Full Text PA-96-021
NIH GUIDE, Volume 25, Number 2, February 2, 1996
PA NUMBER:  PA-96-021
P.T. 34

  Health Services Delivery 
  Health Care Economics 

National Institute on Alcohol Abuse and Alcoholism
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seeks
health services research grant applications that are aimed at
developing a knowledge base to improve the efficiency and
effectiveness of services for alcohol-related problems. This program
announcement invites research applications related to improving the
availability, accessibility, delivery, quality, cost effectiveness,
impact, and outcomes of alcohol-related treatment and prevention
The research objectives include, but are not limited to, four major
areas:  (1) determining impacts of financing and reimbursement
mechanisms on alcohol-related health care program availability,
accessibility, delivery, organization, content, quality, and
outcomes; (2) assessing sources of variation in the utilization and
cost of treatment services for alcohol-related problems; (3)
identifying and assessing the effectiveness and outcomes of
alcohol-related treatment and preventive services; and (4)
identifying factors that influence the organization, management, and
delivery services for alcohol-related problems across regions,
populations, and settings.
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 program
announcement, Health Services Research on Alcohol-Related Problems,
is related to the priority areas of alcohol abuse reduction and
alcoholism treatment.  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,
D.C. 20402-9325 (Telephone:  202-512-1800).
Applications may be submitted by domestic and foreign, 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.
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.
Foreign applicants are not eligible for First Independent Research
Support and Transition (FIRST) Awards (R29).  Regular research grant
applications (R01) from foreign institutions are limited to three
Research support may be obtained through applications for a regular
research project grant (R01) or First Independent Research Support
and Transition (FIRST) Award (R29).  Applicants may also submit
Investigator-Initiated Interactive Research Project Grants (IRPG)
under this program announcement.  Interactive Research Project Grants
require the coordinated submission of related regular research
project grant applications and, to a limited extent, FIRST Award
applications from investigators who wish to collaborate on research,
but do not require extensive shared physical resources.  Further
information on the IRPG mechanism is available in program
announcement PA-96-001, NIH Guide for Grants and Contracts, Vol. 24,
No. 35, October 6, 1995.  Program Project Grants applications (P01)
will not be accepted under this program announcement.
The NIAAA also seeks to increase the pool of health services
researchers who have expertise in the alcohol field.  NIAAA
encourages interested institutions to undertake programs of research
training and career development in the area of alcohol-related health
services research.
The NIAAA estimates that the average research grant (R01) award size
will be approximately $250,000 in total costs for the first year.
Outyear budgets should conform to NIH cost-containment policies.
Investigators who wish to submit an application that request more
than $500,000 in direct costs in any one year must contact program
staff before submitting an application.  Although the financial plans
of NIAAA provide for the support of this program, the award of grants
pursuant to this program announcement is contingent upon the
availability of funds for this purpose.
In June 1992, "The ADAMHA Reorganization Act" (Public Law 101-321)
directed NIAAA to expand its program of health services research.
Health services research is defined in the legislation as "research
endeavors that study the impact of the organization, financing and
management of health services on the quality, cost, access to and
outcomes of care" (Section 409).  Health services research also is
concerned with identifying factors that influence the effectiveness
of health services in "real world" settings.
This program announcement invites research applications related to
understanding and improving the financing, utilization,
effectiveness, and organization of health services for the prevention
and treatment of alcohol-related problems.
For the purposes of this program announcement, health services
research includes: (a) the assessment of the impact of health
services and the effects of organizational and financing arrangements
in "real world" clinical settings on the quality and outcomes of care
provided to patients with alcohol abuse and alcoholism or with
medical problems consequent to alcoholism, and (b) the assessment of
the effectiveness of prevention services as well as their financing,
organization, management, implementation, cost, and utilization.  As
directed by subsequent legislation (P.L. 103-43), for the purposes of
this announcement health services research does not include studies
of the efficacy of specific preventive, diagnostic, and treatment
services where the analysis is directed at the individual as distinct
from the service system.
Applications whose main objective is to establish and support
treatment or prevention services are not eligible for funding under
this program announcement.  Support for research-related treatment,
rehabilitation, or prevention services and programs may be requested
only for those particular costs and for that period of time required
by the research.  These costs must be justified in terms of research
objectives, methods, and designs that promise to yield important
generalizable knowledge and/or to make a significant contribution to
theoretical concepts.
Applicants should adopt the most carefully controlled and rigorous
research designs feasible in conducting treatment and prevention
services research and studies (see Lettieri 1992; Sechrest, Persin,
and Bunker 1990; Cook and Campbell 1979).
As elaborated in the "Review Criteria" section of this program
announcement, applications will judged on the basis of the scientific
and technical merit of the proposed research as well as on the
adequacy and appropriateness of the proposed methodology.  Applicants
may wish to consult generic publications in health services research
as well as alcohol-specific examples of prevention and treatment
The following list of research topics is for illustrative purposes.
Topics not mentioned below that fall within the research objectives
of this program announcement will also be accepted.
Financing and Reimbursement of Services
o  Investigating the impact of innovative financing and reimbursement
approaches on the quality, cost effectiveness, and supply of alcohol
treatment and/or prevention services, as well as demand for and
barriers to those services.
o  Assessing how alternative managed care systems affect
availability, quality, cost, and outcomes of treatment and prevention
o  Developing uniform ways to measure insurance benefits and payments
for treatment of alcohol-related problems in order to compare
performance of alternative health plans.  Alcohol-related problems
include medical consequences of alcohol abuse and alcoholism; such
as, alcohol poisoning, or cardiovascular, gastrointestinal and/or
neurological disorders.
o  Identifying the impact of changes in compensation incentives on
the behavior of consumers, clinicians, and institutions, and on
treatment appropriateness and outcomes.
o  Modeling and assessing the impact of health care reform
legislation and other policy changes on the organization, management,
financing, availability, appropriateness, and cost of alternative
alcohol-related health policies and treatment services.
Utilization and Cost of Services
o  Identifying health service factors and individual characteristics
influencing access to, or compliance with, treatment interventions
for alcohol-related problems (including symptomatic medical
problems), particularly among underserved, uninsured, and
HIV-infected populations.
o  Identifying care-seeking behavior of people with alcohol problems,
including utilization of informal resources (e.g., self-help groups)
and alternative (e.g., acupuncture) health resources, as well as
general medical and specialty alcohol services.
o  Developing standardized criteria for identifying episodes of
alcohol treatment to apply in longitudinal analyses of cost and
utilization data.
o  Determining whether or not prevention programs have significant
effects on the utilization and cost of treatment services.
o  Determining the extent to which costs of treatment or prevention
services are offset by subsequent reductions in health care costs.
For example, evaluating characteristics of individuals, programs,
service systems, and insurance benefits associated with greater cost
offsets and cost effectiveness.
Effectiveness and Outcomes of Services
o  Developing and assessing criteria to classify and measure
objectives, components, and processes involved in delivering major
types of services for alcohol-related problems, and examining
linkages between treatment content, quality of care, and functional
as well as alcohol-specific outcomes.
o  Assessing the effectiveness of brief interventions to treat
problem drinking and its medical and social consequences.  Research
may assess brief interventions in inpatient or outpatient acute and
specialty as well as primary care settings.
o  Assessing adequacy and appropriateness of treatment  services to
meet needs and demands of different groups such as women, youth,
minorities, rural residents, and the elderly.
o  Determining the impact of organization, financing, and management
on the effectiveness of treatment interventions when they are
delivered to heterogeneous populations in natural rather than
experimental settings.
o  Developing classification or measurement systems for use by
clinicians to better assign patients to treatment modalities or to
improve outcomes, particularly management of post-treatment relapse.
o  Assessing the potential of prevention activities, programs, or
policies to reduce the need for, demand for, or utilization of health
care, for either chronic or acute conditions related to the use of
o  Applying cost effectiveness research to estimate the costs and
effectiveness of particular alcohol-related health services
(including treatment and prevention) from the perspective of
consumers or their families as well as from the perspectives of
payers, providers, or employers.
o  Assessing the effects of participation in Alcoholics Anonymous on
treatment utilization, outcome, and cost.
Service System Delivery, Organization, and Management
o  Examining organization and management of alcohol treatment
services, including social, economic, demographic, geographic, legal
or health policy, and other factors that may facilitate or impede
effective and efficient linkage and delivery of those services.
o  Determining the impact of system-level, service integration
initiatives on the coordination, comprehensiveness and continuity of
alcohol treatment services.
o  Identifying different organizational models needed for delivery of
alcohol treatment services to different subpopulations such as the
elderly, youth, women, minorities, rural residents, or HIV-positive
o  Developing and testing innovative management approaches to improve
productivity and efficiency in implementing treatment services.
o  Examining organizational, provider, and consumer responses to
changes in the following areas:  (a) financing and reimbursement
policies, (b) structural aspects of managed-care systems, (c)
insurance coverage characteristics of populations in the service
area, (d) number and characteristics of other organizations and
providers in the area, and (e) demographic factors such as population
density, and/or other factors that may lead to changes in
organizational and provider behavior with ultimate consequences for
access to and outcomes of treatment services.
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 20, 1994 (FR 59 14508-14513) and reprinted
in the NIH Guide for Grants and Contracts, Volume 23, Number 11,
March 18, 1994.
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. 5/95) and will be accepted at the standard application
deadlines as indicated in the application kit.  Applications kits are
available at most institutional offices of sponsored research and may
be obtained from the Grants Information Office, Office of Extamural
Outreach and Information Resources, National Institutes of Health,
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone
301/435-0715, email:  girg@drgpo.drg.nih.gov.  The title and number
of the program announcement must be typed in section 2 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:
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817-7710 (for express/courier service)
Applications that are complete 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 the applications under review, will be discussed, assigned a
priority score, and receive a second level review by the appropriate
national advisory council.
Review Criteria
Criteria to be used in the scientific and technical merit review of
alcohol-related health services research grant applications will
include the following:
1.  The scientific, technical, health or medical significance, and
originality of the proposed research
2.  The appropriateness and adequacy of the research design and
methodology proposed to carry out the research.
3.  The adequacy of the qualifications (including level of education
and training) and relevant research experience of the principal
investigator and key research personnel.
4.  The availability of adequate facilities, general environment for
the conduct of the proposed research, other resources, and
collaborative arrangements necessary for the research.  This includes
the feasibility of implementing the project (including recruitment of
subjects, implementation of the intervention or innovation,
cooperation of relevant organizations, and/or availability and
quality of necessary data).
5.  The appropriateness of budget estimates and duration in relation
to the proposed research.
6.  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.
The initial review group will also examine the provisions for the
protection of human subjects and the safety of the research
The review criteria for FIRST Awards (R29), IRPGs, career development
awards, and institutional training grants are contained in the
relevant program announcements.
Applications recommended for approval will be considered for funding
on the basis of the overall scientific and technical merit of the
application as determined by peer review, programmatic needs and
balance, and the availability of funds.  The NIAAA is interested in
maintaining a portfolio of research activities that is balanced among
the four major issues described in the "Research Objectives" section
of this program announcement.  In order to expedite the achievement
of such balance, special consideration will be given to applications
that focus on:  (a) Financing and Reimbursement of Services or (b)
Service System Delivery, Organization, and Management.
Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.
A copy of the NIH program announcement for National Research Service
Awards for Institutional Research Training Grants as published in the
June 3, 1994, issue of the NIH Guide for Grants and Contracts may be
obtained from the program staff listed under INQUIRIES.
Potential applicants may obtain copies of specific announcements from
the National Clearinghouse for Alcohol and Drug Information, P.O. Box
2345, Rockville, Maryland, 20852, telephone: 301-468-2600 or
1-800-729- 6686.  Further information on grant mechanisms and areas
of research interest may be obtained from the program staff listed in
the Inquiries section of this program announcement.
Direct general inquiries regarding health services research to:
Robert B. Huebner, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-0786
FAX:  (301) 443-8774
Email:  bhuebner@willco.niaaa.nih.gov
Direct inquiries regarding health services treatment research to:
Harold I. Perl, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-0788
FAX:  (301) 443-8774
Email:  hperl@willco.niaaa.nih.gov
Direct inquiries regarding health services prevention research to:
Michael Hilton, Ph.D.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-8753
FAX:  (301) 443-8774
Email:  mhilton@willco.niaaa.nih.gov
Direct inquiries regarding health services epidemiologic research to:
Harold Yahr, Ph.D.
Division of Biometry and Epidemiology
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 594-6230
FAX:  (301) 443-8614
Email:  hyahr@willco.niaaa.nih.gov
Direct inquiries regarding research training and career development
opportunities to:
Frances Cotter, M.P.H.
Division of Clinical and Prevention Research
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-1207
FAX:  (301) 443-8774
Email:  fcotter@willco.niaaa.nih.gov
Direct inquiries regarding fiscal matters to:
Linda Hilley
Grants Management Branch
National Institute on Alcohol Abuse and Alcoholism
6000 Executive Boulevard MSC 7003
Bethesda, MD  20892-7003
Telephone:  (301) 443-0915
FAX:  (301) 443-3891
Email:  lhilley@willco.niaaa.nih.gov
This program is described in the Catalog of Federal Domestic
Assistance, No. 93.273.  Awards are made under the authorization of
the Public Health Service Act, Sections 301 and 464H, and
administered under the PHS policies and Federal Regulations at Title
42 CFR Part 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 PHS strongly encourages all grant 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.
Cook, T.D. and Campbell, D.T.  Quasi-Experimentation:  Design and
Analysis Issues for Field Settings.  Boston:  Houghton Mifflin, 1979.
Lettieri, D.J.  A Primer of Research Strategies in Alcoholism
Treatment Assessment. DHHS Pub. No. (ADM) 92-1882.  Rockville, MD:
National Institute on Alcohol Abuse and Alcoholism, 1992.
Sechrest, L.; Persin, E.; and Bunker, J., eds.  Methodology:
Strengthening Causal Interpretations of Nonexperimental Data. DHHS
Pub. No. (PHS) 90-3454.  Rockville, MD:  Agency for Health Care
Policy and Research, 1990.

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