This Program Announcement expires on: 
Expiration Date for R01 Non-AIDS Applications: November 2, 2006 
Expiration Date for R01 AIDS and AIDS-Related Applications: January 3, 2007


AHRQ HEALTH SERVICES RESEARCH
    
Release Date:  June 22, 2000

PA NUMBER:  PA-00-111 
(March 9, 2007 - The R18 portion of this FOA has been reissued as PA-07-247.

(January 11, 2007 - The R01 portion of this funding 
opportunity has been replaced by PA-07-296, which now uses the electronic SF424 (R&R) 
application for February 5, 2007 submission dates and beyond.)
  
Agency for Healthcare Research and Quality

PURPOSE

The mission of the Agency for Healthcare Research and Quality (AHRQ), 
formerly known as the Agency for Health Care Policy and Research 
(AHCPR), is to enhance the quality, appropriateness, and effectiveness 
of health services, and access to such services, through the 
establishment of a broad base of scientific research and through the 
promotion of improvements in clinical and health systems practices, 
including the prevention of diseases and other health conditions.  AHRQ 
achieves this mission through health services research designed to (1) 
improve clinical practice, (2) improve the health care system’s ability 
to provide access to and deliver high quality, high-value health care, 
and (3) provide policymakers with the ability to assess the impact of 
system changes on outcomes, quality, access to, cost, and use of health 
care services.  Consistent with a broad view of health, healthcare 
practices, and systems, ARHQ considers oral health to fit within the 
framework of this Program Announcement (PA).

AHRQ’s research agenda is designed to be responsive to the needs of 
consumers, patients, clinicians and other providers, institutions, 
plans, purchasers, and public policymakers for the evidence-based 
information they need to improve quality and outcomes, control costs, 
and assure access to needed services.

This PA expresses AHRQ priority interests for ongoing extramural grants 
for research, demonstration, dissemination, and evaluation projects to:

o  Support improvements in health outcomes.  Drawing from literature on 
variations in clinical practice and associated outcomes, the documented 
increase in the prevalence of chronic disease, and growing interest in 
the impact of different delivery modalities and financing arrangements 
on the outcomes of care, AHRQ seeks to support research to understand 
and improve decision-making at all levels of the health care system, 
the outcomes of health care, and, in particular, what works, for whom, 
when, and at what cost.

o  Strengthen quality measurement and improvement.  AHRQ is interested 
in a broad array of research topics, including studies to develop valid 
and reliable measures of the process and outcomes of care, causation 
and prevention of errors in health care, strategies for incorporating 
quality measures into programs of quality improvement, and 
dissemination and implementation of validated quality improvement 
mechanisms. 

o  Identify strategies to improve access, foster appropriate use, and 
reduce unnecessary expenditures.  This area focuses on issues 
pertaining to the types of health care services Americans use, the cost 
of these services and sources of payment, determinants of access to 
care, and whether particular approaches to health care delivery and 
financing, or characteristics of the health care market, alter 
behaviors in ways that improve access and promote cost-effective use of 
health care resources.
  
AHRQ recognizes that a number of populations experience persistent 
disparities in health status, access to care, quality of care, and poor 
health care outcomes.  The AHRQ research agenda includes a special 
focus for health services research on these populations, which include 
low-income groups, racial and ethnic minority groups, women, children, 
the elderly, individuals with special health care needs, including 
individuals with disabilities and those who need chronic care and end-
of-life health care, and individuals living in inner-city, rural, and 
frontier areas.  AHRQ encourages research, demonstration, 
dissemination, and evaluation projects for these priority populations 
to address outcomes, quality, access to, cost, and use of services.

AHRQ encourages research using data from the Medical Expenditure Panel 
Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and 
other AHRQ data.  Information on MEPS and HCUP is available from the 
Data section of the AHRQ website and from AHRQ staff (see “Inquiries”).

AHRQ also encourages partnerships with private and public organizations 
to facilitate development and sharing of scientific knowledge and 
resources, including cost-sharing mechanisms, projects that will 
produce results within 2-3 years, and results that can be integrated 
rapidly in practice and policy.

The program areas outlined in this PA are also applicable to AHRQ 
grants for small projects, dissertation support, health services 
research training and career development, and large and small 
conferences (see Mechanism of Support”).
  
AHRQ’s new legislative reauthorization “Healthcare Research and Quality 
Act of 1999," which provides more information on the Agency’s mission 
is available at http://www.ahrq.gov. 

This PA updates and supersedes “AHCPR Health Services Research,” PA-98-
049, published in the NIH Guide for Grants and Contracts (NIH Guide) on 
March 26, 1998.
  
HEALTHY PEOPLE 2010  
  
The Public Health Service (PHS) is committed to achieving the health 
promotion and disease prevention objectives of "Healthy People 2010," a 
PHS-led national activity for setting health improvement priorities for 
the United States.  AHRQ encourages applicants to submit grant 
applications with relevance to the specific objectives of this 
initiative.  Potential applicants may obtain a copy of "Healthy People 
2010" at http://www.health.gov/healthypeople.

ELIGIBILITY REQUIREMENTS  
  
Applications may be submitted by domestic and foreign, public and 
private nonprofit organizations including universities, clinics, units 
of State and local governments, firms, and foundations.  For the 
purpose of this PA, AHRQ will make grants only to nonprofit 
organizations, however, for-profit organizations may participate in 
grant projects through consortium arrangements or as subcontractors. 
Organizations described in section 501(c)4 of the Internal Revenue Code 
that engage in lobbying are not eligible.  
  
AHRQ encourages women, members of racial and ethnic minority groups, 
and persons with disabilities to apply as Principal Investigators.  
  
MECHANISM OF SUPPORT  
  
The mechanism of support for this PA will generally be the research 
project grant (R01), although research demonstration, evaluation, and 
dissemination projects (R18), as well as other mechanisms, may also be 
supported.  Responsibility for the planning, direction, and execution 
of the proposed project will be solely that of the applicant.  
  
Research applications requesting total costs of $100,000 or less 
("small project grants" or R03s) should follow the application 
procedures in the "AHRQ Small Project Grant Program" PA, published in 
the NIH Guide for Grants and Contracts (NIH Guide), February 23, 1996 
and AHRQ Small Project Grant Program - Addendum, published in the NIH 
Guide, January 29, 1999.  AHRQ also supports conference and 
dissertation grants (NIH Guide:  small conference grants, January 26, 
1996, large conference grants, May 31, 1991, dissertation research 
grants, March 13, 2000), and training and career development through 
National Research Service Award grants and fellowships and the 
Independent Scientist Award grants (K02) and Mentored Clinical 
Scientist Development Award grants (K08).  

Program Announcements and grants policy statements listed above are 
available through the AHRQ Web site http://www.AHRQ.gov (Funding 
Opportunities) and from the AHRQ Publications Clearinghouse (see 
Inquiries).  
  
For research applications requesting $500,000 or more in direct costs 
for any year, investigators must receive written agreement from AHRQ 
prior to submission that it will accept the applications (NIH Guide, 
August 22, 1997).  

RESEARCH OBJECTIVES  

AHRQ seeks research on a wide range of topics under the Priority 
Program Areas:  

1) Supporting Improvements in Health Outcomes, 2) Improving Quality and 
Patient Safety, and 3) Identifying Strategies To Improve Access and 
Foster Appropriate Use and Reduce Unnecessary Expenditures.  
  
A continuing challenge to health services research is to improve the 
translation, dissemination, and use of research findings for 
clinicians, other providers, patients, consumers, policy makers, and 
other decisionmakers to effect needed health care changes, and to 
measure the impact of changes at all levels of health care delivery.  
AHRQ is especially interested in projects across its program areas that 
demonstrate innovative strategies for effecting systemic and sustained 
behavior changes to improve outcomes, quality, access, cost, and use, 
and document the impact of changes at systems, state, and community 
levels.  

PRIORITY PROGRAM AREAS  
  
o  Supporting Improvements in Health Outcomes  
  
Research on clinical outcomes examines the effectiveness of different 
strategies for preventing, diagnosing, treating, or managing conditions 
that are common, expensive, and for which significant variations in 
practice or outcomes exist, or opportunities for improvement have been 
demonstrated.  Research in this area also includes improving our 
understanding of how outcomes data can be incorporated into informed 
decision-making at the patient, provider, and organizational levels of 
the health care system.  Outcomes of clinical interventions include 
functional status, quality of life, patient satisfaction, and costs, in 
addition to morbidity and mortality.  A particular emphasis is on the 
outcomes of care provided to the elderly and those with chronic 
illnesses, including studies that assess when in the course of illness 
intervention is most effective.  Research may focus on the type of 
delivery system or financial arrangements by which care is provided and 
the effects of these on clinical outcomes.  Interests include:  

1.  Effectiveness and cost effectiveness of clinical and organizational  
interventions, including trials of interventions across the spectrum of 
health care settings (including sources of alternative and 
complementary medicine) and those used for multiple conditions, or 
innovative approaches to health care delivery to improve outcomes. 

2.  Assessment of the impact of diagnostic and other health care 
technologies on cost and patient outcomes, and how to prioritize such 
assessments.

3.  Development and testing of practical, ready-to-use outcomes 
measures addressing functional status, quality of life, and severity 
and risk adjustment, as well as general measurement issues, and 
strategies for improving outcome measures for patients with multiple 
comorbid conditions, including incorporation of an individual patient"s 
values and preferences.  In particular, increased use of patient-
reported outcome measures as dependent variables in clinical trials 
offers new opportunities for ancillary studies that can enhance our 
understanding of the characteristics and use of these measures.

4.  Development and evaluation of strategies for informed decision-
making, including evaluation of alternative strategies for implementing 
an infrastructure for collection, analysis and presentation of data, 
and real-time incorporation of outcomes and evidence into decision-
making for patients, providers, and policy-makers.

5.  Development and evaluation of strategies for the use of outcome 
measures including patient-oriented measures in practice (e.g., shared 
decisionmaking), or development, validation and use of measures that 
incorporate patient values and preferences.  

6.  The relationship between processes and outcomes of care, including 
timing of services.  

7.  Evaluation of, and development of measures for outcomes, 
effectiveness, and cost effectiveness of clinical preventive services 
for all ages.  

8.  Analysis of the causes of variations in clinical practice and the 
use of  health care technologies, including the clinical behaviors of 
primary care and specialty providers, provider training, patient 
characteristics and preferences, or other factors. 

9.  Observational studies using Medicare, Medicaid, or managed care 
data to answer discrete questions related to the outcomes, 
effectiveness, cost, cost-effectiveness or quality of medical care.  

10.  The impact of models of undergraduate, graduate, and continuing 
education on the knowledge, skills, and attitudes of providers and 
associated patient outcomes.

11.  Therapeutic outcomes, including:  

a.  Relative safety, effectiveness, and cost effectiveness of available 
pharmaceuticals or combinations of therapies, as well as comparison to 
other treatment options. 

b.  Relationships among prescribing decisions, pharmaceutical services, 
use of prescription drugs, and patient outcomes.  

Methodological approaches may include quasi-experimental studies using 
existing data or experimental studies.  

o  Improving Quality and Patient Safety  

The Agency encourages research to improve the capacity of the health 
care system to deliver quality care and protect patients from medical 
errors. There is increasing emphasis on understanding how to measure 
quality and prevent errors across the full spectrum of care, in various 
settings and in transition across settings, and for different 
population groups.  Key to this understanding is the ability to 
describe the influence of organizational as well as clinical factors on 
levels of quality and occurrence of errors.  Of special interest are 
efforts to develop and test interventions to improve quality and 
patient safety in these varying contexts, especially where evidence can 
be presented that the interventions have widespread applicability.    

A.  Quality Measurement and Improvement. Interests include:

1.  Innovative approaches to measuring quality, including the 
perspectives of providers, patients, and consumers.
 
2.  Methods to identify, understand the causes of, and prevent medical 
errors and improve patient safety.

3.  Adaptation of existing measures as well as development and 
validation of new measures for use with diseases, conditions, and 
procedures and in settings where gaps in knowledge exist, including the 
impact of comorbidities on measurement of quality of end-
of-life care. 

4.  General quality measurement methods, including risk and severity 
adjustment, and methods for measuring functional status and quality of 
life. 

5.  Evaluation of the kinds of quality improvement systems that promote 
systemic and sustainable changes in clinical practice to improve the 
quality of care. 

6.  Evaluation of the appropriateness of different data sources for 
quality measurement, and development and evaluation of methods for 
using data to improve quality of care. 

7.  Description and testing of the effects of (1) computerized 
decision-support systems, (2) integrated information systems, (3) 
electronic medical records, (4) Internet-based information and 
consultation for use by patients, and (5) other information technology 
applications on improving quality of care. 

8.  Development and validation of methods for changing the behavior of 
clinicians, provider institutions, employers, plans, and patients to 
improve quality of care and patient safety. 

9.  Evaluation of strategies for integrating quality measurement and 
improvement and patient safety into office-based, worksite-based, and 
primary care settings, as well as acute and long-term care settings.

10.  Formulation of strategies for improving the delivery of clinical 
preventive services (CPS), including research on quality measurement 
for CPS and on system changes in primary care that enhance the access 
to and quality of CPS.

11.  Studies of the impact of public policy and other system changes, 
and organizational and financial arrangements, on health care quality 
at the national, State, and subpopulation levels. 

12.  Development and evaluation of typologies and measurement 
techniques that allow study of the effects of organizational and 
communication strategies on quality improvement.

13.  Research on patient and consumer issues.  AHRQ is particularly 
interested in:  (1) the perceptions of care of priority populations, 
including those cognitively impaired, institutionalized or living with 
complex care decisions such as people with chronic illness or 
disability, including HIV/AIDS, (2) innovative ways to present 
information on quality to patients and consumers that increase 
salience, usefulness and use, and (3) strategies to assist patient and 
consumer communication with health professionals and participation in 
health care decisionmaking.

B.  Evidence-based Practice.  Integral to improving quality of care is 
the development, use, and evaluation of evidence-based tools and 
information.  Interests include:  
  
1.  Methods for optimal systematic reviews of evidence, including 
methodologic research on meta-analysis, decision analysis, and 
cost-effectiveness analysis.  

2.  Evaluation and comparison of different methods to implement 
evidence-based information and tools in diverse health care settings 
and/or among practitioners or various populations, including:
  
a.  Assessment of the role of organizational structure, capacity, and 
culture in effective use of the tools.  

b.  Effectiveness of different types of evidence-based information and 
specific tools in changing behavior of practitioners, patients, and 
organizations. 

3.  Evaluation of the effects of specific evidence-based guidelines or 
other tools on access, utilization, quality, outcomes, costs, and/or 
patient satisfaction.

4.  Studies of the cost effectiveness/cost benefit of important new or 
existing health care technologies.  

5.  Assessment of the extent to which evidence-based information is 
used in determinations of medical necessity and coverage decisions.

6.  The role of informatics in dissemination of evidence-based 
information, and its impact on patient and clinician behavior. 

7.  The role of evidence-based information in the development of 
informatics tools and information sources, the impact of evidence-based 
decision making and increasing role of “just-in-time” information 
systems, and how evidence is incorporated into these systems.

C.  Clinical Preventive Services.  Interests include: 
1.  Interventions to address specific patient barriers to preventive 
care, with specific focus on vulnerable populations, including older 
women, who may receive fewer or lower quality services.

2.  Interventions to improve quality of screening services, including 
reducing false-positive and false-negative rates, improving follow-up 
procedures, and improving patient satisfaction. 

3.  Improving cost-effectiveness of preventive care through 
interventions to reduce overuse of services, target interventions more 
effectively to high-risk groups, or reduce adverse effects and costs of 
screening (including costs and consequences of followup in persons with 
positive screening results). 

4.  Identifying elements of preventive counseling interventions that 
have greatest impact on behavior change, developing more comprehensive 
quality measures for counseling services and other preventive care that 
extend beyond utilization rates.

5.  Interventions to improve patient involvement in preventive care and 
to improve communication between clinicians and patients around 
screening results. 

o  Identifying Strategies to Improve Access, Foster Appropriate Use, 
and Reduce Unnecessary Expenditures  
  
Research is needed on the impact of system changes on access to, cost, 
and use of health care services.  Research is also needed to examine 
expenditures, cost and financing, and organizational arrangements, and 
to assess the effects of these interrelated factors on the delivery of 
health care, including preventive services, that is accessible and 
equitable, and that demonstrates high quality.  
  
A.  Access, Costs, and Use of Health Services.  Interests include:  
  
1.  Studies that use MEPS and other AHRQ data sources to assess the 
cost and utilization of health resources (See "AHRQ Data").

2.  Impact of the trends in health care prices, costs, and sources of 
payment for services on access, expenditures, and outcomes.  

3.  Development of new and more effective ways to measure the range of 
health care costs and to organize and analyze data on costs by clinical 
condition, sociodemographic factors, site of care, and payment sources.  

4.  Studies assessing the impact of different outreach and social 
marketing strategies to increase enrollment in public insurance (e.g., 
Medicaid, SCHIP) among persons eligible for coverage.

5.  Assessment of the determinants of access to care and strategies to 
improve access, especially for underserved populations.  

6.  The development and use of policy-relevant models to simulate and 
understand behavior governing the use, cost, financing, and 
organization of care.  
  
B.  Organization, Financing, and Delivery.  Interests include studies 
of major changes in health care markets and studies examining how 
variations in health care organization, structure, and delivery affect 
the outcomes, quality, access to, cost, and use of care, such as:  
  
1.  New purchasing activities by employers, coalitions, and 
governments, and their impact on managed care organizations, providers, 
employees, and communities.  

2.  The aggregate impact of major changes in public programs and health 
care markets on health care costs and quality, including the impact on 
providers and beneficiaries. 

3.  Dynamics and impact of recent major changes in financial and legal 
arrangements such as consolidations, conversions to for-profit status, 
development of national ownership links among facilities, new 
relationships among acute, subacute, and long-term care facilities, and 
new methods of sharing financial risk and contracting for services on 
quality, cost, access, and use of services.

4.  The impact of the movement of care from inpatient to outpatient 
settings, and from nursing homes to home care on cost and outcomes.

5.  The effects of disease management and "carve-in" and "carve-out" 
arrangements on health care costs, accessibility, and quality of care, 
particularly for persons with chronic conditions.  

6.  Conceptual models, measures, and financial and organizational 
factors  supporting clinical integration of health care services and 
studies of the impact of clinical integration on access, quality, and 
cost of care.

7.  The implementation and use of new staffing and other clinic-level  
configurations, and evaluations of the effectiveness of particular 
models in improving access, quality, and cost of care.  

8.  The use of information technology applications in providing and 
supporting the delivery of health care and their effects on cost, 
quality, and access.  

9.  The role of nonfinancial incentives and organizational 
characteristics, such as organizational structure and culture, in 
affecting the behavior of health care organizations and units and 
individuals within them.  

10.  Evolving definitions of medical necessity used by managed care 
organizations to determine when and under what circumstances services 
will be covered, and the impact of different methods and processes for 
medical decisionmaking by health plans.  
  
Methods can include rigorous qualitative studies as well as 
quantitative research, and conceptual and methodological as well as 
empirical work.  Research partnerships using private sector data 
sources, such as managed care data, are particularly encouraged.  
  
C.  Primary Care Practice.  The characteristics of primary care 
practice play a crucial role in facilitating access to and use of 
services, influencing health costs, and the resulting outcomes and 
levels of quality.  Interests include:  

1.  Characteristics of primary care practice that lead to improvements 
in outcomes and quality of care.

2.  Effective models of organizing, financing, and managing primary 
care services.

3.  Factors that influence access to primary care services, including 
socioeconomic, cultural, and geographic factors.

4.  Optimal delivery of health care, including primary care services, 
in low-income inner-
city and rural areas.

5.  Access to and availability of clinical preventive services. 

6.  Effects of information technology applications in primary care 
practice, such as computerized decision-support systems, remote 
monitoring of patient conditions, and electronically secure exchange of 
patient health data, on access to care and the costs and quality of 
health care.

7.  Clinical decision-making in primary care, including an emphasis on 
facilitating shared patient-clinician decision-making. 

8.  Strategies for integrating quality measurement and improvement into 
office-based, worksite-based, and primary care settings.

9.  Strategies for reducing medical errors and improving patient safety 
in office-based, worksite-based, and primary care settings.

10.  Strategies for facilitating the integration of research findings 
into office-based, worksite-based, and community primary care 
practices.

11.  Improving the quality, value, and access to health care for 
American workers and individuals with disabilities.

12.  Effective strategies in primary care settings for eliminating 
racial and ethnic disparities in health-related outcomes.

13.  Issues related to the outcomes, costs, and delivery of primary 
care services to the elderly.

14.  Improved care for those at the end of life.

15.  Organizational and other factors affecting the cost and quality of 
transitions between ambulatory and other settings, including home, 
hospital, and long-term care settings.

16.  Health care workforce organization, including communication and 
coordination of services among primary care clinicians and other 
members of the health care team.

17.  The readiness of the health care system, in particular its entry 
points such as emergency rooms and primary care, to recognize and 
respond to the effects of exposure to agents of biological or chemical 
terrorism.

To enhance generalizable results, primary care research may involve 
large data bases or primary care practice-based research networks.  
  
PRIORITY POPULATIONS  
  
A number of populations are particularly vulnerable to impaired access 
to and suboptimal quality of care and experience poor health care 
outcomes.  These groups, which warrant a special focus for health 
services research, include low-income groups, racial and ethnic 
minority groups, women, children, the elderly, individuals with special 
health care needs, including individuals with disabilities and those 
who need chronic care and end-of-life health care, and individuals 
living in inner-city, rural, and frontier areas.  Persistent 
disparities in health status and access to appropriate health care 
services continue to be documented for certain groups, particularly 
racial and ethnic minority populations.  Gender-based differences in 
access, quality, and outcomes are also widespread with little 
understanding of the reasons for these differences.  Health services 
research must do a better job of bringing science-based information to 
bear on these variations so that effective solutions may be found for 
improving health.  
  
AHRQ encourages research to address population-specific health issues 
of outcomes, quality, access to, cost, and use of services in each of 
the Priority Program Areas.  Interests include:  
  
Minority Populations  

1.  Understanding factors that underlie disparities in utilization and 
outcomes for racial and ethnic minorities including epidemiology, 
patient preferences and behavior, education, access, health insurance, 
environment, interactions with the health care system, provider 
expertise, preferences, and bias.
2.  Evaluation of effective service delivery methods for eliminating 
disparities in treatment between minority and non-minority populations.

3.  Effect of cultural competence on improving access to and outcomes 
of care for racial and ethnic minority patients.

4.  Eliminating differences in outcomes and health status for racial 
and ethnic minority populations in six clinical areas: infant 
mortality, cancer screening and management, cardiovascular disease, 
diabetes mellitus, HIV, and immunizations for both children and adults 
(President’s Initiative to Eliminate Racial and Ethnic Disparities in 
Health).

5.  Enhancing meaningful community participation in health services 
research projects.  

Women  

1.  Assessment of the effectiveness of services and treatment 
approaches for common, high-cost conditions in women in various age, 
racial/ethnic, and income groups.  Research to understand and eliminate 
inappropriate disparities in health outcomes associated with race or 
ethnicity, geography, insurance status, or other non-medical factors is 
particularly needed.

2.  Analysis of the cost, use of, and access to primary and specialty 
health care services among women, including the impact of changes in 
health systems on women’s health.

3.  Development and assessment of women-specific and culturally-
appropriate measures of quality, outcomes, and patient satisfaction.

4.  Study of health issues related to older women, including the impact 
of specific clinical and organizational interventions on functional 
status and quality of life, with special attention given to mediating 
factors such as co-morbidity, fragmentation of care, and caregiver 
stress.

5.  Research on prevention and health services with relevance to 
particular populations of women, including victims of family violence, 
lesbian women, and women with HIV/AIDS.

6.  Research on women and pharmaceuticals, including gender differences 
in therapeutic outcomes, prescribing practices, occurrence of adverse 
events, and medical errors.

Children

Dramatic changes are occurring in the organization and financing of 
children"s health services, however, the knowledge base for guiding 
these changes or assessing their impact is not well developed.  
Researchers are strongly encouraged to include children in all 
applications and studies, as scientifically and ethically appropriate.  
Children"s health care research raises some distinct methodological 
issues that studies are encouraged to address.  These include:  the 
need for a development perspective that takes into account the 
variation and rapid changes in development that are characteristic of 
children, especially in the neonatal, infancy, early childhood, and 
adolescent periods, the need for considering a range of perspectives 
(e.g., child, family, community, society at large), the fact that 
children generally are much more resilient physically than are older 
individuals, the need to identify large sample sizes for research with 
children with specific conditions and/or specific developmental stages, 
the need to consider the child-relevant range of health care topics 
(e.g., preventive services through end of life care) and health care 
settings (including community health clinics, school and other 
community-based health care delivery sites, ancillary services, as well 
as health care settings such as community-based offices and hospital 
inpatient and emergency departments), the fact that many children live 
in poverty, the need to consider in more detail long-term outcomes and 
the need for longitudinal research, and ethical issues surrounding the 
delivery of health care to children (e.g., to adolescents).  
Applications with innovative and efficient research designs that can 
address these child-relevant issues are encouraged.  Specific research 
interests include:

1.  The urgent need for outcomes and effectiveness research in many 
areas of children’s health care is well documented.  Specific areas of 
interest in outcomes and effectiveness research include: 1) developing 
valid and useful measures of health, functional status, quality of 
life, satisfaction with care, processes of care, and costs and cost-
effectiveness of care applicable to children of different ages and with 
different health conditions, 2) assessing interventions that are unique 
to children, and that may involve the children’s caregivers (e.g., 
health promotion and disease and disability prevention services such as 
anticipatory guidance and counseling), 3) assessing treatments that are 
commonly administered to children but that may have been evaluated for 
safety and effectiveness only in adult populations, 4) documenting 
long-term effects (or lack thereof) associated with health 
interventions in populations of mothers, infants, and children, and 5) 
evaluating costs, benefits, and cost-effectiveness of care to children.

2.  The development of quality measures for children that can be used 
to enhance accountability, support consumer choice, and develop, test, 
and implement quality improvement strategies in children"s health care.

3.  Evidence-based research translation and quality improvement 
strategies are needed to form the basis of efforts to improve practice 
at the policy, health systems, and clinical practice levels.

4.  The U.S. health care system provides the occasion for many "natural 
experiments" in organizational and financial arrangements for care.   
In addition to examining the effects of these variations and changes on 
children"s health outcomes (see above), there is a need to continue to 
carefully examine their impact on quality, cost, use, and access.

5.  Local, federal, and private efforts to increase children"s 
enrollment in Medicaid and the State Child Health Insurance Program 
(Titles XIX and XXI of the Social Security Act, respectively) can be 
enhanced by providing an evidence base for effective strategies.  There 
is a critical need for rigorous research on what works in outreach and 
other strategies. 

6.  AHRQ encourages researchers to address the needs of children living 
in inner-city, rural, and frontier areas, low-income children, minority 
children, female children, and children with special health care needs.

7.  AHRQ encourages researchers to include adolescents and the health 
care settings that are used by adolescents in research about children 
and children"s health care.

Additional guidance on AHRQ"s previous activities and current interests 
in children as a priority population can be found in AHRQ"s 1999 GPRA 
report on children as a priority population 
(http://www.ahrq.gov/about/gpra2001/gpra01app6.htm) and in AHRQ"s 
strategic plan for children as a priority population 
(http://www.ahrq.gov/about/stratpln.htm).

Elderly

Providing health care to the aging U.S. population is one of the most 
pressing health care challenges confronting the nation.  Although the 
scientific knowledge base exists to extend the years of active life and 
prevent the onset of disability with age, current clinical practice 
falls far short in delivering these interventions to older people.  The 
underuse of effective interventions, the overuse of interventions shown 
to be ineffective, and the misuse of others (especially polypharmacy) 
have all been well documented in the elderly.  There is a need for 
studies that focus on interventions aimed at reducing well-documented 
disparities in health status, access, use of services, and health 
outcomes by gender, race/ethnicity, and socioeconomic status among the 
elderly.  Interests include:

1.  Developing cost-effective models of acute, preventive, chronic, 
rehabilitative, and long-term care delivery (including informal care) 
that improve the health and functioning of the elderly.

2.  Assessing the outcomes and effectiveness of clinical, 
organizational, and social interventions that improve or delay decline 
of functional status.
 
3.  Improving our ability to measure change in functioning across the 
broad range of functional levels for a diverse aging population and 
developing strategies to incorporate these functional status measures 
routinely in clinical practice.

4.  Understanding the impact of comorbidities (physical and mental) on 
disease management, clinical decisionmaking, preventive care, and 
health and functional outcomes, and how best to adjust clinical 
practice to account for them. 

5.  Assessing models of collaborative care so that patients and their 
families can be active participants in the decision making process and 
age bias in clinical decision makings is minimized.

6.  Understanding how best to integrate preventive, acute, chronic, and 
long-term care (formal and informal care), and to coordinate the 
delivery of care across multiple sites and settings of care, including 
out-patient, hospital, rehabilitation, subacute care, home care, long-
term care (institutional and community care), and community-based 
social services.

7.  Understanding the impact of financial incentives ( including 
health-based payments) on health care decisions and their subsequent 
effect on the health and outcomes of elderly. 

End-of-Life Health Care

Further research is needed on how to provide appropriate health 
services for patients living with fatal or serious chronic illness 
(such as cancer, stroke, dementia, congestive heart failure, lung 
failure).  While increased life span may be desirable, the goals of 
medical interventions for these patients also include a greater focus 
on preventing excess disability and assuring symptom reduction (e.g., 
pain and dyspnea control) or palliative care.  Specific research 
interests include:

1.  Optimal processes for advance care planning.

2.  Methods of maximizing connectivity and continuity between different 
providers and systems of health care (e.g., nursing home, hospice, home 
care, acute care, ambulatory care).

3.  Evaluation of the comparative costs and quality of care at 
different sites of end-of-life care.

4.  Methods of using severity data to identify those patients in need 
of more extensive services.

5.  Studies of ways to expand access to appropriate sites of end-of-
life care (e.g., hospice, home or community-based).

6.  Research on the financial and social burden of family caregivers.

7.  Development of methods to improve joint patient/family/provider 
decision-making at the end of life.

Research priorities are being developed for the additional populations 
listed including: individuals living in inner-city, rural, and frontier 
areas, individuals with special health care needs, individuals with 
disabilities, and low-income groups.

EMERGING RESEARCH INTERESTS  
  
Two additional areas of health services research that have  become 
increasingly important in today"s rapidly changing market-driven 
delivery system are research on methodologic advances, especially 
cost-effectiveness analysis (CEA) and research on ethical issues, which 
may be related to decisions based on cost effectiveness, but which also 
cut across the spectrum of health care delivery.  Interests include:  
  
A. Cost-Effectiveness Analysis (CEA) and Other Methodological Advances 
that will enhance the capacity of health services research to provide 
needed information.  Interests include:  
  
1.  Production of standardized analytical components (e.g., cost 
components, general population health profiling, national health 
utility index, and incidence-based illness burdens) to facilitate the 
comparability of CEA findings.  

2.  Exploration of the use of CEA as a framework for guiding decisions, 
both clinical and organizational.  

3.  Systematic reviews, meta-analyses, and other methods that enhance 
the generalizability of clinical and other research for application to 
practice.  
  
B.  Ethical Issues raised by changes in the health care delivery system 
that need to be addressed.  Interests include:

1.  Studies on ethical issues across the spectrum of health care 
delivery,  including equity in access to all levels of care.  

2.  Studies on the impact of genomics on the organization and delivery 
of health services.

3.  Studies on changing values regarding the provision of care, from 
the  provision of all possible care without cost considerations, to the 
provision of less costly care.  

4.  Studies to emphasize and clarify tradeoffs related to resource 
allocation and the tension between individual and population or 
societal needs.  
  
SPECIAL REQUIREMENTS

AHRQ Data  
  
To the extent feasible, AHRQ applicants are encouraged to submit 
projects that build on available data, will generate early results, and 
are modest in time, scale, and cost.  
  
AHRQ encourages research applications that will use data from the 
Medical  Expenditure Panel Survey (MEPS), the Healthcare Cost and 
Utilization Project (HCUP), and other AHRQ data.  
  
The MEPS is a rich data source for health care utilization, 
expenditure, and insurance information, directly linking data about 
persons and their families with information obtained from their 
employers, insurers, and health care providers.  It is the third in a 
series of nationally representative surveys of medical care use and 
expenditures in the U.S.  The 1996 MEPS updates previous survey data to 
reflect the changes that have occurred over the past decade.  MEPS 
collects data on the specific health services that Americans use, how 
frequently they use them, the cost and source of payment for services, 
and information on the types and costs of private health insurance held 
by and available to the U.S. population.  It provides a foundation for 
estimating the impact of changes in sources of payment and insurance 
coverage on different economic groups or special populations of 
interest, such as the poor, elderly, uninsured, and racial and ethnic 
minorities.  
  
Some data from the Household and Nursing Home Components of the 1996 
MEPS became available for use by researchers beginning Spring 1997.  
The release schedule for other data through calendar year 1998 is 
available from the MEPS section under “Data” of the AHRQ Web site 
(http://www.ahrq.gov).  

The HCUP includes databases covering 1988-1997, with 1998 and 1999 data 
available in 2001.  These all-payer databases were created through a 
Federal-state-industry partnership to build a multistate health care 
data system.  The main HCUP databases contain discharge-level 
information for inpatient hospital stays in a uniform format with 
privacy protections.  The Nationwide Inpatient Sample (NIS) is a 
nationwide probability sample of about 1000 hospitals.  The State 
Inpatient Databases (SID) contain inpatient records for all community 
hospitals in 22 states.  Other HCUP databases contain ambulatory 
surgery data from nine states.  These databases can be directly linked 
to county-level data from the Health Resources and Services 
Administration"s Area Resource File and to hospital-level data from the 
Annual Survey of the American Hospital Association.

Information on MEPS and HCUP is available from the Data section of the 
AHRQ Web site http://www.ahrq.gov and AHRQ staff (See INQUIRIES).  

CONDITIONS OF AWARD

Data Privacy

Pursuant to section 924(c) of the Public Health Service Act (42 USC 
299c-3(c)), information obtained in the course of any AHRQ-study that 
identifies an individual or entity must be treated as confidential in 
accordance with any promises made or implied regarding the possible 
uses and purposes of the data collection.  In the Human Subjects 
section of the application, applicants must describe procedures for 
ensuring the confidentiality of such  identifying information.  The 
description of the procedures should include a discussion of who will 
be permitted access to the information, both raw data and machine 
readable files, and how personal identifiers and other identifying or 
identifiable data will be restricted and safeguarded.

The grantee should ensure that computer systems containing confidential 
data have a level and scope of security that equals or exceeds those 
established by the Office of Management and Budget (OMB) in OMB 
Circular No. A-130, Appendix III - Security of Federal Automated 
Information Systems.  The National Institute of Standards and 
Technology (NIST) has published several implementation guides for this 
circular.  They are: An Introduction to Computer Security: The NIST 
Handbook, Generally Accepted Principals and Practices for Securing 
Information Technology Systems, and Guide for Developing Security Plans 
for Information Technology Systems.  The circular and guides are 
available on the web at 
http://csrc.nist.gov/publications/nistpubs/800-12/handbook.pdf.     

The application of these confidentiality and security standards to 
subcontractors and vendors should be addressed as necessary.

Rights in Data

AHRQ grantees may copyright or seek patents, as appropriate, for final 
and interim products and materials including, but not limited to, 
methodological tools, measures, software with documentation, literature 
searches, and analyses, which are developed in whole or in part with 
AHRQ funds.  Such copyrights and patents are subject to a worldwide 
irrevocable Federal government license to use and permit others to use 
these products and materials for government purposes.  In accordance 
with its legislative dissemination mandate, AHRQ purposes may include, 
subject to statutory confidentiality protections, making research 
materials, data bases, results, and algorithms available for 
verification or replication by other researchers, and subject to AHRQ 
budget constraints, final products may be made available to the health 
care community and the public by AHRQ or its agents, if such 
distribution would significantly increase access to a product and 
thereby produce public health benefits.  Ordinarily, to accomplish 
distribution, AHRQ publicizes research findings but relies on grantees 
to publish research results in peer-
reviewed journals and to market grant-supported products.

Important legal rights and requirements applicable to AHRQ grantees are 
set out or referenced in the AHRQ’s grants regulation at 42 CFR Part 
67, Subpart A (Available in libraries and from the GPO’s website 
http://www.access.gpo.gov/nara/cfr/index.html).
 
INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY 
POPULATIONS

It is the policy of AHRQ that women and members of minority groups be 
included in all AHRQ-supported research projects involving human 
subjects, unless a clear and compelling rationale and justification are 
provided that inclusion is inappropriate with respect to the health of 
the subjects or the purpose of the research. 

All investigators proposing research involving human subjects should 
read the "NIH Guidelines on the Inclusion of Women and Minorities as 
Subjects in Clinical Research," which have been published in the 
Federal Register of March 28, 1994 and in the NIH Guide for Grants and 
Contracts of March 18, 1994 .  To the extent possible, AHRQ requires 
adherence to these NIH Guidelines.

Investigators may obtain copies from the above sources or from the AHRQ 
Publications Clearinghouse, listed under INQUIRIES, or from the NIH 
Guide Web site http://grants.nih.gov/grants/guide/index.html.

AHRQ also encourages investigators to consider including children in 
study populations, as appropriate.  AHRQ announced in the NIH Guide of 
May 9, 1997, that it is developing a policy and implementation plan on 
the inclusion of children in health services research.  

This Notice is available through the AHRQ Website http://www.AHRQ.gov
(Funding Opportunities) and InstantFAX (see instructions under 
INQUIRIES).

AHRQ Program staff may also provide additional information concerning 
these policies (see INQUIRIES).
  
APPLICATION PROCEDURES  

The research grant application form PHS 398 (rev. 4/98) is to be used 
in applying for these grants.  Applications will be accepted at the 
standard application deadlines as indicated in the form PHS 398.  State 
and local government applicants may use PHS 5161-1, Application for 
Federal Assistance (rev. 5/96), and follow those requirements for copy 
submission.  Applicants are encourage to read all form PHS 398 
instructions prior to preparing an application in response to this PA.  
The PHS 398 type size requirements (p.6) will be enforced rigorously 
and non-compliant applications will be returned.

AHRQ is not using the Modular Grant Application and Award process.  
Applicants for funding from AHRQ should ignore application instructions 
concerning the Modular Grant Application and Award process, and prepare 
applications according to instructions provided in form PHS 398 
(revised 4/98).

Application kits are available at most institutional offices of 
sponsored research.  They may also be obtained from the Division of 
Extramural Outreach and Information Resources, National Institutes of 
Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, 
telephone (301) 435-0714, E-mail: grantsInfo@nih.gov.

AHRQ applicants are encouraged to obtain application materials from the 
AHRQ Publications Clearinghouse  (see INQUIRIES).

The PA title and number must be typed on line 2 of the face page of the 
application form and the YES box must be marked.
 
Complete and signed, typewritten original of the application, including 
the Checklist and five legible signed photocopies, must be submitted in 
one packet to:
  
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040 - MSC 7710
Bethesda, MD  20892-7710 (20817 for express/courier service)

Application Preparation  
  
For applications that propose to use Medicare or Medicaid data that are 
individually identifiable, applicants should state explicitly in the 
"Research Design and Methods" section of the Research Plan (form PHS 
398) the specific files, time periods, and cohorts proposed for the 
research.  In consultation with HCFA, AHRQ will use this information to 
develop a cost estimate for obtaining the data.  This estimate will be 
included in the estimated total cost of the grant at the time funding 
decisions are made.  
  
Applicants should be aware that for individually identifiable Medicare 
and  Medicaid data, Principal Investigators and their grantee 
institutions will be required to enter into a Data Use Agreement (DUA) 
with HCFA to protect the confidentiality of data in accordance with OMB 
Circular A-130, Appendix III--Security of Federal Automated Information 
Systems.  The use of the data is restricted to the purposes and time 
period specified in the DUA.  At the end of this time period, the 
grantee is required to return the data to HCFA or certify that the data 
have been destroyed.  Grantees must also comply with the 
confidentiality requirements of Section 903(c) of the PHS Act.  

In carrying out its stewardship of human resource related programs, the 
AHRQ, at some point in the future, may begin requesting information 
essential to an assessment of the effectiveness of Agency research 
programs.  Accordingly, grant recipients are hereby notified that they 
may be contacted after the completion of awards for periodic updates on 
publications resulting from AHRQ grant awards, and other information 
helpful in evaluating the impact of sponsored research.  AHRQ expects 
grant recipients to keep the Agency informed of publications or the 
impact from Agency sponsored research.
  
REVIEW CONSIDERATIONS  
  
Applications that are complete will be evaluated for scientific and 
technical merit by an appropriate peer review group convened in 
accordance with AHRQ peer review procedures.  As part of the initial 
merit review, all applications will receive a written critique, and 
also may undergo a process in which only those applications deemed to 
have high scientific merit will be discussed and assigned a priority 
score.  

General Review Criteria  
  
Review criteria for grant applications are: consistency with the 
Agency’s mission and research priorities, significance and originality 
from a scientific or technical viewpoint, adequacy of the method(s), 
availability of  data or adequacy of the proposed plan to collect data 
required for the project, adequacy and appropriateness of the plan for 
organizing and carrying out the project, qualifications and experience 
of the Principal Investigator and proposed staff, reasonableness of the 
proposed budget and the time frame for the project in relation to the 
work proposed, adequacy of the facilities and resources available to 
the applicant, the extent to which women, minorities, and if applicable 
children, are adequately represented in study populations, and as 
applicable, the adequacy of the proposed means for protecting human 
subjects.  

AWARD CRITERIA  
  
Applications will compete for available funds with other 
investigator-initiated applications requesting AHRQ support.  The 
following will be considered in making funding decisions:  quality of 
the proposed project as determined by peer review, how well it fits 
AHRQ priorities, program balance, and availability of funds. 

INQUIRIES  

Copies of this PA and copies of the grant application form PHS 398 
(rev. 4/98) are available from:

AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone: 1-800-358-9295 
TDD Service: 888-586-6340

The PA is also available on AHRQ’s Web site, http://www.AHRQ.gov, and 
through AHRQ InstantFAX at (301) 594-2800.  To use InstantFAX, you must 
call from a facsimile (FAX) machine with a telephone handset.  Follow 
the voice prompt to obtain a copy of the table of contents, which has 
the document order number (not the same as the PA number).  The PA will 
be sent at the end of the ordering process.  AHRQ InstantFAX operates 
24 hours a day, 7 days a week.  For comments or problems concerning 
AHRQ InstantFax, please call (301) 594-6344.

AHRQ welcomes the opportunity to clarify any issues or questions from 
potential applicants who have read the PA.  Written and telephone 
inquiries concerning this PA are encouraged.  Direct inquiries 
regarding program matters to the contacts listed below by specific 
program areas: 
  
Improving Health Outcomes  
Carolyn Clancy, M.D.  
Director  
Center for Outcomes and Effectiveness Research  
Telephone:  301/594-1485
E-mail:  cclancy@AHRQ.gov   

Quality of Care  
Gregg Meyer, M.D.  
Director, Center for Quality Measurement and Improvement  
Telephone:  301/594-6672
E-mail: gmeyer@AHRQ.gov  
  
Evidence-based Practice and Technology Assessment 
Douglas B. Kamerow, M.D.  
Director  
Center for Practice and Technology Assessment  
Telephone:  301/594-4026
E-mail:  dkamerow@AHRQ.gov   
  
Primary Care  
Helen Burstin, M.D.  
Director  
Center for Primary Care Research  
Telephone:  301/594-1357
E-mail:  hburstin@AHRQ.gov
  
Cost and Financing  
Steven B. Cohen, Ph.D.
Acting Director  
Center for Cost and Financing Studies  
Telephone:  301/594-6171
E-mail:  scohen@AHRQ.gov 
  
Organization, Delivery, and Markets  
Irene Fraser, Ph.D.  
Director  
Center for Organization and Delivery Studies  
Telephone:  301/594-6824
E-mail:  ifraser@AHRQ.gov   

Minority Health  
Francis D. Chesley, M.D.
Director, Office of Research Review, Education, and Policy
Telephone:  301/594-6410
E-mail:  fchesley@ahrq.gov 

Women’s Health
Marcy Gross, Women"s Health Coordinator
Telephone:  301/594-2429
E-mail:   mgross@AHRQ.gov

Children’s Health
Denise Dougherty, Ph.D., Child Health Coordinator
Telephone:  301/594-2051
E-mail:  ddougher@AHRQ.gov

Clinical Preventive Services  
David Atkins, M.D.  
Medical Officer  
Center for Practice and Technology Assessment  
Telephone:  301/594-4016
E-mail:  datkins@AHRQ.gov

Cost-effectiveness Analysis and Other Methodological Advances  
Joanna Siegel, Sc.D.,R.N.  
Center for Outcomes and Effectiveness Research  
Telephone:  301/594-0667

AHRQ Data Sources:  
  
MEPS Household Component  
Nancy Krauss  
Center for Cost and Financing Studies  
Telephone:  301/594-0846
E-mail:  nkrauss@AHRQ.gov

MEPS Nursing Home Component  
Jeffrey Rhoades  
Center for Cost and Financing Studies  
Telephone:  301/594-0891
E-mail:  jrhoades@AHRQ.gov

HCUP-3  
Kelly Carper  
Telephone:  301/594-3075
E-mail:  kcarper@AHRQ.gov or  
hcupnis@AHRQ.gov or hcupsid@AHRQ.gov

Direct inquiries regarding fiscal matters to:  
  
Mable L. Lam  
Director, Division of Grants Management
Agency for Healthcare Research and Quality  
540 Gaither Road
Rockville, MD  20852 
Telephone:  301/427-1448 
Fax:  301/427-1462
E-mail:  mlam@AHRQ.gov

AUTHORITY AND REGULATIONS  
  
This program is described in the Catalog of Federal Domestic 
Assistance, Number 93.226.  Awards are made under authorization of 
Title IX of the Public Health Service Act (42 USC 299-299c-7) as 
amended by P.L. 106-129 (1999).  Awards are administered under the PHS 
Grants Policy Statement and Federal Regulations 42 CFR 67, Subpart A, 
and 45 CFR Parts 74 or 92.  This program is not subject to the 
intergovernmental review requirements of Executive Order 12372 or 
Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to 
provide a smoke-free workplace and promote the non-use of all tobacco 
products.  In addition, Public Law 103-227, the Pro-Children Act of 
1994, prohibits smoking in certain facilities (or in some cases, any 
portion of a facility) in which regular or routine education, library, 
day care, health care or early childhood development services are 
provided to children.  This is consistent with the PHS mission to 
protect and advance the physical and mental health of the American 
people.



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