控制的诊所总风险人群比例的影响;最后，计划通过在一个额外的社区复制它，确定其核心组成部分，创建和传播复制工具包，并通过NC的多个临床，公共卫生和研究网络促进该战略的采用，从而将CHANGE战略扩展到规模。

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.