Key Dates

Related Announcements

PA-20-183 - Research Project Grant (Parent R01 Clinical Trial Required)

PA-20-185- NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

Issued by

National Institute on Minority Health and Health Disparities (NIMHD)

Purpose

Purpose

The purpose of this Notice of Special Interest is to support multidisciplinary, investigative and collaborative research focused on developing and testing multi-level strategies to effectively implement recommended guidelines of comprehensive clinical care for individuals with Type 2 diabetes from health disparity populations.

Key Definitions

NIH-designated U.S. health disparity populations include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities (https://www.nimhd.nih.gov/about/overview/).

The term “multi-level” refers to the multi-dimensional framework of determinants relevant to understand and address minority health and health disparities. This concept is further described under the NIMHD Research Framework (https://www.nimhd.nih.gov/about/overview/research-framework/).

Background

Most current national statistics reveal an overall prevalence of diabetes mellitus (all types) of 14.3%. The prevalence of diabetes mellitus among racial/ethnic minorities has consistently been significantly higher (more recently in the 20.6%-23.5% range or 2-3 times as high) than that of non-Hispanic Whites (NHWs) (11.3%) and is on the rise. In addition, the prevalence of self-reported diabetes mellitus in rural areas is 17% higher than in metropolitan areas, 20-55% higher in sex and gender minority (SGM) individuals than non-SGM individuals, and inversely associated with income and socioeconomic status.

The limited existing data on diabetes-related complications in U.S. populations with health disparities points towards a significant risk of and burden of complications. On the other hand, completion rates of all or some of the recommended clinical assessments for persons with diabetes (e.g., A1C/lipid/blood pressure targets, annual retinal exam, foot exam, urine albumin and estimated glomerular filtration rate, influenza/pneumonia vaccines and others) tend to be 10-30% lower for racial/ethnic minority populations than for NHWs; and 17% in rural settings and 7-11% in the U.S. territories Puerto Rico, USVI and Guam. These lower completion rates may in part contribute to increased odds for preventable hospitalizations and readmissions.

Effective implementation of and adherence to recommended guidelines of care is urgently needed for individuals with diabetes from U.S. populations with health disparities. Effective strategies would be expected to impact health across all populations in a positive way, while potentially generating new information and research hypotheses on treatment effectiveness and precision medicine.

Research Objectives

This initiative will support innovative multidisciplinary and multi-level research designed to optimize type 2 diabetes care for U.S. health disparity populations concordant with evidence-based guidelines. Proposed projects would be expected to develop and/or test patient-centered strategies, which in addition to optimal glycemic control, would aim at completing other recommended guidelines: annual fundoscopic exam, comprehensive foot evaluation at least once a year, annual urinary albumin test, hemoglobin A1c testing at least two times a year or as needed, peripheral neuropathy assessment as needed, and other recommended assessments based on the patient's health profile, and optimal blood pressure and LDL-cholesterol control, intake of ACEI or ARB/statin/aspirin and others, as indicated.

The initiative will support interventions (especially multi-level interventions), clinical trials (including cluster-randomized trials, pragmatic trials), mixed-methods studies, retrospective quantitative research, simulation and modeling, policy, or economic analyses, and evaluations of existing interventions and practices in health care settings serving U.S. health disparity populations.

Specific Areas of Interest

Examples of potential topic areas include but are not limited to:

• Multi-level studies that explore the individualization of guidelines of care based on age (e.g., older adults), sex/gender, race/ethnicity, pregnancy status, comorbidities, state of progression of the disease (newly diagnosed diabetes compared to advanced disease), and social determinants of health, including whether health care is provided in urban or rural settings. The feasibility of the individualization at multiple levels and the effects on health outcomes are of interest.
• Studies that explore clinician decision-making and best practices related to prioritizing or integrating guidelines of care within the context of comorbidities (e.g. cardiovascular risk factors, co-existing chronic conditions including dementia, anxiety, depression).
• Innovative multi-level interventions that promote a proactive care delivery. For example, studies exploring the role of health information technology across different levels (e.g. patient-health care provider, patient-health care system, clinician-heath care system, within-system communication) on patient self-management, patient-clinician shared decision making, and diabetes care coordination.
• Innovative strategies that enhance patient self-management, continuity of care, medical specialty referrals and/or shared patient care in health care settings with limited resources and clinical personnel. These strategies may include digital interfaces and electronic health records portals, among others.
• Studies that assess the role of the family unit and the family comorbidities in the patient-clinician shared decision making and patient-self-management (for example, in older adults), and their effect on health outcomes
• Studies that explore the effect of trust on communication between patient and clinician and/or patient and health care system, and subsequently on health outcomes. Studies that further explore the building of an effective patient-clinician relationship are of interest.
• Studies that address implicit/explicit bias, racism or discrimination related to access and provision of diabetes care (e.g. access and provision of timely, effective and indicated medical/pharmacological/surgical treatment) through strategies/practices across different levels in the health outcomes/care continuum
• Innovative multi-level strategies to implement guidelines of care within the context of challenging housing- and/or work-related conditions or settings
• Studies that identify intermediary factors that mediate or contribute to health or effectiveness of treatment outside of the health care setting (e.g., social determinants of health, sociocultural factors, community resources, ongoing interventions at the community level, natural experiments resulting from policy changes)
• Health care coordination between traditional and non-traditional health care settings (e.g., pharmacies, fire stations, other community resources)
• Health economic analyses and sub-analyses on the sustainability of the implementation of recommended guidelines of diabetes care, including actual or projected health care costs, prevention of hospitalizations and other complications, quality of life and other relevant measures. In addition, analyses of costs of interventions could assess the actual costs of and access to medications, supplies and sub-specialty care within the context of health care payer policies and processes and considering different payment models.
• Studies on the multi-level effects of the COVID-19 pandemic and/or their intersection on access to health care services and continuity of care, for example patient level factors (e.g., loss of health insurance due to job loss; impact on self-management due to caregiving and homeschooling responsibilities) health care setting level factors (e.g., changes and rescheduling of services due to policies on physical distancing; medication availability and refills, health care settings strategies and best practices to ensure appropriate and timely care), and societal factors (impact of policies on physical distancing on nutrition, physical activity, and emotional well-being). Costs/economic analyses are of interest.

Applications non-responsive to terms of this NOSI will not be considered. The following types of projects would generally not be appropriate and may be deemed non-responsive:

• Projects without a focus on one or more U.S. health disparity populations
• Projects or collaborators outside of the United States and its territories
• Projects that do not consider more than one level of analysis (individual, interpersonal, institutional, community, and policy)
• Projects that are exclusively qualitative (though mixed quantitative and qualitative are acceptable)

Application and Submission Information

This notice applies to due dates on or after October 5, 2020 and subsequent receipt dates through May 8, 2021.

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

• PA-20-183 - Research Project Grant (Parent R01 Clinical Trial Required)
• PA-20-185- NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)

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

• For funding consideration, applicants must include “NOT-MD-20-026” (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

Scientific/Research Contact(s)

Larissa Aviles-Santa, MD, MPH
National Institute on Minority Health and Health Disparities (NIMHD)
Tel. 301-827-6924
Email: avilessantal@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)

Priscilla Grant, JD
National Institute on Minority Health and Health Disparities (NIMHD)
Tel. 301-594-8412
Email: grantp@mail.nih.gov