Center for Health Promotion and Disease Prevention

描述（由申请人提供）：本建议是继续UNC现有的PRC（健康促进和疾病预防中心- HPDP）的工作，但通过开发和测试技术辅助社区卫生工作者实施心血管疾病预防策略，将新的重点放在社区和卫生保健工作之间的联系上，以预防和控制疾病（CDC领域4），最初的重点是低收入，农村社区，有大量服务不足的少数民族。为了支持这一努力以及本中心通过高质量研究加强公共卫生实践的更广泛的工作，HPDP将在传播和实施（D&I）研究方面建立新的能力，增加教师在系统动态建模和卫生服务研究方面的专业知识。此外，在医疗信息技术和以病人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攸关方合作，传播ebi，并建立公共卫生从业人员实施针对各级社会生态模式的ebi的能力。该中心将以过去25年的社区合作为基础，解决与心血管疾病预防和治疗最相关的可打赢的战斗——营养、体育活动、肥胖和烟草。我们的工作将以NCCDPHP （CDC）战略重点（卫生公平，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，赋予个人健康选择）为指导。目前，人们普遍认为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对慢性疾病风险因素有显著影响的潜力，但诊所和公共卫生部门与社区卫生工作者合作的协调项目尚未得到充分的测试。该提案的应用研究项目被称为CHANGE (Carolina Heart Alliance network for Greater Equity)，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；进行前后比较，以评估执行情况和有效性；与三个匹配的对照诊所相比，进行匹配对照前后比较，以评估CHANGE策略对控制胆固醇和血压的诊所总高危人群比例的影响；最后，通过在另一个社区中复制CHANGE策略，确定其核心组件，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策略的采用，从而规划将CHANGE策略扩展到规模。

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.