Full Text PA-95-066


NIH GUIDE, Volume 24, Number 19, May 26, 1995

PA NUMBER:  PA-95-066

P.T. 34

  Mental Disorders 

National Institute of Mental Health


The purpose of this program announcement is to encourage grant
applications for research on the quality of care delivered in various
settings for mental disorders.  The goal is to further understanding of
what contributes to quality of care and ultimately to ensure that
people with mental disorders are provided the best care possible.

This program announcement addresses recommendations set forth in the
Clinical Services Research section of "Caring for People with Severe
Mental Disorders: A National Plan of Research to Improve Services" and
in earlier National Institute of Mental Health (NIMH) initiatives about
specific populations and disorders, including children and adolescents,
the elderly, rural populations, and schizophrenia.


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.  This PA,
Research on Quality of Care for Mental Disorders, is related to the
priority area of mental health and mental disorders.  Potential
applicants may obtain a copy of "Healthy People 2000" (Full Report:
Stock No. 017-001-00474-0 or Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238).


Applications may be submitted by foreign and domestic, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.  Foreign
institutions are not eligible for First Independent Research Support
and Transition (FIRST) (R29) awards.  Racial/ethnic minority
individuals, women, and persons with disabilities are encouraged to
apply as Principal Investigators.


Research support may be requested through applications for research
project grants (R01), small grants (R03), and FIRST awards (R29).

Because the R03 and R29 mechanisms have special requirements regarding
eligibility, application format, and review criteria, applicants are
strongly encouraged to consult with program staff (listed under
INQUIRIES) and obtain specialized announcements.


Background.   Quality of care research attempts to determine reasons
for differences between clinically or scientifically derived standards
of care and the actual care provided in everyday practice.  In
addition, it is concerned with how well the performance of providers
increases the probability of desired patient outcomes.  Studies of
quality of care often separate the context of care into three
components: structure, process, and outcome.  Structure refers to
characteristics of the community, service system, and client that might
affect process and outcome (e.g., system configuration, demographics,
staffing ratios, ownership). Process refers to interventions that are
intended to influence the course of a disorder (e.g., assessment,
treatment approaches). Outcome refers to the impact of interventions on
the disorders and client (e.g., clinical status, quality of life,
expenditures, satisfaction).

The quality of care provided to people with mental disorders varies
across the Nation and among different service sectors. Recent changes
in the organization and management of mental health services have
heightened concern that quality of care may become compromised.
Delineation of the components of good care and improved understanding
of the factors that contribute to variation in the quality of care can
help to ensure that the best treatment is provided.

Research Issues.  Listed below are examples of research topic areas
that focus on quality of care in mental health.  The list of examples
is illustrative, not exhaustive; it is expected that additional
important research topics will be identified by researchers who respond
to this program announcement.

o  Studies that validate measures of the various domains of outcome in
mental health treatment (e.g., symptoms, functional status,

o  Studies that determine the factors contributing to variations in
quality of care across communities and service settings

o  Studies focusing on process factors that contribute to appropriate
and effective care (e.g., what contributes to technical excellence)

o  Studies assessing contributions of structural characteristics to
quality (e.g., system, community, provider characteristics)

o  Studies that link process with outcomes (e.g., management of
psychotropic medications and clinical outcome)

o  Studies involving development, testing, and refinement of methods to
establish quality of care standards (i.e., meta-analysis, consensus
development conferences, decision analysis)

o  Studies of whether quality monitoring programs or treatment
guidelines improve process and outcomes


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 a 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, and Concerning the Inclusion
of Minorities in Study Populations), which have been in effect since
1990. The new policy contains some 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, Volume 23, Number 11, March 18,

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.


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.  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, 6701 Rockledge Drive, Room 3032, MSC
7762, Bethesda, MD 20892-7762, telephone 301/435-0715.  The title and
number of the 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 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
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for courier/overnight service)


Applications that are complete and responsive to the program
announcement will be evaluated for scientific and technical merit by an
appropriate peer review group convened in accordance with the standard
NIH peer review procedures.  As part of the initial merit review, all
applications will receive a written critique and undergo a process in
which only those applications deemed to have the highest scientific
merit, generally the top half of applications under review, will be
discussed, assigned a priority score, and receive a second level review
by the appropriate national advisory council or board, when applicable.

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

The initial review group will also examine the provisions for the
protection of human subjects and the safety of the research


Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding
decisions:  quality of the proposed project as determined by peer
review, availability of funds, and program priority.

As part of the NIMH Public-Academic Liaison (PAL) initiative, among
applications assigned to the NIMH, preference may be given to those
that involve active collaborations between academic researchers and
public sector agencies in planning, undertaking, analyzing, and
publishing research pertaining to persons with severe mental disorders.
The PAL initiative is based on the premise that important new advances
in understanding and treatment of severe mental disorders can result
from improved linkages between the Nation's scientific resources and
the public sector agencies and programs in which many persons with
severe mental disorders receive their care.


Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Ann A. Hohmann, Ph.D., M.P.H.
Division of Epidemiology and Services Research
National Institute of Mental Health
Parklawn Building, Room 10C-06
Bethesda, MD  20857
Telephone:  (301) 443-3364

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
Parklawn Building, Room 7C-08
Bethesda, MD  20857
Telephone: (301) 443-3065
FAX:  (301) 443-6885
Email:  Diana_Trunnell@nih.gov


This program is described in the Catalog of Federal Domestic Assistance
No. 93.242.  Awards are made under authorization of the Public Health
Service Act, Title IV, Part A (Public Law 78-410, as amended by Public
Law 99-158, 42 USC 241 and 285) 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.  Awards will be
administered under PHS grants policies stated in the Public Health
Service Grants Policy Statement, April 1, 1994.

The Public Health Service (PHS) strongly encourages all grant and
contract recipients to provide a smoke-free workplace and to 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.


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