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Impact Briefs
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The Impact Brief is the official newsletter for the National Association of Chronic Disease Directors. It is distributed monthly to approximately 4,800 NACDD members, partners, and stakeholders. You can view NACDD's Impact Brief archive here:


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Top tags: Arthritis  capacity building  CNMI  CVH  Diabetes  Health Promotion  Healthy aging  heart disease  Louisiana  Medicaid  STAR  stroke  Walk with Ease 

NACDD’s ProVention Health Foundation Hosts a Thought Leader Roundtable on Oral Health and Chronic Disease in Older Adults

Posted By Barbara Park, Monday, June 24, 2019

In February, the ProVention Health Foundation (the Foundation established to support NACDD's work) convened a Thought Leader Roundtable on Oral Health and Chronic Disease in Older Adults. Invited participants included Chronic Disease Directors and Dental Directors from 13 states as well as a diverse group of national partners representing chronic disease, oral health, older adults, academia, and research.

Read the report from the roundtable, which summarizes the themes and recommendations that were identified related to addressing oral health and chronic disease in this growing population. Funding for this roundtable was provided by Glaxo Smith Kline.

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NACDD Receives Funding to Expand its Portfolio in Oral Health

Posted By Barbara Park, Monday, June 24, 2019

In 2018, NACDD was awarded funding under DP18-1811 “Partner Actions to Improve Oral Health Outcomes” by CDC’s Division of Oral Health to provide technical assistance to five states working on medical-dental integration projects focusing on diabetes prevention and control, hypertension awareness and early detection, and tobacco use prevention. NACDD will be responsible for developing success stories to document and promote the approaches these states take over the course of the 5-year project period in addition to providing opportunities for peer-to-peer learning and technical assistance. A brief synopsis of what the states will be doing is provided below:

  • The Colorado Department of Public Health and the Environment will implement a Diabetes, Cardiovascular Disease and Oral Health (DCVDOHI) model for medical and dental systems to sustain medical-dental integration interventions for patients with co-morbid conditions.

  • The Connecticut Department of Public Health will address diabetes and oral disease risk factors by integrating prediabetes and oral health screening, education, and bi-directional referrals into medical and dental systems in federally qualified health centers.
  • The North Dakota Department of Health will use evidence-based and supported strategies to address hypertension in dental office settings and encourage bi-directional referrals between dental and medical health professionals serving low income, rural, American Indian, and underserved populations in the state.
  • The South Carolina Department of Health and Environmental Control will collaborate with community leaders and partners to increase awareness and facilitate access to services for people with diabetes that have unmet oral health needs.
  • The Virginia Department of Health will develop a bi-directional referral system that encourages hypertension screening and counseling, including tobacco cessation counseling, by dental professionals, oral cavity examination by primary care physicians, and active referrals between the two healthcare providers in a safety net setting.

Learn more about NACDD's Oral Health work.

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STAR Teams Visit Louisiana and the Commonwealth of the Northern Mariana Islands

Posted By Jeanne Alongi, Monday, June 24, 2019
NACDD's STAR Program works with state and territorial chronic disease prevention and health promotion programs to build organizational capacity and practice effectiveness. This past month, NACDD subject matter experts in leadership shared information about the program and its unique approach at the National Network of Public Health Institutes Annual Conference in Washington, DC. Additionally, two STAR teams traveled to deliver workshops for Melissa Martin and her Chronic Disease Unit in the Louisiana Department of Health and Amber Mendiola and the Non-Communicable Disease Bureau in the Commonwealth of the Northern Mariana Island.

Tags:  capacity building  CNMI  Louisiana  STAR 

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New Guide Provides a Roadmap for Operationalizing Medicaid Coverage

Posted By Kelly McCracken, Monday, June 24, 2019

New Guide Provides a Roadmap for Operationalizing Medicaid Coverage

NACDD and ChangeLab Solutions, in collaboration with CDC, has released Establishing and Operationalizing Medicaid Coverage of Diabetes Self-Management Education and Support: A Resource Guide for State Medicaid and Public Health Agencies. This guide walks readers through the steps required to make Medicaid coverage a reality for diabetes self-management education and support (DSMES). The guide examines strategies to support State Health Department and Medicaid agency staff in their efforts to increase coverage and utilization of DSMES services in their states. For states that now have Medicaid coverage of DSMES, this document offers additional information on increasing utilization of the DSMES benefit. It also provides stakeholders with information and resources to help promote the expansion of Medicaid coverage of DSMES services.

Specifically, the guide provides:

  • An overview of DSMES services
  • The landscape of Medicaid coverage for DSMES
  • Pathways to Medicaid coverage of DSMES
  • A summary of how to make the case for coverage and steps stakeholders can take to expand Medicaid coverage of DSMES
  • Suggestions about how to address the challenge of low utilization rates for DSMES

For more information, please contact Kelly McCracken or Trish Herrmann.

**Below are additional resources developed and supported by CDC to increase access to diabetes self-management education and support.**  

CDC’s Diabetes Self-Management Education and Support Toolkit

The purpose of this  toolkit is to increase use of DSMES services among people with diabetes and promote healthcare provider referrals. Expanded use of DSMES can help ensure that mpeople with diabetes receive the support they need. The toolkit provides resources and tools in one place to assist with the development, promotion, implementation, and sustainability of DSMES services.

Specifically, the toolkit is designed to:

  • Communicate the evidence supporting DSMES, including the clinical and economic benefits.
  • Clarify the process for establishing a DSMES service that meets minimum standards and is eligible for reimbursement.
  • Provide resources and tools to facilitate becoming a recognized or accredited DSMES provider.
  • Describe common barriers to DSMES use and referral, and provide tips for overcoming these barriers.

Diabetes Education: Policies to Help Patients

With support from the CDC, ChangeLab worked with the Temple University Policy Surveillance Program to develop an interactive website51 state fact sheets, and a national policy poster to analyze insurance coverage for Diabetes Self-Management Education/Training (DSME/T) and the DSME/T policy landscape. Get started here to check out these resources!


Tags:  Diabetes  Medicaid 

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From Our Experts: Cognitive Decline, Coronary Heart Disease and Stroke, and Caregiving: A Related Triad

Posted By Adeline Yerkes, Monday, June 24, 2019

Were you aware that one in nine adults aged 45 years and older report subjective cognitive decline? Or are you even aware of the term, "subjective cognitive decline"? Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss. It is a form of cognitive impairment, and one of the earliest noticeable symptoms of Alzheimer’s disease and related dementias.

Coronary heart disease (CHD) can lead to decreased cognitive function or SCD. One in five adults aged 45 years and older diagnosed with CHD, or a stroke, or both report SCD. Both SCD and coronary heart disease and stroke can impact effective chronic disease self-management and the successfulness of activities of daily living. This lessening ability to effectively self-manage conditions and daily living may lead to the need for a caregiver.

Almost one in four adults, mostly women, ages 45 to 64 years are caregivers. Caregivers are at increased risk for having multiple chronic diseases as they may neglect their own personal health needs while providing care to others. 
More than one third of caregivers report having two or more chronic diseases, and 14.4% reported having coronary heart disease or having had a stroke.

The National Association of Chronic Disease Directors and CDC's Alzheimer’s Disease and Healthy Aging Program are collaborating on the above issues to increase awareness and stimulate public health action by developing a series of five briefs. These briefs are based on the Behavioral Risk Factor Surveillance System (BRFSS) with data aggregated for years 2015-2017. The data are examined in two age groups (adults aged 45-64 years and aged 65 years and older) as well as by sex, race, Hispanic ethnicity, chronic disease status, and other demographic characteristics. The three briefs are formatted in the same style and address a number of common themes. Each brief ends with a public health call to action. To date, three briefs are published and reside on the Healthy Aging pages of NACDD’s and CDC’s websites: Subjective Cognitive Decline, Caregiving and Coronary Heart Disease and Stroke. Start implementing one or more of these calls to action in your community

Tags:  CVH  Healthy aging  heart disease  stroke 

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New Leadership Opportunity: ECHO Clinics

Posted By Administration, Wednesday, May 29, 2019

NACDD unveiled a new leadership opportunity, ECHO Clinics, for state Chronic Disease Directors to engage in peer conversations on emerging topics: Adverse Childhood Effects (ACEs) and Public Health Linkages and Housing. NACDD collaborates with the University of New Mexico ECHO Project on these virtual peer-learning sessions using the ECHO Platform and Zoom technology. These clinics provide a “case management” focus to these topics and allow for in-depth discussion by the participants. The clinics leverage ECHO hub-and-spoke connectivity technology and are founded on principles that support communities of practice and peer mentoring. The clinics are meant to create a facilitated discussion and to engage creative thinking about emerging issues impacting public health practitioners working in chronic disease.  

Linda Scarpetta, MPH, Director, Division of Chronic Disease and Injury Control, Michigan Department of Health and Human Services and Jodi Spicer, MA, Consultant, Division of Chronic Disease and Injury Control, Michigan Department of Health and Human Services, kicked off the first ECHO Clinic, providing information on the impact of ACES on chronic diseases and sharing their Michigan state case story—particularly how they leveraged funding to create a position that supports and collaborates with other partners on ACES. Additionally, they shared their success at the 2019 NACDD Chronic Disease Academy in Atlanta. 

Gabriel Kaplan, PHD, MPA, Colorado Chronic Disease Director and NACDD Board President, along with Cassandra Dove, MPH, Chief Program Officer, Office of Preventive Health and Director, Delta Health Collaborative, Mississippi Department of State, and Tameka Ivory Walls, PhD, MS, Community Clinical Linkage Director, Mississippi State Department of Health –Delta Health Collaborative, shared the importance that housing can play in improving health of the community, particularly on hypertension screening during the second ECHO Clinic.

Two additional ECHO Clinics are planned for this summer. More information will be forthcoming once dates are finalized for the remaining two clinics.  

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Tribal/Territorial Cancer Screening Capacity Building Workshop

Posted By Adeline Yerkes, Wednesday, May 29, 2019

The Tribal/Territorial Cancer Screening Capacity Building Workshop was held April 29 through May 3, 2019. The workshop brought together 12 tribal and 6 territorial organizations to improve skills for staffs of breast and cervical cancer and colorectal cancer screening and prevention programs. The workshop was a series of skill building workshops focusing on evidence-based screening interventions, leadership, communication, and collecting and reporting data relevant to screening programs. During each workshop, participants were involved in reviewing or revising their work plans to capture ideas presented during the workshop. Participant evaluations reported the workshops were useful, applicable, and would very likely use the information gained to improve their programs.

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CDC’s 6|18 Initiative: Medicaid Coverage for the National DPP Lifestyle Change Program

Posted By Wendy Childers, Wednesday, May 29, 2019

CDC’s 6|18 Initiative brings together state Medicaid, public health, and partners to target six high-burden health conditions with effective, evidence-based interventions to improve health and control health care costs. The 6|18 priorities include: reduce tobacco use, improve antibiotic use, prevent unintended pregnancies, control high blood pressure, control asthma, and prevent type 2 diabetes.

NACDD is working with the Division of Diabetes Translation at CDC to provide technical assistance to eight states that chose Medicaid coverage for the National Diabetes Prevention Program (National DPP) as a focus for their 6|18 work. The 2018 – 2019 6|18 diabetes prevention cohort includes Medicaid and public health representatives from the following states: California, Indiana, Kentucky, New Hampshire, New Jersey, Pennsylvania, Rhode Island, and Wyoming.

NACDD and Leavitt Partners are providing group-based technical assistance through a Peer Learning Collaborative to share information and facilitate state-to-state engagement related to Medicaid coverage for the National DPP lifestyle change program. Three sessions have been held since this project kicked off in October 2018: Introduction and Overview: The Basics of Medicaid Coverage and the National DPP Coverage Toolkit (optional introductory session); Making the Case for Coverage: Cost Analysis, Communication, and Partnerships; and Medicaid Policy: State Options and Strategies for Coverage of the National DPP. A fourth session is planned for the end of May, which will focus on working with Medicaid managed care organizations (MCOs) and CDC-recognized organizations, and will include information on contracting, establishing referral systems, and building network capacity for delivering the program statewide. Two final sessions will be held in July and September of this year.

NACDD and Leavitt Partners are also supporting these states through direct technical assistance on an as-needed basis (including participating in webinars or other meetings, providing information and resources, and facilitating state-to-state communications) and continuing to engage states as they complete their 6|18 work plans.

For more information on Medicaid coverage for the National DPP, visit the Coverage Toolkit

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Cancer Prevention Across the Lifespan

Posted By Leslie Best, Wednesday, May 29, 2019

The Cancer Prevention Across the Lifespan project builds upon past work of the CDC Cancer Prevention and Control’s Cancer Prevention Across the Lifespan Workgroup (CPAL), which included collaboration with NACDD to conduct literature reviews and convene meetings of experts to identify factors that influence cancer risk and promising strategies to address these risks throughout the lifespan.

The first year of this new project is focused on the development of innovative resources for public health practitioners in four key focus areas: calculating and communicating cancer risk, avoiding unnecessary exposure to radiation in cases of pediatric mild traumatic brain injury, physical inactivity, and caregiver stress.

The focus on physical inactivity will be highlighted by a webinar on July 22 on innovative ways to implement the Complete Streets program in Indiana and Louisiana, which will be accompanied by case studies on the experiences in each state. A meeting of the Calculating and Communicating Cancer Risk Workgroup is scheduled for June 25, with subject matter experts presenting innovative ways for public health practitioners to communicate data and cancer trend to the general public and policymakers.

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Lupus Awareness Month

Posted By Leslie Best, Wednesday, April 24, 2019

May is Lupus Awareness Month in the United States. Lupus is most common in women between the ages of 18-45, but it can affect men also. Lupus can affect almost any organ in the body. The symptoms of lupus also differ from person to person. For example, one woman with lupus may have swollen knees and fever. Another woman may be tired all the time or have kidney trouble. Someone else may have rashes. Over time, new symptoms can develop, or some symptoms may happen less often. Lupus symptoms also usually come and go, meaning that you don’t have them all of the time.

Systemic lupus erythematosus (SLE) is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help control it. The causes of SLE are unknown, but are believed to be linked to environmental, genetic, and hormonal factors.

Recent studies indicate that lupus incidence rates are almost three times higher in black women than white women and affect 1 in 537 young African-American women. Minority women tend to develop lupus at a younger age, experience more serious complications, and have higher mortality rates—up to three times the mortality rate of white women. In 2015, NACDD led a cooperative effort with the CDC, the Lupus Foundation of American and other stakeholders that included public health professionals, lupus experts, clinicians and individuals living with the disease to develop the first-ever National Public Health Agenda for Lupus (Agenda) to help prioritize public health efforts to improve the care and quality of life for people living with lupus. The Agenda outlines a broad public health approach to lupus diagnosis, disease management, treatment, and research.

Since then, NACDD has collaborated with the American College of Rheumatology, the Georgia Council on Lupus Education and Awareness and the Big Bend Rural Health Network to develop state-based plans to address lupus that reflect the strategies identified in the Agenda. These partnerships have resulted in improved data collection, as questions about lupus were added to the 2019 BRFSS in both states, and every school district in Florida and two in Georgia now collect data on students with a diagnosis of lupus. The school health results should be available later this year. Lupus Care Plans and Transition to Adult Care Plans were developed for use by school nurses, and recent Georgia-based trainings received very enthusiastic evaluations from the 55 nurse participants. For more information about lupus, visit, or

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