WISEWOMAN Programs

DACH HDSP MIS 1.0

Data Collection

Revision History

Date	Changes	By Whom:
05/25/04	Original document.	J Casner
02/05/07	2007 Enhancements and WISEWOMAN Program Updates	Alison Knight

Overview

The following table defines the data proposed for collection through the CDC Heart Disease and Stroke Prevention and WISEWOMAN Information System (HDSP IS). For each key section, the question and response options are identified. If the response option is labeled “text”, the responder can enter free form text. * indicates a required field. “(WW)” indicates information that is specific to the WISEWOMAN program. “(HDSP)” indicates information that is specific to the HDSP program.

Information Sections

The data collected is grouped according to the key sections listed below.

• Program information

• Key Personnel

• State Planning Group

• Key Partners

• Key Contractors

• Standard Data Sources

• Other Data Sources

• Burden Report

• Long Term Intervention Objective

• Supporting Intervention Objective

• Objective Progress

• Activity

• Activity Progress

• Products

Program Information

Question	Response Options
Program Name	Text
Grant Number	Text
Program Type	Display only
Primary Program Telephone	Text
Business Official	Text
Mailing Address Line 1	Text
Mailing Address Line 2	Text
Mailing City	Text
Mailing State	Select state from list
Mailing Postal Code	Text
Shipping Address Line 1	Text
Shipping Address Line 2	Text
Shipping City	Text
Shipping State	Select state from list
Shipping Postal Code	Text
Program Web Address	Text
Program Fax	Numeric

Key Personnel

Question	Response Options
First Name *	Text
Middle Name	Text
Last Name *	Text
Telephone *	Text
E-mail Address *	Text
Primary Role *	Select one: Administrative Support Communication Specialist Community Health Advisors Data Manager (WW) Data Management Staff (WW) Epidemiologist Evaluator Health Educator Health Systems Specialist Lifestyle Intervention Specialist (WW) Nutrition Coordinator (WW) Physical Activity Coordinator (WW) Policy Analyst Program Coordinator Program Director Program Manager Other (specify)
Secondary Role (WW)	Select one: Administrative Support Communication Specialist Community Health Advisors Data Manager (WW) Data Management Staff (WW) Epidemiologist Evaluator Health Educator Health Systems Specialist Lifestyle Intervention Specialist (WW) Nutrition Coordinator (WW) Physical Activity Coordinator (WW) Policy Analyst Program Coordinator Program Director Program Manager Other (specify)
Program Time Allocation *	Percentage
Percentage of Salary paid by CDC DHDSP	Percentage
Is this individual a contractor? *	Select one: Yes No
Is this individual the primary program contact? *	Select one: Yes No
Personnel Attachments Title*	Text – file name
Date Revised*	Date
Type of Evidence*	Select one: Resume CV Other (Specify)
Other (specify)	Text

Key Partners

Question	Response Options
Partner Type*	Select one: Academia (university or college) Community based organization (WW) Community health center (FQHC) (WW) District or local government agency (WW) Faith based organization Healthcare Organization Organization Representing Priority Population(s) Other State Government Entity Private sector business State Health Department Programs Voluntary agencies or professional organizations Other (specify)
Other (specify)	Text
Partner Name*	Text
Partner Contact Name*	Text
Is this partner a member of the statewide work group responsible for the comprehensive CVH State plan*	Select one: Yes No
Upload Evidence of Commitment*	Text – file name
Type of Evidence	Select one: Letters of support Memorandum of Understanding Other (specify)
Other (specify)	Text

Key Contractors

Question	Response Options
Organization Name*	Text
Contact Name	Text
Primary Role*	Select one: Communication Communication/Marketing (WW) Data Management (WW) Epidemiologist Evaluator Health Educator Health Systems Specialist Information Technology Specialist (WW) Lifestyle Intervention Service Delivery(WW) Policy Analyst Program/Intervention Development (WW) Screening Service Delivery (WW) Other (specify)
Secondary Role*	Select one: Communication Communication/Marketing (WW) Data Management (WW) Epidemiologist Evaluator Health Educator Health Systems Specialist Information Technology Specialist (WW) Lifestyle Intervention Service Delivery(WW) Policy Analyst Program/Intervention Development (WW) Screening Service Delivery (WW) Other (specify)
Other (specify)	Text
Amount of Contract Funded by CDC CVH *	Percentage

State Plan (HDSP)

Question	Response Options
Title*	Text
Plan Timeframe*	Dates
Status*	Select one: Draft Published
Website Address	Text
State Planning Group Name	Text
List Subgroups	Text
State Plan Attachments Title*	Text – file name
Type of Evidence	Select one: Meeting Agenda or Minutes State Plan Other (specify)
Other (specify)	Text

Burden Report (HDSP)

Question	Response Options
Your state’s burden report is currently:	Select one: Published Unpublished
Title*	Text
Publish Date*	Month and year
Report Focus*	Select one: Heart Disease Stroke
Date hard copy sent to CDC*	Month and year
Priority Populations:
Gender*	Select one: Female Male Not Specific
Geography*	Select all that apply: Rural / Low Density Urban / High Density Not Specified
Race *	Select up to 3: American Indian or Alaska Native Asian African American or Black Native Hawaiian or other Pacific Islander White Not Specified
Ethnicity*	Select all that apply: Hispanic or Latino Not Hispanic or Latino Not Specific
Socioeconomic Status (SES)*	Select one: Low Not Specified
Additional Population Comments	Text
Burden Report Web Address	Text - URL
Upload Burden Report(s): Document Title	Text – file name
Date Last Revised	Month and year
Working Report Title*	Text
Anticipated Publish Date*	Month and year
Describe Progress to Date*	Text

Standard Data Sources

Question	Response Options
Standard Data sources*	Select one or more: BRFSS Alcohol Consumption Module (WW) BRFSS Cardiovascular Disease Module BRFSS Cholesterol Awareness Module BRFSS Core Modules (WW) BRFSS Fruits and Vegetables Module (WW) BRFSS Healthy Days Module (WW) BRFSS Heart Attack and Stroke Module (WW) BRFSS Heart Disease and Stroke Signs and Symptoms Module BRFSS Hypertension Awareness Module BRFSS Other Tobacco Products Module (WW) BRFSS Physical Activity Module (WW) BRFSS Quality of Life Module (WW) BRFSS Smokeless Tobacco Module (WW) BRFSS Tobacco Use Prevention Module (WW) BRFSS Weight Control Module (WW) Centers for Medicare and Medicaid Services (CMS) Health Care Organization Health Plan Employer Data and Information Set (HEDIS) Hospital Discharge Data Indian Health Service (WW) U.S. Bureau of Census Vital statistics WISEWOMAN Minimum Data Elements (WW) Youth Risk Behavior Surveillance (YRBS) Other (specify)
Other (specify)	Text
Most Recent Data Set Year (YYYY)*	Year

Other Data Sources

Question	Response Options
Data Source Name*	Text
Describe Population Sampled*	Text
Describe Collection Method*	Text
Collection Frequency*	Select one: Single Collection Ongoing Collections
Most Recent Year Collected*	Year

Policy and Environmental Assessments (HDSP)

Question	Response Options
Title*	Text
Assessment Type*	Select one: State level District level
Assessment Setting*	Select one: Health Care Work Site Community School
Last Assessment Date*	Enter Date
Summarize the data collected in the assessment*	Text
Summarize the methods used for the assessment*	Text
Summarize the findings of the assessment*	Text
Attachments	Upload File

Intervention Long Term Objective

Question	Response Options
Objective Title*	Text
Objective Description*	Text
Status*	Select one: Planned In Process Completed Cancelled Deferred
Related Recipient Activity (WW)	Select one: Develop a preventive health services program or preventive health services research study/studies. Staff with at least two professional staff members to work full-time on WISEWOMAN or a plan for hiring such staff members. Work with health care systems that can effectively deliver WISEWOMAN services and that target the population in need of these services. Establish a cardiovascular disease prevention program as the primary focus, with culturally appropriate interventions addressing multiple risk factors that must include physical inactivity, poor nutrition, and tobacco use. Implement screening, referral, and follow-up according to the recommendations of the National Cholesterol Education Program (NCEP). Design culturally appropriate lifestyle interventions aimed at lowering blood pressure or cholesterol, improving physical activity or nutrition, or achieving smoking cessation in a similar target population. Propose methods aimed at sustaining behavioral change. Propose methods aimed at sustaining the program in future years. Plan or conduct evaluation strategies to include reporting of suggested minimum data elements and cost information. Formalize plans for Recipient Activities through development of program protocols or conduct program operations according to previously developed and approved program protocols. Work collaboratively to develop methods that have the potential to be implemented in other WISEWOMAN programs.
Primary Priority Area* (HDSP)	Select one: Control of high blood pressure Control of high blood cholesterol Increase knowledge of signs and symptoms and importance of calling 9-1-1 Improve emergency response Improve quality care (prevent first and second events; control risk factors and diseases) Eliminate Disparities
Secondary Priority Area (HDSP)	Select one: Control of high blood pressure Control of high blood cholesterol Increase knowledge of signs and symptoms and importance of calling 9-1-1 Improve emergency response Improve quality care (prevent first and second events; control risk factors and diseases) Eliminate Disparities
Related HP2010 National Goal (HDSP)	Select one: Prevention of Risk Factors Detection and Treatment of Risk Factors Early Identification and Treatment of Heart Attacks and Strokes Prevention of Recurrent Cardiovascular Events
Direction of change* (HDSP)	Select one: Increase Decrease
Unit of Measurement* (HDSP)	Select one: Number of Percent of Rate of
What will be measured? (HDSP)	Text
Baseline* (HDSP)	Numeric Not required if “Baseline Unknown” is selected
Baseline Unknown (HDSP)	Select one: Yes No
Target * (HDSP)	Number
Evidence of measuring target* (HDSP)	Select one: BRFS Cholesterol Awareness Module BRFS Cardiovascular Disease Module BRFS Heart Disease and Stroke Signs and Symptoms Module BRFS Hypertension Awareness Module Centers for Medicare and Medicaid Services (CMS) Health Care Organization Health Plan Employer Data and Information Set (HEDIS) Hospital Discharge Data U.S. Bureau of Census Vital statistics Youth Risk Behavior Surveillance (YRBS) Other (Specify)
Other (specify) (HDSP)	Text
Measurement (WW)*	Select one Increase the number of women to be screened each year for chronic disease risk factors and to receive risk reduction counseling based on the screening results. Increase the percentage of new WISEWOMAN participants screened who return for the evaluation (first annual) screening visit within 10-14 months from baseline screening. This is required for purposes of program evaluation. Increase the percentage of new women screened who attend at least one standardized lifestyle intervention session. Increase the percentage of new women screened who have completed standardized lifestyle intervention sessions. Decrease the percentage of failure to complete diagnostic/medical follow-up for women who have an alert screening value. Increase the percentage of participants who adopt a healthier lifestyle during the year following baseline screening. Reduce the percentage of expected cardiovascular disease events and deaths per 1,000 women, in 10 years.
Specify the measurement for the performance indicator selected above (WW)*	Baseline: Number Target: Number
If baseline is unknown, explain how baseline will be defined: (HDSP)	Text
Which state plan objective does this objective relate to? (HDSP)	Text
Related RE-AIM Goal* (WW)	Select one: To build a national WISEWOMAN program that provides every eligible NBCCEDP woman with an opportunity for WISEWOMAN services. (R-1) To establish a WISEWOMAN program that reaches NBCCEDP women with the highest cardiovascular disease risk, including minority women in numbers that represent the proportion seen in NBCCEDP. (R-2) To establish a WISEWOMAN program where at least 60% to 75% of the women screened receive the lifestyle intervention (LSI). (R-3) To establish a WISEWOMAN program that improves lifestyle behavior. (E-1) To establish a WISEWOMAN program that improves CVD risk scores. (E-2) To ensure that WISEWOMAN is a cost effective program. (E-3) To establish a WISEWOMAN program that is easy to adopt. (A-1) To establish a WISEWOMAN program that can be delivered as intended (i.e. implemented with fidelity). (I-1) To establish that the benefits of the WISEWOMAN program can be maintained over time at the individual level. (M-1) To establish that the activities of the WISEWOMAN program can be sustained over time at the organizational level. (M-2)
Estimated Start Date*	Month and year
Estimated End Date*	Month and year
Describe revisions to this objective (required if target is updated, status is deferred or cancelled, start date is delayed, or end date is extended.):	Text

Intervention Supporting Objective

Question	Response Options
Objective Title*	Text
Objective Description*	Text
Status*	Select one: Planned In Process Completed Cancelled Deferred
Setting	Select one: Healthcare Community Worksite Other (Specify)
Other (specify)	Text
Measurement (WW)*	Select one Increase the number of women to be screened each year for chronic disease risk factors and to receive risk reduction counseling based on the screening results. Increase the percentage of new WISEWOMAN participants screened who return for the evaluation (first annual) screening visit within 10-14 months from baseline screening. This is required for purposes of program evaluation. Increase the percentage of new women screened who attend at least one standardized lifestyle intervention session. Increase the percentage of new women screened who have completed standardized lifestyle intervention sessions. Decrease the percentage of failure to complete diagnostic/medical follow-up for women who have an alert screening value. Increase the percentage of participants who adopt a healthier lifestyle during the year following baseline screening. Reduce the percentage of expected cardiovascular disease events and deaths per 1,000 women, in 10 years.
Specify the measurement for the performance indicator selected above (WW)*	Baseline: Number Target: Number
Direction of change* (HDSP)	Select one: Increase Decrease
Unit of Measurement* (HDSP)	Select one: Number of Percent of Rate of
What will be measured?* (HDSP)	Text
Baseline* (HDSP)	Numeric Not required if “Baseline Unknown” is selected
Baseline Unknown	Select one: Yes No
Target * (HDSP)	Number
Evidence of measuring target* (HDSP)	Select one: BRFS Cholesterol Awareness Module BRFS Cardiovascular Disease Module BRFS Heart Disease and Stroke Signs and Symptoms Module BRFS Hypertension Awareness Module Centers for Medicare and Medicaid Services (CMS) Health Care Organization Health Plan Employer Data and Information Set (HEDIS) Hospital Discharge Data U.S. Bureau of Census Vital statistics Youth Risk Behavior Surveillance (YRBS) Other (Specify)
Other (specify) (HDSP)	Text
If baseline is unknown, explain how baseline will be defined:	Text
Objective Focus*	Select one: General Population Based WISEWOMAN Population Based (WW) Priority Population Based (specify below) Gender* (HDSP) Select one: Female Male Not Specific Geography* (HDSP) Select all that apply: Rural / Low Density Urban / High Density Other (Specify) Not Specified Geography* (WW) Select all that apply City County District/Region Entire State Entire Territory Frontier Rural Tribal Reservation/Service Area Urban Not Specific Ethnicity* Select all that apply: Hispanic or Latino Not Hispanic or Latino Not Specific Race* Select up to 3: American Indian or Alaska Native Asian African American or Black Native Hawaiian or other Pacific Islander White Not Specified SES* (HDSP) Select one: Low Not Specified
Describe the steps taken to ensure the objective is culturally competent for the priority population identified. (HDSP) Additional Population Comments (WW)	Text
Supplemental project (HDSP)	Select one: None Stroke Registry Optional Funding
Summarize how resources have been leveraged for this objective*	Text
Estimated Start Date*	Month and year
Estimated End Date*	Month and year
Describe revisions to this objective (required if target is updated, status is deferred or cancelled, start date is delayed, or end date is extended.):	Text

Objective Progress

Question		Response Options
Date Progress Occurred*	Month and year
Describe Progress*	Text
Has the objective’s target been met?	Select one: Yes No Currently Ongoing
Date objective’s target was met	Month and year
Actual Measurement	Direction of Change Select one: Increase Decrease Unit of Measurement Select one Number of Percent of Rate of What was measured?: Text Actual level: Number
Facilitating factors for success	Text
Describe any barriers and/or issues to meeting the objective and plans to overcome:	Text
Describe any additional benefits (unexpected outcomes) as a result of this objective:	Text

Activity

Question		Response Options
Activity Title*	Text
Activity Description*	Text
Estimated Start Date*	Month and year
Estimated End Date*	Month and year
Current Status*	Select one: Planned In Process Completed Cancelled Deferred
Lead Personnel*	Select from list
Other personnel assigned to this activity	Select from list
Contractors assigned to this activity	Select from list
Partners assigned to this activity	Select from list
Describe Partner Involvement:	Text
Other (specify)	Text

Activity Progress (HDSP)

Question		Response Options
Date Progress Occurred*	Month and year
Describe Progress*	Text

Products

Question		Response Options
Title*	Text
Type*	Select one: Audio Book Book Chapter Booklet Conference Paper Conference Proceedings Curriculum Electronic Tool/Resource Evaluation Plan Fact Sheet Featured Article Journal Article Manual Newsletter Policy Document Poster/Billboard Presentation Press Kit Report Slideshow Survey/Instruments Video Other (specify)
Other (specify)	Text
Product Description*	Text
Authors	Text
Product Focus*	Select one or more: Assessment and inventory Awareness approaches/strategies Burden of Cardiovascular Disease Cultural competence Data Management Disease/Risk Factors Epidemiology Environmental approaches/strategies Evaluation Health Communication Lifestyle Intervention (Nutrition) (WW) Lifestyle Intervention (Physical Activity) (WW) Lifestyle Intervention (Tobacco) (WW) Partnerships Policy approaches/strategies Population based strategies Priority population strategies Program planning Recruitment (WW) System approaches/strategies Training & Technical Assistance Other (specify)
Other (specify)	Text
Product Language*	Select all that apply English Spanish Other(Specify)
Other (specify)	Text
Intended Audience*	Select one or more: General Population (WW) WISEWOMAN population (WW) Priority Population (WW) Community/local program Decision/policy makers Faith-based organization General population Healthcare organization Healthcare provider Lifestyle Intervention Delivery (WW) Lifestyle Intervention Development (WW) Local health department Other state government entity Priority population Private sector business State health department Voluntary agency or professional organization Other (specify)
Other (specify)	Text
Website Address	Text
Upload product	Text – file name
Date last revised	Date
Can this product be shared?	Select one: Yes No

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