increasing north dakota’s influenza immunization …...grant due date: applications are due to...
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Due: Friday, May 11, 2018 by 12:00 P.M. (CST) Page 1
Increasing North Dakota’s Influenza Immunization Rates Request for Proposals
Purpose: The purpose of this grant is to provide funding to two to three organizations to increase
influenza immunization rates.
Number of Awards: 2 – 3
Amount of Each Award: $5,000 - $10,000
Grant Period: July 1, 2018 - June 30, 2019
Grant Due Date: Applications are due to Andy Noble by Friday, May 11, 2018 at 12:00 P.M. (CST).
Please send them via e-mail to [email protected], with the subject line, Increasing North Dakota’s
Influenza Immunization Rates. Any questions can be directed to Andy Noble at [email protected] or by
calling 701.328.4557. Sites will be notified via e-mail of their award no later than June 4, 2018.
Eligible Applicants: Must be located in North Dakota and may include, but are not limited to:
• Local Public Health Units
• Health Systems, Clinics, FQHCs, RHCs
• Educational Institutions
• Public Health Partners (i.e. QIO’s, Coalitions)
• Long Term Care Facilities
• Medical and Health Associations
• Pharmacies
Scope: In an effort to increase North Dakota influenza immunization rates, implement strategies and
activities to:
• Increase knowledge of influenza immunization recommendations
• Increase access to influenza vaccines
• Increase the number of influenza vaccines administered
• Decrease influenza immunization missed opportunities
• Improve influenza immunization rates on a facility, county, or state level
Required Activities:
• Assign a “project lead” or “coordinator” for this grant.
• Compare and report influenza immunization rates pre- and post-implementation of grant
activities.
Due: Friday, May 11, 2018 by 12:00 P.M. (CST) Page 2
• Request reimbursement and submit a quarterly activity report to the NDDoH.
• Submit required quarterly reports using North Dakota’s Program Reporting System.
• By the end of the grant period, develop and submit a plan (minimum of two pages) to maintain
and increase influenza vaccination rates beyond the grant period.
Suggested Optional Activities:
• Implement best practices to increase immunization rates as recommended by The Community
Guide
(www.thecommunityguide.org/topic/vaccination?field_recommendation_tid=All&items_per_pa
ge=5&page=1)
• Examples of activities may include, but are not limited to:
o Implement influenza immunization clinics in your community (i.e., onsite or offsite
clinics for high-risk groups, worksite wellness, schools, long-term care facilities, etc).
o Collaborate with nontraditional immunization providers to increase influenza
immunization services.
o Implement peer-to-peer influenza immunization best practice and quality improvement
programs.
o Offer influenza immunizations during all medical visits (i.e. well child exams, sick visits,
or routine prenatal visits, walk-in clinics, etc.).
o Implement changes to the electronic medical record to ensure prompts for influenza
immunizations.
o Implement influenza immunization reminder/recall.
o Utilize an immunization forecaster at every patient visit in an electronic medical record
or IIS to avoid missed opportunities.
o Determine if all staff (physicians, nurses, and medical assistants) are screening,
recommending and communicating influenza immunizations in a consistent manner and
making strong recommendations.
o Provide influenza immunization education to all staff.
o Implement monthly or quarterly monitoring of influenza immunization rates.
o Develop web-based continuing education opportunities for both traditional and
nontraditional immunization providers.
o Establish a community-wide coalition to increase influenza immunization rates.
Applications: All applications must be submitted in Microsoft Word or Adobe pdf, 12-point font, and maintain one-inch margins. Applications must include the following three components.
1. Background and Need: Provide a brief narrative (maximum of two pages) describing the background and need for the proposed influenza immunization project. Applicants should include information regarding the organization’s patient population or area population, recent influenza immunization coverage data, and perceived influenza immunization barriers. Descriptions of prior or recent influenza immunization activities should be included.
Due: Friday, May 11, 2018 by 12:00 P.M. (CST) Page 3
2. Objectives, Activities, and Evaluation: must follow the format shown in the Sample Workplan
(add additional pages, as needed). a. Objectives: each objective must satisfy the SMART objective requirements (Example: By
June 30, 2019, increase influenza vaccination rates among adults 65 and older to 80%. Baseline: 65% according to the NDIIS.)
i. Specific - Concrete, detailed, and well defined so that you know where you are going and what to expect when you arrive.
ii. Measurable - Numbers and quantities provide means of measurement and comparison.
iii. Achievable - Feasible and easy to put into action. iv. Realistic - Considers constraints such as resources, personnel, cost, and time
frame. v. Time-Bound - A time frame helps to set boundaries around the objective.
b. Activities: must describe the tasks and timeline that will be utilized to accomplish the objective. A minimum of two activities will be required for each objective.
c. Evaluation Method: an evaluation must be completed for each objective to determine if the grant objectives are met, unmet, or ongoing and demonstrate the impact of each objective.
3. Budget: Please use the format shown in the excel document, Influenza Immunization Budget. Funding Restrictions: Grant funds may not be used for the following.
• Existing activities (funds may only be used to support new activities)
• Incentives (i.e., gift cards, money, food, etc.)
• Research
• Vaccine
Scoring: Applicants will be scored based on the following.
• Extent to which the applicant justifies the project need within the applicant’s area/organization.
• Did the applicant include a current overview of influenza immunization rates?
• Did the applicant describe current or past efforts to increase influenza immunization rates in the
area or organization?
• Did the applicant discuss the perceived influenza immunization barriers?
• Are the objective(s) reasonable in the timeframe of the grant?
• Does the workplan adequately address the objectives and the purpose of the funding
opportunity?
• Is the workplan complete, sound, and practical?
• Does the workplan include S.M.A.R.T. objectives, relevant activities, and evaluation methods?
• Does the workplan identify adequate staff in a way that demonstrates applicant understanding
of the labor resources needed to implement each of the specified activities consistent with the
defined purpose?
• Is the budget complete and does it provide adequate justification?
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 1
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 2
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 3
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 4
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 5
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Due: Friday, May 18, 2018 by 12:00 P.M. (CST) Page 6
Increasing North Dakota’s Influenza Vaccination Rates
Organization Name
Contact First and Last Name
Contact Phone Number/Email Phone: Email:
Objective Objective must be SMART – specific,
measurable, achievable, realistic, and time-bound.
Activities to Reach Objective Activities are the specific actions implemented to accomplish the objective.
Describe staffing to complete the activities.
Completion Date
Objective Evaluation Method
Project Title: Increasing North Dakota's
Influenza Immunization Rates
Organization Name: Total Project Amount: $0
(cannot exceed $10,000)
Personnel Computation/Detailed description Cost
Name:
Title:
Period of Performance:
Justification
Total Personnel: $0
Fringe Computation/Detailed description Cost
Justification:
Total Fringe: $0
Indirect Computation/Detailed description Cost
Justification:
Total Indirect: $0
Travel Computation/Detailed description Cost
Justification:
Total Travel: $0
Supplies Computation/Detailed description Cost
Justification
Due: Friday May 11, 2018 by 12:00 P.M. (CST)
Project Title: Increasing North Dakota's
Influenza Immunization Rates
Due: Friday May 11, 2018 by 12:00 P.M. (CST)
Total Supplies: $0
Other Computation/Detailed description Cost
Justification
Total Other: $0
Contracts Computation/Detailed description Cost
Justification
Total Contracts: $0