Key Dates

Related Announcements

• October 2, 2023 - Notice of Availability of Frequently Asked Questions (FAQs) for NOT-HL-23-083. See Notice NOT-HL-23-0915.
• May 10, 2022 - Dissemination and Implementation Research in Health (R01 Clinical Trial Optional). See NOFO PAR-22-105.
• October 12, 2021 - Exploratory Grants in Cancer Control (R21 Clinical Trial Optional). See NOFO PAR-21-341.
• May 5, 2020 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed). See NOFO PA-20-185.
• November 12, 2020 - Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required). See NOFO PAR-21-035.

Issued by

National Heart, Lung, and Blood Institute (NHLBI)

National Cancer Institute (NCI)

All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers. The following NIH Offices may co-fund applications assigned to those Institutes/Centers.

Division of Program Coordination, Planning and Strategic Initiatives, Office of Disease Prevention (ODP)

Purpose

Purpose

This Notice of Special Interest (NOSI) aims to support research that generates evidence on the real-world effectiveness of telehealth collaboration among healthcare providers for consultation, second opinions, and other purposes, referred to as provider-to-provider telehealth (PPT). PPT offers remote access to critical health expertise that might not exist locally in certain communities. For the purpose of this NOSI, PPT is defined broadly to include any health technology meant to connect healthcare providers to one another for the care of patients (e.g., video, chat or audio consults with a clinical specialist for patients under the care of a primary care clinician located in another healthcare facility).

Research supported by this NOSI is expected to:

1. Contribute to the advancement of health equity and access to care in rural communities through implementation research focused on telehealth-guided provider-to-provider communication;
2. Stimulate evidence-based interventional and observational research to investigate the real-world effectiveness of provider-to-provider telehealth in managing the health of rural populations while observing, gathering, and assessing information on implementation;
3. In settings where evidence of clinical effectiveness of PPT is robust, develop and test implementation strategies while observing and gathering information on the intervention’s impact on relevant outcomes.

This NOSI is intended to support the use of these telehealth interventions and tools aimed at the prevention, management and treatment of heart, lung, blood, and sleep (HLBS) conditions (NHLBI), and of cancer (NCI) in rural communities.

In addition to funding consideration by participating ICs, meritorious applications may be supported jointly by a participating IC and the National Institute of General Medical Sciences (NIGMS) through IDeA co-funding.

Background

In the United States, about 20% of the population lives in rural areas. In rural communities, health disparities continue to be a pressing issue, and can result in increased mortality rates, a higher prevalence of diseases, and lower life expectancy than in urban areas. While the underlying causes of such disparities are complex, social determinants of health (e.g., access to care, education, and income) play an important role, and an estimated 22.2 million rural residents live in areas with a shortage of healthcare providers.

As the healthcare landscape in the United States and around the world continues to dramatically evolve, telehealth services with their telecommunication capacity have been one of the expanding interventions that could help address the growing demand for health services in underserved areas. Among these telehealth modalities, PPT offers the unique opportunity for healthcare providers to remotely collaborate, with the potential to increase the availability of expert knowledge in locations where certain medical specialties or health services might not be present. As such, PPT has the potential to increase access to certain services and improve health outcomes among underserved rural communities. There are many examples of such PPT services related to HLBS conditions and cancer, respectively, including:

• Outpatient clinic
  • Remote evaluation of patients by a cardiologist to provide blood pressure management consultation to an on-site primary care physician or nurse practitioner.
  • Virtual collaboration between academic medical center oncology care teams and community-based oncology providers related to interpretation and analysis of laboratory, imaging, and biopsy results to inform cancer treatment planning.
• Inpatient service
  • Remote consultation with a respiratory therapist to the on-site generalist in a community hospital for the management of the respiratory parameters of patients with complicated chronic obstructive pulmonary disease (COPD).
  • Remote oncology consultation with an on-site generalist physician in a community hospital for the management of cancer- or treatment-related symptoms and side effects.
• Emergency setting
  • Remote consultation with a neurologist to an on-site generalist physician to provide timely evaluation of imaging and examination of stroke patients, followed by clinical recommendations; or a remote consultation with a cardiologist who could provide similar care for a patient with angina pectoris, evaluating the patient’s condition, imaging, labs and ECG for the diagnosis and management of a possible myocardial infarction.
  • Remote oncology consultation with an on-site generalist physician to provide timely evaluation of imaging and examination of cancer patients experiencing an adverse event, followed by clinical recommendations.

The COVID-19 pandemic also served as a catalytic period for the expansion of telehealth services and technology at a time when in-person visits were limited, and remote care was often the only form of accessing care. During this period, there was an accelerated nationwide and worldwide acceptance of telehealth, leading to a rapid uptake of digital health technologies delivered online across a variety of platforms, including when addressing HLBS health and disease management, as well as cancer prevention and control. Among other changes promoted by the pandemic, there were also changes in policies, like the Medicare Coverage Waiver. With the waiver, all restrictions on telemedicine use based on geographic location were eliminated, and providers were permitted to bill for virtual visits at the same rate as in-person visits, ultimately also contributing to the boom in the use of telehealth, including PPT.

This NOSI is also inspired by the recommendations of the trans-NIH Pathways to Prevention (P2P) Program, which convened: 1) A 2021 Workshop that assessed available scientific evidence and identified gaps in the use and effectiveness of PPT to improve health in rural communities; 2) A Federal Partners Meeting that discussed implementation examples that could illustrate potential drivers for improving PPT communication and collaboration in rural settings; 3) A Systematic Review that assessed the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare. The independent findings from the workshop and the Federal Partners Meeting identified a set of recommendations, including, but not limited to, the need to examine definitional issues related to rural PPT; uptake of PPT in the context of broadband availability; rural provider recruitment and retention; workforce training; payment policy; and methodologically complex study designs.

Similarly, the American Heart Association (AHA) has released a set of recommendations for the implementation of telehealth in cardiovascular and stroke care (Circulation, Vol. 135, No.7, December 2016) as well as a scientific statement urging for new policies and identifying areas for future research to ensure that telehealth continues to enhance the quality of cardiovascular and stroke care (Circulation, Vol. 146, No.25, November 2022). The American Society for Clinical Oncology (JCO Oncology Practice, Vol 17, No. 9, September 2021) also released standards and practice recommendations for the use of telehealth in oncology. In these national reports, organizations recognized the effectiveness of telehealth in advancing healthcare quality, but also acknowledged that despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. In that sense, attention is called to better identify obstacles to the adoption and delivery of telehealth that need to be addressed to improve health care accessibility and equity, and the need to propose steps to overcome these barriers.

PPT is a promising approach to bringing needed expertise for an equitable delivery of care to rural populations. Evidence supporting its use is available, but studies are needed to explore the real-world effectiveness of PPT that can further inform implementation, as well as studies to identify the barriers and facilitators for the uptake of PPT to better inform future dissemination and implementation strategies. Investigation of strategies to ensure that the use of telehealth in rural areas is sustainable; studies to better understand how PPT affects patients, populations, health care providers, and payers in rural areas; and research to explore the effectiveness of telehealth-guided clinical decision-making and its timeliness for improving health outcomes for rural patients are also called for. Generating additional evidence on the effectiveness of PPT will help identify new approaches to expand and improve telehealth in rural areas, where it will have the greatest impact nationally and globally, including in the management of HLBS conditions and cancer prevention and control, respectively.

Specific Areas of Interest

Areas of interest include, but are not limited to:

• Pertinent to PA-20-185 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed): Observational research evaluating the outcomes of real-world applications of the PPT interventions (e.g., secondary data analysis from the use of PPT during the COVID-19 pandemic; qualitative mixed-methods studies with focus groups assessing the acceptance of PPT by providers and patients, and others).
• Pertinent to PAR-22-105 - Dissemination and Implementation Research in Health (R01 Clinical Trial Optional): High-priority dissemination and implementation (D&I) research relevant to HLBS disease prevention and control, as well as cancer, with a focus on identifying barriers and facilitators for PPT implementation; effectiveness-implementation type-1 hybrid design for the real-world use of PPT. This path also serves for interventional research evaluating the real-world applications of the PPT interventions (e.g., mechanistic clinical trials).
• Pertinent to PAR-21-035 Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required): Investigator-initiated clinical trials related to the telehealth research interests of NCI’s Division of Cancer Control and Population Sciences, with a focus on studies that have the potential to reduce the burden of cancer through improvements in prevention, early detection, screening, healthcare delivery, quality of life, and/or survivorship related to cancer and improve clinical practice or public health.
• Pertinent to PAR-21-341 Exploratory Grants in Cancer Control (R21 Clinical Trial Optional): Early and conceptual stages of research efforts on novel scientific ideas that have the potential to substantially advance population-based cancer research, such as the development of novel techniques, interventions, methodologies, models, or applications that could have a major impact on a field of cancer research (e.g., epidemiologic, biomedical, behavioral, health care delivery or clinical).
  

NHLBI NOFOs for this NOSI

NCI NOFOs for this NOSI

Selected Research Examples

Research examples include, but are not limited to:

• Studies that perform secondary data analysis from the use of PPT during the COVID-19 pandemic towards the remote management of HLBS diseases or cancer.
• Research evaluating the real-world effectiveness of PPT strategies for prevention and treatment of COPD or cancer among rural patients.
• Studies that attempt to standardize organizational elements (e.g., technology, infrastructure, engagement processes) and measurable outcomes (e.g., transfers, length of stay, episode cost of care, readmissions) across multiple sites that can serve as facilitators or barriers for the implementation and sustainability of PPT in the management of cardiovascular- or oncology-related diseases.
• Research to identify drivers through which PPT partnerships are established and sustained between major academic medical institutions and rural health clinics or Federally Qualified Health Centers (FQHCs) to guide widespread adoption and dissemination of Asthma Management Guidelines, especially in underserved communities.
• Research to identify drivers through which PPT partnerships are established and sustained between major academic medical institutions and rural health clinics or FQHCs to guide care across the cancer control continuum, especially in underserved communities.
• Studies that evaluate the effectiveness of telehealth in improving communication and coordination of oncology care, including communication and coordination between oncology care and primary care providers.
• Research evaluating the effectiveness of PTT for precision oncology, including the use and interpretation of tests for genomic or other molecular biomarkers.
• Research evaluating the use of PPT for recruitment, enrollment, monitoring, and retention of patients in cancer clinical trials.
• Studies that evaluate the implementation and outcomes of virtual multidisciplinary cancer conferences.
• Research to evaluate PPT coordination for hospital/cancer care using at-home care delivery models.
• Studies that aim to understand the clinical workflow and the cognitive and other burdens imposed by current clinical information technology (IT) systems on providers in their telehealth-related interactions.
• Research evaluating how organizational policies, clinical team interactions, and the configuration of IT systems influence the clinical workflow and delivery of PPT.
• Studies that examine the cost-effectiveness of PPT in cancer-related care.

The following types of projects are not considered priorities under this NOSI:

• Research that is exclusively an efficacy study.

Application and Submission Information

This notice applies to due dates on or after October 5, 2023 and subsequent receipt dates through October 9, 2026.

Submit applications for this NOSI using one of the following notices of funding opportunity (NOFOs) or any reissues of these announcements through the expiration date of this notice. This NOSI expires on October 10, 2026, thus no applications will be accepted on or after October 10, 2026. Applicants must select the IC and associated NOFO to use for submission of an application in response to the NOSI. The selection must align with the IC requirements listed in order to be considered responsive to that NOFO. Non-responsive applications will be withdrawn from consideration for this initiative.

In addition, applicants using NIH Parent announcements (listed below) will be assigned to those ICs on this NOSI that have indicated those NOFOs are acceptable and based on usual application-IC assignment practices.

• PA-20-185 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)
• PAR-22-105 - Dissemination and Implementation Research in Health (R01 Clinical Trial Optional)
• PAR-21-035 Cancer Prevention and Control Clinical Trials Grant Program (R01 Clinical Trial Required)
• PAR-21-341 Exploratory Grants in Cancer Control (R21 Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and the notice of funding opportunity used for submission must be followed, with the following additions:

• For funding consideration, applicants must include NOT-HL-23-083 (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.

Inquiries

Please direct all inquiries to the contacts in Section VII of the listed notice of funding opportunity with the following additions/substitutions:

Scientific and Research Contact

Fernando P. Bruno, MD, MPH
Center for Translation Research & Implementation Science (CTRIS)
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-496-0886
Email: fernando.bruno@nih.gov

Robin C. Vanderpool, DrPH
Health Communication and Informatics Research Branch
National Cancer Institute (NCI)
Telephone: 240-276-6558
Email: robin.vanderpool@nih.gov

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Louis Velasco
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-827-7977
Email: louis.velasco@nih.gov

Crystal Wolfrey
National Cancer Institute (NCI)
Telephone: 240-276-6277
Email: crystal.wolfrey@nih.gov