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Home My WebLink AboutAgreement A-19-100 with CSU Fresno Foundation.pdfAgreement No. 19-100 1 IN WITNESS WHEREOF,. he parties hereto have execLJted this Agreement as dflne day 2 ang yef:lrfirst hereinabOve written .. 3 CONTRAC:fOR: CAL.IF.ORN IA STA:'J'.E UNIVERSITY; 4 . FRESNO FOUNDATION . . 5 6 7 (Authorized Sig'tiature) 8 9 10 11 12 13 14 . (Authorized Signature) 15 16 17 rn 19 Mailing Address 49-10 N •. Chest:r,ut.Ave. MIS of 123 20 Fresnq, California 9372,q . 9ontact: Dr .. John_ Caf;!itillan · 21 Phone: 559~228"':2157 22 23 24 25 2.6 · FOR ACCOUNTING USE ONLY: · ORG No.: 56201!;>54 27 Account No.: 7295 28 JW COUNTY OF F'RESNO: --z~~5~::2 Nathan MagsigtChairman ofthe Board' Qf $uperv!sors of the County of Fres·no -14· ATTEST: Bernice E.;Seidel Clerk oftne Board 0fSupervisors County ofFresno; $late of California By: Deputy (j Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 1 Category B: Cardiovascular Disease Prevention and Management Strategy Description B.1 Increase identification of patients with undiagnosed hypertension using EHRs/HIT. Activity Description Start Quarter End Quarter Activity B.1.1  Work with clinic subcontractor to determine protocols for identifying patients with undiagnosed hypertension or those at risk.  Work with clinic subcontractor to determine definition for patients with undiagnosed hypertension or those at risk. Y1Q1 Y1Q4 Short Term Outcomes(s) Short Term Measures Increased identification of patients at-risk for hypertension and screened for potential referral to intervention programs. Measure: Increased number of patients identified for screening for hypertension. -Baseline: 0 -Year 1 Target: 50 -Data Source: EHR queries Population of focus Hispanic adults African American adults Low socioeconomic status adults Urban and rural areas Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 2 Strategy Description B.3 Explore and test innovative ways to engage non-physician team members (e.g., nurses, nurse practitioners, pharmacist, nutritionists, physical therapists, social workers) in hypertension and cholesterol management in clinical settings. Activity Description Start Quarter End Quarter Activity B.3.1  Administer the motivational interviewing training  Develop survey tool for those who attended the motivational interviewing training or health coach training. Y1Q1 Y5Q4 Short Term Outcomes(s) Short Term Measures Increased engagement of non-physician team members. Measure: Number of non-physician team members trained in advanced skills to engage patients and provide referrals using the Rx for Health program. -Baseline: 0 -Year 1 Target: 25 -Data Source: Healthcare systems self-reporting Increased blood pressure control and management among patients using the Rx for Health program. Measure: Percentage improvement in blood pressure control and cholesterol management among patient referred using the Rx for Health program. Baseline: 0 Year 1 Target: 10% Data Source: EHR BP queries Population of focus Hispanic adults African American adults Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 3 Low socioeconomic status adults Urban and rural areas Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 4 Strategy Description B.4 Promote the adoption of MTM between community pharmacists and physicians for the purpose of managing high blood pressure, high blood cholesterol, and lifestyle modification. Activity Description Start Quarter End Quarter Activity B.4.1  Develop survey tool to measure beliefs, knowledge, attitudes  Train clinic staff to administer survey tool Y1Q1 Y2Q1 Short Term Outcomes(s) Short Term Measures Increased access to MTM programs in Fresno County for patients with or at-risk for hypertension. Measure: Number of pharmacists and/or physicians implementing MTM to refer patients with or at-risk for hypertension. -Baseline: 0 -Year 1 Target: 5 -Data Source: Healthcare systems self-reporting, EHR queries Population of focus General Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 5 Strategy Description B.5 Facilitate engagement of patient navigators/community health workers in hypertension and c holesterol management in clinical and community settings. Activity Description Start Quarter End Quarter Activity B.5.1  Administer the motivational interviewing training  Develop survey tool for those who attended the motivational interviewing training or health coach training. Y1Q1 Y4Q3 Short Term Outcomes(s) Short Term Measures Increased engagement of patient navigators/community health workers. Measure: Number and percent of patients within healthcare systems that utilize community health workers or community navigators to link patients to community resources that promote self-management of high blood pressure and high blood cholesterol and manage barriers that prevent patients from utilizing these resources. -Baseline: TBD -Year 1 Target: 25 -Data Source: EHR queries, healthcare systems self-reporting Population of focus Hispanic adults African American adults Low socioeconomic status adults Urban and rural areas Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 6 Strategy Description B.6 Implement systems to facilitate bi-directional referral between community programs/resources and healthcare systems (e.g. using EHRs, 800 numbers, 211 referral systems, etc.). Activity Description Start Quarter End Quarter Activity B.6.1  Develop tracking tools for clinic system to use Rx for Health program  Develop tracking tools for bi-directional referrals bet partners.ween clinic system and community  Train clinic staff and community partners to use the tracking tools for all listed interventions Y1Q4 Y5Q4 Short Term Outcomes(s) Short Term Measures Increased community clinical links that support bi-directional referrals and enrollment in evidence based lifestyle change programs for people with or at-risk for high blood pressure and/or cholesterol. Measure: Number of organizations using the Rx for Health program to refer participants to evidence based programs for people with or at risk for high blood pressure and/or cholesterol. -Baseline: 1 -Year 1 Target: 2 -Data Source: Healthcare systems and/or lifestyle change program self-reporting Increased referrals to evidence based programs for people with or at risk for high blood pressure and/or high cholesterol. Measure: Number of referrals made to evidence based programs for people with or at risk for high blood Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 7 pressure and/or cholesterol through the Rx for Health program. -Baseline: 0 Year 1 Target: 50 -Data Source: EHR queries Population of focus General Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 8 Strategy Description B.8 Explore and test innovative ways to enhance referral, participation, and adherence in cardiac rehabilitation programs in traditional and community settings, including home-based settings. Activity Description Start Quarter End Quarter Activity B.8.3  Work with clinic subcontractor to develop tracking tools for cardiac rehabilitation program Y1Q1 Y5Q4 Short Term Outcomes(s) Short Term Measures Increased awareness and utilization of cardiac rehabilitation program in Fresno County. Measure: Number of referrals to the cardiac rehabilitation program using the Rx for Health program. -Baseline: 0 -Year 1 Target: 25 -Data Source: EHR queries Population of focus Hispanic adults African American adults Low socioeconomic status adults Urban and rural areas Collaborating for Wellness CVHPI Workplan Exhibit A Rx for Health Program 9 Program activities for evaluator in years 1-5 for would include: Evaluator will attend required meetings/calls organized by the Centers for Disease Control and Prevention (CDC). Y1Q1-Y5Q4 Evaluator attend monthly program meetings to share progress of program activities with local health department and program evaluator. Y1Q1-Y5Q4 Evaluator will work with two clinic systems to identify and collect data for required performance measures. Y1Q1-Y5Q4 Evaluator will develop appropriate tools for collecting data Y1Q1-Y5Q4 Evaluator will help to develop the Evaluation Plan and Data Management Plan Y1Q1-Y1Q4 Manage data and ensure quality Y1Q1-Y5Q4 Exhibit B Lead PI/PD: Proposal due:11/8/19 Dept:Y N (circle)Start Date:01/00/00 Co-PI(s):End Date: 01/00/00 Dept:Y N (circle)BUDGET Current Year Project Title:Direct Costs $137,021 Indirects $36,311 Year of Federal CFDA #:Total $173,332 Funding Agency: (check) (check) (check) YES NO PERSONNEL Is Reimbursed Released time requested? If yes,RSP Manager: Name:% time/aca yr:0%in compliance with campus/Foundation policies and Name:% time/aca yr:0%funding agency guidelines. Name:% time/aca yr:0%Signature: Date: YES NO ACADEMIC YEAR OVERLOAD Is Academic Year Overload requested? If yes: PI(s): All required information is correct and complete. Name:% time/aca yr:0%PI Signature: Name:% time/aca yr:0%Date: Name:% time/aca yr:0% Co-PI Signature: YES NO Date Is Summer pay requested? If yes: Name:# mos 0 Co-PI Signature: Name: # mos 0 Date: Name:# mos 0 Department Chair(s): I have been apprised and YES NO SALARY approve of the attached proposal and budget, including Does this project budget include salary for:release time/additional pay for faculty in my department. Post Doc Tech Clerical Signature(s): Other Professional Student Date: YES NO COST SHARE/MATCH Signature(s): Date: $ $School Dean(s): I have been apprised and approve of the attached proposal and budget. YES NO INDIRECT COSTS/F&A Signature(s): Rate: Date: Base:(check)Modified Total Direct Costs Total Direct Signature(s): YES NO CONFLICT OF INTEREST Date: Is the funding source a non-governmental agency, NSF, or NIH? If “yes,” a Conflict of Interest form must be RSP Director: on file with ORSP prior to receipt of funding in compliance with campus/Foundation policies and YES NO ACADEMIC CREDIT funding agency guidelines. Does project offer academic credit through Cont. Ed?Signature: If "yes," obtain Cont/Global Ed Dean signature Date: YES NO SPECIAL COMPLIANCE n*Human Subjects (Interviews/surveys/etc)*(IRB) Dean of Research or Provost or Designee: n*Animals *(IACUC)Signature: n*Unmanned Aircraft Systems (UAS) *(UAS)Date: n*Radiation, biological, or toxic chemicals *(Biosafety) n Contact with School Aged Children (HR follow-up) VP of Admin/ Univ CFO or AVP for Finance: YES NO SPACE/FACILITIES/EQUIPMENT/TECH Signature: Is additional or special space needed for this project?Date: Is funding requested for renovation or construction? Requesting equipment requiring special space or installation? Is additional tech support required? If "yes," consult w/SATO Describe equipment/space needs: Attachments:Budget Guidelines Federal State Local Date:Private Passthrough March 2018 Health Foreign National? Attach Itemized Budget Spreadsheet PROJECT INFORMATION FORM (PIF) To be Completed by Principal Investigator (PI)/Project Director (PD) (with assistance from RSP Grant Manager) Foreign National? APPROVALS 0 0 % time based on 30 WTU = 100% Budget and PIF are complete, correct and CATEGORY:Instruction Public Service Research 0 0 0 0 If Research:Basic Applied Developmental Focus:Air Water Logged in SAR by: Current & Pending Support ORSP Comments: 0 0 * If "yes," appropriate Committee approval must be in place prior to award If "no," attach Indirect Cost Reduction form and guidelines Not required, but volunteered? Is Cost Share/Match required? (Please check all that apply) Itemized cost share/match must be included on attached budget Is maximum allowable IDC rate applied? SUMMER PAY Budget and PIF are complete, correct and 0 PIF Printed 2/11/2019 Exhibit B PIF Printed 2/11/2019 Exhibit B Proposal Due:11/8/2019 Start date:End Date:Title: A. Personnel Wages STAFF #Position on Grant Calendar Yr Salary OR hrly rate % Time Person months Year 1 Year 2 Year 3 Total E. Alcala Project Director $45,760 18%8236.8 $5,491 $8,237 $8,237 $21,965 TBN Research Analyst Y1 50%, Y2 42%, and Y3 42%$31,200 50%6 $10,400 $13,104 $13,104 $36,608 Y. Silva Research Assistant Y1 20%, Y2 25%, and Y3 25%$32,136 20%2.4 $4,285 $8,034 $8,034 $20,353 M. Flores Program Assistant $32,136 15%1.8 $3,214 $4,820 $4,820 $12,854 $23,390 $34,195 $34,195 $91,780 $23,390 $34,195 $34,195 $91,780 Category Rate Alcala 38%$2,087 $3,130 $3,130 $8,347 TBN 10%$1,040 $1,310 $1,310 $3,661 Silva 35%$2,624 $4,499 $4,499 $11,623 Flores 35%$482 $1,687 $1,687 $3,856 Subtotal Fringe Benefits $6,233 $10,627 $10,627 $27,487 TOTAL SALARY AND FRINGE BENEFITS $29,623 $44,822 $44,822 $119,267 D. Travel Local Travel $1,500 $1,113 $1,113 $3,726 Subtotal Travel $1,500 $1,113 $1,113 $3,726 F. Other Direct Support Description Paper, pens, ink, etc. $1,232 $1,848 $1,848 $4,928 Communications Copying, web meetings, conference calls, etc. $1,900 $3,600 $3,600 $9,100 $3,132 $5,448 $5,448 $14,028 I. Total Direct Costs $34,255 $51,383 $51,383 $137,021 MTDC $34,255 $51,383 $51,383 $137,021 Rate: J. Indirect Costs 26.5%MTDC $9,078 $13,616 $13,616 $36,311 K. Total Proposed Costs $43,333 $64,999 $64,999 $173,332 43,333 65000 65000 Subtotal Other Materials and Supplies $154 per month $237.50 per month Y1 and $200 per month Y 2 & 3 Calculation Subtotal ALL Personnel B. Fringe Benefits (5% increase in Workers Comp) ITEMIZED BUDGET Fresno County Collaboration for Wellness Subtotal Staff Salaries Exhibit C Page 1 of 2 SELF-DEALING TRANSACTION DISCLOSURE FORM In order to conduct business with the County of Fresno (hereinafter referred to as “County”), members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must disclose any self-dealing transactions that they are a party to while providing goods, performing services, or both for the County. A self-dealing transaction is defined below: “A self-dealing transaction means a transaction to which the corpora tion is a party and in which one or more of its directors has a material financial interest .” The definition above will be utilized for purposes of completing this disclosure form. INSTRUCTIONS (1) Enter board member’s name, job title (if applicable), and dat e this disclosure is being made. (2) Enter the board member’s company/agency name and address. (3) Describe in detail the nature of the self -dealing transaction that is being disclosed to the County. At a minimum, include a description of the following: a. The name of the agency/company with which the Corporation has the transaction; and b. The nature of the material financial interest in the Corporation’s transaction that the board member has. (4) Describe in detail why the self -dealing transaction is appropriate based on applicable provisions of the Corporations Code. (5) Form must be signed by the board member that is involved in the self -dealing transaction described in Sections (3) and (4). Exhibit C Page 2 of 2 (1) Company Board Member Information: Name: Date: Job Title: (2) Company/Agency Name and Address: (3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to): (4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a): (5) Authorized Signature Signature: Date: