Full Text PA-95-010

ENHANCING CLINICAL CARE THROUGH NURSING INFORMATICS

NIH GUIDE, Volume 23, Number 42, December 2, 1994

PA NUMBER:  PA-95-010

P.T. 34

Keywords: 
  0710078 
  Nursing 
  Clinical Medicine, General 

National Institute of Nursing Research
National Library of Medicine

PURPOSE

The National Library of Medicine (NLM) and the National Institute of
Nursing Research (NINR) invite applications for grants to support
research in nursing informatics.  Of particular interest is
investigation that addresses improvements in the delivery of clinical
nursing care through the use of information systems.  The intent of
this program announcement is to generate research that will examine
systems to manage and process data, information and knowledge with
the goal of facilitating appropriate and effective clinical care.
Although NLM's existing program in medical informatics addresses the
application of informatics to health care broadly defined, this
program announcement has the specific purpose of calling the
attention of those interested in informatics research to the set of
issues of particular concern and importance to the nursing
profession.

HEALTHY  PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  The program
announcement, Enhancing Clinical Care Through Nursing Information, is
related to the priority area of surveillance and data systems.
Potential applicants may obtain a copy of "Healthy People 2000" (Full
Report:  Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary
Report:  Stock No. 017-001-00473-1) through the Superintendent of
Documents, Government Printing Office, Washington, DC 20402-9325
(telephone 202-783-3238).

ELIGIBILITY  REQUIREMENTS

Applications may be submitted by domestic and foreign, for-profit and
non-profit, public and private organizations such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.  Topics
studied by foreign applications must have direct relevance to U.S.
populations.  Applications from minority individuals and women are
encouraged.  Foreign institutions are not eligible for the First
Independent Research Support and Transition (FIRST) award (R29).

MECHANISM OF SUPPORT

The mechanisms of support will be the National Institutes of Health
research project grant (R01) and FIRST award (R29).  Responsibility
for the planning, direction, and execution of the proposed project
will be solely that of the applicant.  Though the length of
individual studies will vary, support will be provided for a period
of up to five years, based on availability of funds and sufficient
scientific progress.  Applicants must plan for five years of support
for the R29 award.  Costs of individual projects will vary.  Direct
costs for R29 awards are capped at $100,000 in any one year and
$350,000 across all years.  The average direct cost of a R01 award in
FY 1993 was $186,000.

RESEARCH OBJECTIVES

This initiative builds directly on the work of a panel of scientific
experts on nursing informatics convened as part of the development of
the National Nursing Research Agenda.  The work of this panel was
published in a 1993 report entitled, "Nursing Informatics:  Enhancing
Patient Care".  This report is available from NINR; see INQUIRIES
section.

The goal of this PA is to encourage proposals of innovative research
that focus on the use of nursing information systems to strengthen
the quality of clinical care.  The term nursing informatics combines
the scientific areas related to computers, information and nursing.
Nursing informatics assists in the management and processing of
nursing data, information, and knowledge to support clinical practice
and the provision of nursing care.

Well designed studies are needed to develop, expand, or test a
variety of nursing informatic areas.  These include, but are not
limited to nursing clinical data, processes and outcomes of care, and
clinical decision making.  Some examples of possible topics are:

o  Examine methods to integrate existing terminologies representing
nursing concepts, patient problems and nursing interventions into
larger and broader based systems.

o  Test the reliability and validity of clinical language for nursing
related assessments, diagnoses, interventions and outcomes.

o  Determine the validity of existing data sets of clinical terms
with emphasis on the continuum of care.

o  Explore processes to link clinical conditions, nursing
interventions and treatments with measures of clinical end points.

o  Ascertain the effectiveness of existing information strategies
that support the decision process by nurses in clinical practice.

o  Examine information systems designed to improve quality of care by
defining optimal sequencing and timing of interventions, detailing
expected outcomes and determining resource use such as data bases
supporting clinical pathways or care mapping focusing on particular
patient cohorts frequently requiring concentrated nursing care, eg.
CVAs, multiple traumas, or patients who may make frequent transitions
across health care settings such as children or older adults.

o  Analyze the relationship of patient assessment, processes of
diagnostic development and clinical inference, and choice of related
treatments and intervention alternatives.

o  Explore the processes of clinical decision making, the extent and
influence of participation of patients and their family members in
decision making.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS

It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations) which have
been in effect since 1990.  The new policy contains some new
provisions that are substantially different from the 1990 policies.
All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion Of Women And Minorities As
Subjects In Clinical Research," which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513), and reprinted
in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume
23, Number 11.

Investigators may obtain copies from these sources or from the
program staff or contact person listed below.  Program staff may also
provide additional relevant information concerning the policy.

APPLICATION  PROCEDURES

Applications are to be submitted on the grant application form PHS
398 (rev. 9/91) and will be accepted at the standard application
deadlines as indicated in the application kit.  The receipt dates for
applications for AIDS-related research are found in the PHS 398 (rev.
9/91) instructions.  Application kits are available at most
institutional offices of sponsored research and may be obtained from
the Office of Grants Information, Division of Research Grants,
National Institutes of Health, Westwood Building, Room 449, Bethesda,
MD 20892, telephone 301/435-0714.  The title and number of this
program announcement must be typed in Section 2a on the face page of
the application.

Applications for the FIRST Award (R29) must include at least three
sealed letters of reference attached to the face page of the original
application.  FIRST Award (R29) applications submitted without the
required number of reference letters will be considered incomplete
and will be returned without review.

The completed original application and five legible copies must be
sent or delivered to:

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

REVIEW CONSIDERATIONS

Applications received under this program announcement will be
assigned to an initial review group (IRG) on the basis of established
Public Health Service referral guidelines. The IRG will review the
applications for scientific and technical merit in accordance with
the standard NIH peer review procedures.  Applications will receive a
second-level review by the appropriate national advisory council.
Only applications recommended for further consideration by the
Council may be considered for funding.

As part of the initial merit review, a process (triage) may be used
by the initial review group in which applications will be determined
to be competitive or non-competitive based on their scientific merit
relative to other applications received in response to the RFA.
Applications judged to be competitive will be discussed and be
assigned a priority score.  Applications determined to be non-
competitive will be withdrawn from further consideration and the
Principal Investigator and the official signing for the applicant
organization will be notified.

Review Criteria

o  scientific, technical, or medical significance and originality of
proposed research;

o  appropriateness and adequacy of the experimental approach and
methodology proposed to carry out the research;

o  qualifications and research experience of the Principal
Investigator and staff, particularly, but not exclusively, in the
area of the proposed research;

o  availability of the resources necessary to perform the research;

o  appropriateness of the proposed budget and duration in relation to
the proposed research;

o  Adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.

AWARD CRITERIA

Applications recommended for further consideration will be considered
for available funds on the basis of the scientific and technical
quality of the proposed project determined by peer review,
appropriateness of budget estimates, program needs and balance,
policy considerations, and availability of funds.

INQUIRIES

Written and telephone inquiries are encouraged.  The opportunity to
clarify any issues or questions from potential applicants is welcome.

To receive a copy of "Nursing Informatics:  Enhancing Patient Care,"
direct your inquiries to:

Office of Information and Legislative Affairs
National Institute of Nursing Research
Building 31, Room 5B13
31 Center Drive MSC 2178
Bethesda, MD  20892-2178
Telephone:  (301) 496-0207

Direct inquiries regarding scientific programmatic issues to:

Dr. Patricia Moritz
Nursing Systems Branch
National Institute of Nursing Research
Building 45, Room 3AN-12
45 Center Drive MSC 6300
Bethesda, MD  20892-6300
Telephone:  (301) 594-5966
FAX:  (301) 480-8260

Dr. Milton Corn
Division of Extramural Programs
National Library of Medicine
Building 38A, Room 5N-505
Bethesda, MD  20894
Telephone:  (301) 496-4621
FAX:  (301) 402-0421
E-Mail:  CORN@NLM.NIH.GOV

Direct inquiries regarding fiscal matters to:

Ms. Sally A. Nichols
Grants Management Office
National Institute of Nursing Research
Building 45 Room 3AN-32
45 Center Drive MSC 6301
Bethesda, MD  20892-6301
Telephone:  (301) 594-6869
FAX:  (301) 480-8256

Ms. Ruth E. Bortz
Division of Extramural Programs
National Library of Medicine
Building 38A, Room 5N-515
Bethesda, MD  20894
Telephone:  (301) 496-4253
FAX:  (301) 402-0421

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance Nos. 93.879 and 93.361.  Awards are made under
authorization of the PHS Act, Title III, Part A, Section 301, Title
IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42
USC 241 and 285) and Part D, Subpart 2, Sections 472-476, as amended,
Public Law 100-607, and administered under PHS grants policies and
Federal Regulations 42 CFR 52 and 45 CFR Part 74.  This program is
not subject to the intergovernmental review requirements of Executive
Order 12372 or Health Systems Agency Review.

The Public Health Service (PHS) strongly encourages all grant
recipients to provide a smoke-free workplace and promote the non-use
of all tobacco products.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American
people.

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