Overview of Notice of Funding Opportunity (NOFO)

Q: Can you please describe in detail the eligibility criteria on the bottom of page 9 of the NOFO, including the rates that need to be met in order to apply? Please address the language that indicates applicants “must demonstrate” they meet the burden thresholds.

The stroke mortality of 55.4 per 100,000 is the crude rate and was calculated using CDC WONDER  (age 15 years and older) using ICD codes 160-169.  The stroke hospitalization rate of 283 per 100,000 is also the crude rate and was calculated using HCUP NIS 2017 data at the national level.

Applicants may show that their state level mortality and/or hospitalizations are above the hospitalization and mortality levels indicated in the NOFO, or they may clearly demonstrate high burden populations and/or regions exhibiting this level, or a disproportionately high level, of mortality or hospitalization within the state. Applicants must address how they intend to develop, strengthen, and expand state-wide stroke efforts, in addition to focused efforts among identified high burden populations/regions to reduce the disparities observed.

For this NOFO, high burden populations are those that state-level data indicate are disproportionately impacted by stroke outcomes, including stroke hospitalizations and stroke mortality, and have disproportionately high prevalence for those at highest risk for stroke events, including individuals with high blood pressure and/or high blood cholesterol, which may be a result of socioeconomic factors, such as living in underfunded urban and rural communities, being uninsured/underinsured, having limited access to routine medical care, or other related factors.

Q: Can you confirm the source of the US average mortality and hospitalization rates listed in the NOFO?

The stroke mortality of 55.4 per 100,000 is the crude rate and was calculated using CDC WONDER  (age 15 years and older) using ICD codes 160-169.  The stroke hospitalization rate of 283 per 100,000 is also the crude rate and was calculated using HCUP NIS 2017 data at the national level.

Q: If the state does not meet the overall state rate, but has a target population with higher rates can we still apply?

Yes. Applicants may show that their state level mortality and/or hospitalizations are above the hospitalization and mortality levels indicated in the NOFO, or they may clearly demonstrate high burden populations and/or regions exhibiting this level, or a disproportionately high level, of mortality or hospitalization within the state. Applicants must address how they intend to develop, strengthen, and expand state-wide stroke efforts, in addition to focused efforts among identified high burden populations/regions to reduce the disparities observed.

For this NOFO, high burden populations are those that state-level data indicate are disproportionately impacted by stroke outcomes, including stroke hospitalizations and stroke mortality, and have disproportionately high prevalence for those at highest risk for stroke events, including individuals with high blood pressure and/or high blood cholesterol, which may be a result of socioeconomic factors, such as living in underfunded urban and rural communities, being uninsured/underinsured, having limited access to routine medical care, or other related factors.

Q: We are part of the Paul Coverdell National Acute Stroke Program, but are wondering if we are still eligible to apply for the funding outlined in CDC-RFA-DP21-2102?

This NOFO is full and open competition. Applicants may show that their state level mortality and/or hospitalizations are above the hospitalization and mortality levels indicated in the NOFO, or they may clearly demonstrate high burden populations and/or regions exhibiting this level of mortality or hospitalization within the state. Applicants must address how they intend to develop, strengthen, and expand state-wide stroke efforts, in addition to focused efforts among identified high burden populations/regions to reduce the disparities observed.

Q: Can we apply as a University or is this only open for the department of Health as an applicant?

This NOFO is full and open competition. Refer to the list of Eligible Applicants identified on Pages 27-28 of the NOFO.

Q: What is the overall definition of person at-risk for stroke?

For this NOFO, those at highest risk for stroke events, includes individuals with risk factors for stroke events, such as high blood pressure, high blood cholesterol, untreated heart disease, history of a prior stroke event, poor dietary habits, physical inactivity, overweight/obesity, diabetes, smoking and use of commercial tobacco, and alcohol consumption. Additionally, societal and socioeconomic factors contribute to putting individuals at highest risk for stroke events, such as poverty and low SES, low educational attainment, living in resource poor urban and rural communities, being uninsured/underinsured, having limited access to routine medical care, and other related factors.

Q: Does the approximate average award of $575,000 per project period mean that the recipient may expect to receive that amount per year/budget period?

Successful applicants are expected to receive an average award of $575,000 per year/per project period, subject to the availability of funds, the evidence of satisfactory progress by the recipient (as documented in required reports), and the determination that continued funding is in the best interest of the federal government.

Q: The call referenced  $7,700,000.00 funding for “at least” 10 sites. If only 10 sites are selected is there an opportunity for selected sites to apply for additional funding?

The estimated floor for awards is $500,000. The estimated ceiling for awards is $650,000. The estimated average award is $575,000.

Applicants may submit an application for more than the published amounts for the anticipated floor, ceiling, and average awards. However, there is no guarantee funding will be awarded at levels higher than indicated.

Q: Can the CDC please confirm that the anticipated award date is 5/30? It also states in the NOFO that all notifications will be made by 6/29. We know that those two things are not mutually exclusive, but wanted to confirm the anticipated award date. Can the CDC also provide clarification on the terms “Period of Performance” and “Project Period”?

The anticipated award date for this NOFO is 5/30/2021, which in accordance with Office of Grant Services policy, is typically 30 days prior to the actual start date of the Year 1 Project Period, which is 6/30/2021 for this NOFO. However, notification of successful awards may be made up until the day before the Project Period start date, i.e. 6/29/2021.

Total Period of Performance: June 30, 2021 through June 29, 2024

Year 1 Project Period Start Date: June 30, 2021

Estimated Award Date: May 30, 2021

Q: Would indirect costs come directly out of the total award? I have been told by our accounting department that traditionally most agencies give the IDC in addition to our directs. Would that be the case with this grant or does everything come out of the total award if obtained?

Successful applicants are expected to account for indirect costs from the total award each year/per project period. Please refer to the required forms and documentation applicants must include with the application submission. You may preview the required documents and forms under the PACKAGE tab here:

• https://www.grants.gov/web/grants/search-grants.html?keywords=Coverdell

Q: Where it states in the NOFO that recipients will be expected to submit linked pre- and in-hospital data to the CDC on a recurring basis, what is meant by recurring? Would that happen quarterly?

Successful applicants will receive additional details regarding the frequency of pre- and in-hospital data submissions. This frequency may be quarterly or semi-annually. Recipients funded under past Coverdell NOFOs have experienced recurring submissions on a quarterly basis.

Q: If a state doesn’t currently have a stroke registry,  what time frame would be allowed  to get one up and running for data collection? 

Successful applicants will work closely with CDC Subject Matter Experts, partners and stakeholders addressing stroke systems of care to assess readiness to establish a state-wide stroke registry, including building partnerships with EMS agency partners, hospitals, stroke-care teams, and administrators. Through these partnerships, the recipients are expected to develop and implement systems for collecting data on acute stroke care provided to patients, analyze the collected data, and use the results of those analyses to guide quality improvement interventions at the EMS and hospital level. Given the complexities that may be involved, CDC will work with the recipient to determine an acceptable time frame for the full establishment of the registry; however, all recipients are expected to participate in all data submissions, whether or not the full registry has been established.

Q: I do not see mention of a concordance process between the original data abstractor and re-abstractor or submission of annual chart re-abstraction results according to CDC Guidelines in the new NOFO.  Will this be an expectation for those receiving the Paul Coverdell National Acute Stroke Program award?

Additional guidance related to specific requirements for data submissions and stroke registry development, design, and maintenance will be provided post award.

Q: Will grantees be required to conduct chart audits on their state registry? If so, what will be the general parameters? (This will affect our budget proposal.)

Additional guidance related to specific requirements for data submission and stroke registry development, design, and maintenance will be provided post award. Regarding the impact on budget proposals, the estimated floor for awards is $500,000. The estimated ceiling for awards is $650,000. The estimated average award is $575,000.

Applicants may submit an application for more than the published amounts for the anticipated floor, ceiling, and average awards. However, there is no guarantee funding will be awarded at levels higher than indicated.

Q: Can hospitals be recruited who do not enter into the state-wide registry?  For example, a CAH with limited resources would like to participate to raise their stroke capacity, but does not enter abstracts into the state registry?

Recipients are expected to engage in efforts supporting the development and implementation of a state wide stroke registry, and also the implementation of evidence-based strategies and activities to measure, track, and improve access to and quality of care for those individuals at highest risk for stroke events and for stroke patients from onset of stroke symptoms through rehabilitation and recovery, thereby improving stroke care across the care continuum. Successful applicants are expected to work towards increasing the number of EMS agencies and hospitals over time that are participating in the state-wide registry, which includes building the capacity of partners who may not initially be prepared to do so.

Q: For strategy C1, is the CDC intending for the grantee to access the EHRs or HIT to identify patients with stroke risk factors and monitor health care disparities, or could it be a localized QI effort on the hospital/clinic side?

Depending upon how the effort fits into the broader goal of expanding and improving stroke systems of care, applicants may propose either or both activities.

Q: In the work plan, where it states “Period of Performance Outcome”, is that referring to the two long-term outcomes from the logic model?

It is appropriate to include to the long-term outcomes listed in the logic model.

Q: In reference to the Strategies, Outcomes, and Performance Measure Table on pages 12-16, what is the short-term outcome for the strategy “Track and Monitor Clinical Measures to Improve Data Infrastructure Across Stroke Systems of Care”?

The following are the short-term outcomes listed in the program logic mode on page 5 of the NOFO. The first one is aligned in the model with this strategy.

• Increased measurement, tracking and assessment of data across stroke systems of care for those at highest risk for stroke events and stroke patients
• Increased implementation of data-driven Quality Improvement activities across stroke systems of care for those at highest risk for stroke events and stroke patients
• Increased establishment of community resources and clinical services for those at highest risk for stroke events and stroke patients across stroke systems of care

Q: In the Outcomes section of the NOFO, the following intermediate outcome is listed twice.  What are the intermediate outcomes for the program?

Three unique intermediate outcomes are listed in the program logic model on page 5 of the NOFO. The intermediate outcomes of the program are:

• Increased linkage and usage of data across stroke systems of care for those at highest risk for stroke events and stroke patients.
• Increased coordination of care across stroke systems of care for those at highest risk for stroke events and stroke
• Increased provision of community resources and clinical services to those at highest risk for stroke events and stroke patients across stroke systems of care.

Q: Will there be a short-term performance measure for strategy C1?

CDC will work with recipients to clarify the performance measures and will provide guidance prior to the first year of reporting.

Q: In the current grant, we are monitoring hospitals for inter-rater reliability and providing feedback back to participating hospitals for quality improvement. Will the CDC require information on hospitals data validity and reliability in this next competitive grant cycle?

Successful applicants are expected to engage in data driven Quality Improvement programs and activities for stroke care and propose data from a variety of sources to inform overall QI efforts. Additional guidance regarding reporting requirements related to selected Quality Improvement efforts will provided post-award.