Heart and lung disease are the leading causes of illness and death in the United States, and the disease burden is unequal across groups defined by race/ethnicity, sex and/or gender, and socioeconomic status. Numerous programs have been proven to reduce heart and/or lung disease, but too often they are not put into practice in the communities where they are most needed. The National Heart, Lung and Blood Institute (NHLBI) recognized the need to fund studies to identify implementation strategies to effectively deliver evidence-based interventions and engage diverse multidisciplinary stakeholders in communities with high burdens of heart and/or lung disease.

In September 2020, the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance was initiated with funding from the Center for Translation Research and Implementation Science (CTRIS) Branch of the NHLBI. The DECIPHeR Alliance is comprised of seven Implementation Research Centers (IRC) hosted at:

• University of California at Los Angeles
• University of Colorado Denver
• University of Illinois at Chicago
• Johns Hopkins University/University of Michigan
• Northwestern University
• New York University School of Medicine
• Tulane University

In addition, a Research Coordinating Center (RCC) is located at the University of North Carolina at Chapel Hill.

This 7-year (2020-2027) cooperative agreement is bi-phasic. The first phase, UG3 (2020-2023), is exploratory. Activities at the IRCs are:

• Identifying high burden communities/populations
• Conducting needs assessments;
• Establishing community advisor boards;
• Identifying implementation strategies to be tested during the UH3 phase;
• Preparing to deliver the evidence-based intervention during the UH3 phase.

Community engagement is a key component of all the studies in the DECIPHeR Alliance. The DECIPHeR investigators will engage multiple types of community stakeholders including faith-based organizations, schools, community-based social services providing organizations, study participants and caregivers, health systems, payer organizations, government officials/ organizations, community health workers, advocacy organizations, large non-profit organizations, and institutional partners.

The second phase (UH3) is the implementation phase (2023-2027). During that phase, the DECIPHeR Alliance will utilize connections made and lessons learned in the UG3 phase to test implementation strategies for optimally and sustainably delivering two or more proven-effective, evidence-based multi-level interventions to reduce or eliminate cardiovascular and/or pulmonary health disparities. The implementation strategies, outcomes, interventions, and health outcomes vary across the studies in the DECIPHeR Alliance. The implementation strategies include (but are not limited to):

• economic incentives
• practice facilitation
• training
• navigation
• coaching and monitoring.

Implementation outcomes include

• reach,
• acceptability
• adoption
• appropriateness

IRCs also examine health outcomes including hypertension control/management, childhood asthma, cardiovascular health and smoking cessation.