2a QIF Project Plan Form

The Health Center Program Application Forms

2023 QIF Project Plan Form

OMB: 0915-0285

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration
QIF Project Plan Form

FOR HRSA USE ONLY

Grant Number

Application Tracking Number



Instructions

The Project Plan form is divided into two sections: (1) Project Overview and (2) Innovation Tables.

  • In the Project Overview section, provide information that applies to the entire project including: project name, problem statement, project goals, population of focus, and barriers summary.

  • In the Innovations Tables section, describe each proposed innovation(s) in detail.

Align all sections of the Project Plan with your responses provided in the Project Narrative.

Project Overview

Project Name

Provide a brief title for your entire project.


Problem Statement

Provide a brief, broad description of the disparities your proposed innovation(s) will address.


Goal

Provide a brief description of the overarching goal(s) your proposed innovation(s) will achieve. Goals should be realistic, reflect input from health center patients who have experienced maternal health barriers, and correspond to improved maternal health and reduced racial and ethnic maternal health disparities in the population of focus.


Population of Focus

Briefly describe your population of focus for all of the proposed innovation(s). The description should align with the information provided in the NEED section of the Project Narrative.



Barriers Summary

Below, select the broad categories your project will address. Responses should be aligned with the most significant disparities described in the NEED section of the Project Narrative.

Which of the following categories of barriers will your project and corresponding innovation(s) address? (select all that apply)

Access and affordability

Clinical quality and safety

Continuity of care

Health outcomes

Patient experience

Which of the following categories of health related social needs will your project and corresponding innovation(s) address? (select all that apply)

Language access challenges

Cultural barriers

Housing insecurity

Food insecurity

Financial strain

Geographic barriers

Transportation barriers

Intimate partner violence

Innovation Tables

Provide a detailed description of each innovation in a separate entry. For each innovation entry, include:

    • A narrative description of the innovation,

    • Which stage of maternal health it will address, and

    • A complete activity table with the following information: the specific barriers the innovation will address, the activities you will implement to carry out the innovation, and the evaluative measures you will use to assess the success of the innovation.

Descriptions should align with responses provided in the Project Narrative and with the information above.

Innovation


Innovation Proposal

Provide a brief narrative overview of the proposed innovation.





Which stage(s) of maternal health will be the focus of your proposed innovation? (select all that apply)

Preconception

Prenatal

Intrapartum

Postpartum

Barriers

List the specific barriers to optimal maternal health for your population of focus that the proposed innovation will address. Specific barriers listed below should align with the broad categories of barriers selected in the Project Overview section of this form and with the descriptions of barriers included in the Project Narrative.

Innovative Activities

List and describe the activities you will implement to address the identified barriers and achieve your project goals.

Evaluative Measures

List the evaluative measures you plan to use to assess the success of your innovation.









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