Duke Center for Community Research
Stage 2 Application
Planning Grants for
Innovative Duke-Durham Partnered Approaches to Specific Health Problems in Durham County
PURPOSE OF THE PROGRAM
Duke Medicine is committed to working with the people of Durham County to improve the health
of all residents in the County. In addition to providing traditional health care through clinics,
hospital-based care and home health, Duke is making resources available, through this RFP, to
Duke-Durham partnerships to develop plans for innovative models of care and/or services that
will improve health in Durham County and address our most intransigent health disparities.
Funds to support this RFP come from the Clinical and Translational Sciences Award (funded by
the National Institutes of Health) and from Duke University.
OBJECTIVES OF STAGE 2 APPLICATION
The Stage 2 application should outline the specific health needs and populations that will be
served, the innovative model of care proposed, the metrics that will be used to determine
changes in health outcomes, and the process for developing a full Stage 3 implementation plan
if selected for the 8-month planning period. Teams submitting a Stage 2 application should
target the improvement of a health indicator(s) on a county-wide level. Applications may focus
on specific subgroups if such a targeted approach will lead to improvement in a particular health
indicator(s) for Durham County. Teams will be led by Duke and community co-team leaders.
Funding awarded to successful Stage 2 applicants will support development of a full-scale
implementation plan during the 8-month Stage 3 planning period. These funds can not be used
to fund implementation or pilot projects. We anticipate making awards of up to $100,000 to up to
10 teams.
REQUIREMENTS OF STAGE 2 TEAMS
Clear Identification of a Relevant Health Issue and Population
In most cases, relevant conditions are diseases (e.g., cancer, stroke, diabetes), although
conditions (e.g., obesity, pregnancy, frailty, blindness) are eligible, as are specific behaviors
(e.g., smoking, violence). Teams must clearly identify how the need was determined. While all
ages are eligible for consideration, the team must clearly identify the population affected.
Preference will be given to the more common causes of death and disability and to situations in
which results can be achieved in a 5 year period. “Bundling” is also encouraged where common
interventions can be used together (e.g. it would be preferable to have a “vascular disease”
primary and secondary prevention intervention rather than separate interventions for
hypertension, exercise, smoking, lipids, etc.).
An Interdisciplinary Duke-Durham Team
Teams must be interdisciplinary and include expertise in areas appropriate to the proposal from
across Duke University and Medical Center (at a minimum a Duke physician, nurse, and Health
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System administrator) and must include residents and partners from the Durham Community
(who are not Duke employees), as part of the core team. Teams are encouraged to include
Duke trainees where they can contribute to the process.
Description of an Innovative Model of Care
Duke-Durham Teams will propose plans that will describe a significant change in the structure
or function of a service or clinic(s), including such innovative models as: clinics and clinical
services provided by midlevel providers; use of lay or community health workers; services or
systems that effectively combine the services of public or non-profit agencies and Duke
Medicine services; services that are provided in non-health care settings (such as local
businesses, houses of worship, schools, or public facilities); and/or use of new technologies
(including information systems) that reduce cost, increase efficiency, or provide health and
disease monitoring. Coordinated interventions at multiple levels (individual, community,
provider, clinic, etc.) are encouraged if they will assist in needed changes.
Use of Institutional Resources: Data Support Repository (DSR) and Geospatial/Temporal
Mapping
While any public or private source of data may be used, the Duke-Durham Teams are required
to review the data available through the Duke Data Support Repository in Stage 2 application
development. In some cases, additional data from other Health System entities may be
required. Duke-Durham Teams will also be expected to utilize geospatial/temporal mapping
from the DSR.
Financial Model
Duke is committed to caring for the people of Durham County in a way that reflects community
priorities. At the same time, Duke has a responsibility to maintain financial solvency to carry on
its missions in patient care, research, and teaching. Duke-Durham Teams will need to
incorporate a number of factors in developing models for the financial efficacy of their plans.
Such factors may include reducing the utilization of high-cost services (such as the use of
emergency departments for non-emergent conditions), and reducing admissions to limited
subspecialty hospital beds which can be freed up for “high tech” interventions that need to be
accessible on a broader geographical base.
Evaluation Plan
The Stage 2 application must describe an evaluation plan that establishes measurable markers
to determine the efficacy of the proposed activities/service.
Dissemination Requirements
The Stage 2 application must also describe how the project team intends to maintain
communication with the community and inform members of the community or population
targeted of its findings, and future steps. In addition, Duke-Durham teams will be required to
submit at least one manuscript to an appropriate peer-reviewed journal by the end of the 8month funded planning period.
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TIMELINE
July, 2008
RFP Released
August 15, 2008, September 2, 2008,
October 10, 2008
Stage 1 required technical assistance
sessions
November 7, 2008
Stage 1 brief proposals due
November 8, 2008 – December 14, 2008
Review of Stage 1 brief proposals
December 15, 2008
March 2, 2009
Notification to Duke-Durham teams invited
to Stage 2
Stage 2 required technical assistance
sessions
Stage 2 applications due
March 3, 2009 - April 2, 2009
Review of Stage 2 applications
April 3, 2009
Notification to Duke-Durham teams invited
to Stage 3 (funds awarded)
December 4, 2009
Stage 3 implementation plans due and
manuscript(s) submitted
January, 2009
STAGE 2 ELIGIBLE APPLICANTS
Applicants who successfully completed Stage 1 and who have been invited to submit a Stage 2
application may apply. Stage 2 applications must clearly identify Duke and Community Co-team
Leaders. Teams must be interdisciplinary and include expertise in areas appropriate to the
proposal. Teams must include residents and partners from the Durham community, who are
not Duke employees, and a Duke physician, nurse, and administrator as members of the
core team. Teams are expected to designate one of their members (who may be from the
community or from Duke) to perform project management functions such as facilitating the
planning process, submitting progress reports, and serving as a liaison with the DTMI technical
assistance cores (see below).
Teams formed during Stage 1 are encouraged to collaborate with other Stage 1 teams and/or
invite additional Duke and community members into their group.
TECHNICAL ASSISTANCE RESOURCES
Support will be provided to Duke-Durham teams through three technical assistance cores:
community engagement, data and analysis, and implementation plan development. Each team
is expected to work closely with all three technical assistance cores while developing their Stage
2 applications.
The Community Engagement Core will provide support to Duke-Durham teams on all issues
related to building relationships between Duke Medicine providers and researchers and
community members, organizations, and agencies. Staff from the Community Engagement
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Core are available to connect community members, Duke personnel, and Stage 2 teams with
common interests. The point of contact for the Community Engagement Core is Michelle Lyn
(lyn00001@mc.duke.edu or 919-681-3192).
The Data and Analysis Core will provide support on all issues related to finding data and
undertaking analyses necessary to identify populations, patterns of utilization, and associated
costs. Staff from the Data and Analysis Core are available to help determine what data from the
Duke Data Support Repository (DSR) and from other health-related data resources are relevant
to the project under consideration. In addition, the Data and Analysis Core staff will work with
teams to map data. The Data and Analysis Core will work in conjunction with the Community
Engagement Core to identify partners who might contribute to the data and analysis, and the
Implementation Plan Development Core to identify appropriate billing and other cost-related
data of relevance to the model of care under consideration. Finally, the Data and Analysis Core
will support teams in addressing the ethical, regulatory, and legal issues related to use of health
related data. The point of contact for the Data and Analysis Core is Marie Lynn Miranda
(mmiranda@duke.edu or 919-613-8723).
The Implementation Plan Development Core will provide support on all issues related to
planning innovative models of care. Analyses will include how existing models of care are
financed within our current health care delivery system and what the financial mechanisms will
be in the new model of care. The Implementation Plan Development Core will work with both
the Community Engagement and Data and Analysis Cores to ensure that plans reflect the
needs, strengths, and contributions of Duke and Durham partners. The point of contact for the
Implementation Plan Development Core is Krishna Udayakumar (ku@duke.edu or 919-6688585).
During Stage 2, regular Technical Assistance Workshops will be scheduled for all teams, and
with the Technical Assistance Cores, to answer questions, build connections, and strengthen
the ability of teams to proceed to Stage 3. Attendance by one or more members of the project
teams is expected at each workshop, and sessions will be scheduled to accommodate as many
team members as possible. Elements of the Stage 2 Requirements will be further developed
through this process. These workshops will also review the criteria that will be used for judging
Stage 2 applications.
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Technical Assistance Cores
Community Engagement
Data and Analysis
Point of contact:
Michelle Lyn
Point of contact:
Marie Lynn Miranda
Implementation Plan
Development
Point of contact:
Krishna Udayakumar
Analysis
Data confidentiality issues
STAGE 2 APPLICATION ELEMENTS
Cover page
 Project title
 Team Co-chairs from Duke and the community
 Other team members and their organizational affiliations
Abstract of narrative (250 word maximum)
 Outcomes to be achieved for Durham County
 Proposed new model of care
Duke- Durham team description
 List each team member and his/her affiliation. Please include the following information
for each member:
1. Brief background including qualifications and experience
2. Specific contributions to the proposed project
 Specify who will serve as the Co-team Leaders (one must be a Duke faculty member,
and one must be from the community), project manager (may be from the community or
Duke), Duke physician, Duke nurse, and Duke administrator serving on the team.
Outline the specific responsibilities of each
 Provide a statement confirming that the community residents and partners represented
on the team are not Duke employees.
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Proposal (8 pages maximum)
Statement of Goal
 Describe the specific health needs that your innovative model will address, and the
specific health indicators you intend to improve.
 Provide data that supports the importance of the health needs targeted, as well as
evidence of disparate burden/impact in Durham County. Utilize at minimum data from
the 2007 Durham County Health Department’s Community Health Assessment. The
Data and Analysis Core can also facilitate access to other relevant data.
 Identify the populations that you will target including location, race/ethnicity, age,
socioeconomic status, and gender.
Innovative Model of Care
 Describe the innovative model of care proposed by your team (i.e., what change(s) are
proposed in the structure or function of a service, system, or care delivery setting)?
 Present the evidence base for your proposed innovative model of care by documenting
any similar examples from around the country of this model (i.e., what is the evidence
base).
 How does your proposed innovative model differ from current models of care delivery,
and what evidence suggests it is better?
 What evidence exists that the innovative model of care/proven interventions will be
accepted and effective? Have there been pilot studies? Does it implement practice
guidelines?
 What would be the interface to and/or involvement of the Duke University Health System
and community partner organizations?
Partnerships
 Describe the ability of community members, agencies, and Duke members and
organizations to effectively address the needs identified in your proposal.
 Describe the community and Duke strengths of your team, particularly as they are
relevant to the proposed health need and populations being targeted.
 List community members and agencies that live in or serve this population, and have
been involved in the assessment and proposal development.
 Identify how your innovative model might impact other community programs and
projects.
Planning Process
 Describe the planning process that your team will use (meetings, focus groups,
community town halls, etc.).
 Describe the plan for maintaining communication and receiving input from all members
of your proposed team.
 Describe how you intend to maintain communication with the community or population
served and receive input and feedback from community members during the planning
process.
Evaluation
 Delineate how you will evaluate the success of your team.
 Describe how you will ensure that your innovative model will be endorsed by the
communities you propose to serve.
 Identify any specific metrics that can be used to track intermediate and outcome
endpoints associated with your identified health needs.
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




How will your innovative model result in improved health status for the population served
and how will you measure this?
What is the period of time over which you expect to achieve results in improved health
status for each set of metrics above?
How does your innovative model aim to 1) reduce health disparities, 2) improve quality,
3) reduce cost and/or increase efficiency?
What evidence will you need to demonstrate that your innovative model can be
successfully implemented and sustainably operated?
What are the financial and operational impacts of your innovative model on projects in
Durham County and Duke University Health System?
Is your plan scalable beyond Durham County? Explain.
Dissemination
 How do you intend to engage and inform members of the community or population
served of your findings and future steps?
 How do you plan to disseminate your findings through academic journals and other
publications? To which academic journals or other publications will you be submitting
your findings?
Appendices
 Schedule and Milestones – Prepare a timeline that describes activities you propose to
accomplish during the planning period. Include target dates as well as team members
responsible for the proposed activities, where appropriate.

Letters of support – Include letters of support from all participating agencies and
organizations. Letters from additional organizations are optional.

Budget and Justification – Include a proposed Line-Item Budget and Budget Narrative
for the Stage 3 implementation plan development process that are linked to the goals
and outcomes of the proposed plan. The Budget Narrative must include an explanation
for each line-item you include in your proposed budget. Please note that the budget is
for the Stage 3 implementation plan development process, not for implementation itself
or for pilot projects. Clarification of acceptable budget expenses will be provided during
the technical assistance workshops. Please see the attached sample budget template.
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SAMPLE BUDGET TEMPLATE
Duke Personnel
Role
Percent
effort
Salary
Fringe
Total
Total
Sub-Contracts
Description
Total
Description
Total
Description
Total
Total
Meeting expenses
Total
Materials and supplies
Total
Total funds requested ___________
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SUBMISSION FORMAT
Please compend all required elements into a single PDF document and submit via email to
DukeDurhamTeams@mc.duke.edu.
Applications must be received by 5:00 pm on March 2, 2009. A complete application must
include all of the elements above, be typed, single-spaced using 12 point Times New Roman
font on 8.5 X 11 paper, 1” margins, and pages numbered at the right lower corner.
INQUIRIES
We welcome the opportunity to answer questions from Stage 2 applicants. Please feel free to
direct inquiries related to this funding announcement to:
Sue Schneider
Duke Center for Community Research
Tel: (919) 681-8598
E-mail: Suzanne.schneider2@duke.edu or DukeDurhamTeams@mc.duke.edu
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Stages of Duke-Durham RFP Application, Award, and Planning Process

RFP Released July 2008
STAGE 1 BRIEF PROPOSAL DEVELOPMENT
Stage 1 brief proposals due ………………………………
November 7, 2008
Review of Stage 1 brief proposals ……………………….
November 8 – December 14, 2008
Notifications sent to Stage 2 invitees …………………….
December 15, 2008
STAGE 2 APPLICATION DEVELOPMENT
Stage 2 applications due ………………………………….
March 2, 2009
Review of Stage 2 applications …………………………..
March 3 – April 2, 2009
Notifications sent to funded Stage 3 teams ………………
April 3, 2009
STAGE 3 FUNDED 8-MONTH IMPLEMENTATION PLAN DEVELOPMENT
Awarded teams work on Stage 3 implementation plans …
April 3 – December 4, 2009
Stage 3 implementation plan due ………………………….
December 4, 2009