Department of Health and Human Services
Part 1. Overview Information
Participating Organization(s)

National Institutes of Health (NIH)

Components of Participating Organizations

National Heart, Lung, and Blood Institute (NHLBI)

Funding Opportunity Title

Strategies to Increase Delivery of Guideline-Based Care to Populations with Health Disparities (R01)

Activity Code

R01 Research Project Grant

Announcement Type

New

Related Notices
  • September 6, 2016 - Notice on Upcoming Webinar for PAR-15-279. See Notice NOT-HL-16-445.
  • NOT-OD-16-004 - NIH & AHRQ Announce Upcoming Changes to Policies, Instructions and Forms for 2016 Grant Applications (November 18, 2015)
  • NOT-OD-16-006 - Simplification of the Vertebrate Animals Section of NIH Grant Applications and Contract Proposals (November 18, 2015)
  • NOT-OD-16-011 - Implementing Rigor and Transparency in NIH & AHRQ Research Grant Applications (November 18, 2015)
Funding Opportunity Announcement (FOA) Number

PAR-15-279

Companion Funding Opportunity

None

Catalog of Federal Domestic Assistance (CFDA) Number(s)

93.837, 93.838, 93.839, 93.233 

Funding Opportunity Purpose

This Funding Opportunity Announcement (FOA) invites applications to conduct innovative and feasible studies to test strategies to accelerate the adoption of guideline-based recommendations into clinical practice among populations with health disparities.  Applications that propose strategies with a focus on providers who care for clinical populations with excess burden of cardiovascular, lung, blood, and sleep diseases and disorders, in concert with the health care delivery systems in which they practice, are strongly encouraged. Applications that test systems, infrastructures, and strategies to implement guideline-based care for NHLBI disorders in clinical care settings are also of high programmatic interest.

Key Dates
Posted Date

June 17, 2015

Open Date (Earliest Submission Date)

September 21, 2015

Letter of Intent Due Date(s)

30 days prior to the application due date

Application Due Date(s)

October 21, 2015; June 21, 2016; October 21, 2016; June 21, 2017; October 20, 2017; and June 21, 2018, by 5:00 PM local time of applicant organization. All types of non-AIDS applications allowed for this funding opportunity announcement are due on these dates.

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

AIDS Application Due Date(s)

Not Applicable

Scientific Merit Review

March 2016; November 2016; March 2017; November 2017; March 2018; November 2018

Advisory Council Review

May 2016; January 2017; May 2017; January 2018; May 2018; January 2019

Earliest Start Date

July 2016; March 2017; July 2017; March 2018; July 2018; March 2019

Expiration Date

June 22, 2018

Due Dates for E.O. 12372

Not Applicable

Required Application Instructions

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this FOA or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the FOA) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

There are several options to submit your application to the agency through Grants.gov. You can use the ASSIST system to prepare, submit and track your application online. You can download an application package from Grants.gov, complete the forms offline, submit the completed forms to Grants.gov and track your application in eRA Commons. Or, you can use other institutional system-to-system solutions to prepare and submit your application to Grants.gov and track your application in eRA Commons. Learn more.

Problems accessing or using ASSIST should be directed to the eRA Service Desk.
Problems downloading forms should be directed to Grants.gov Customer Support.
Table of Contents

Part 1. Overview Information
Part 2. Full Text of the Announcement

Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement
Section I. Funding Opportunity Description

Clinical practice guidelines are available for the diagnosis, management, treatment, and prevention of a number of heart, lung, and blood diseases, and sleep (HLBS) disorders.  The American Heart Association (AHA) and the American College of Cardiology (ACC) have recently released guidelines on the management of obesity and overweight, blood cholesterol levels, lifestyle interventions for risk factors, and cardiovascular risk assessment. Comprehensive guidelines for the treatment of sleep disordered breathing, asthma, von Willebrand disease, pediatric cardiovascular risk reduction, and other conditions are available as well. Development of practice guidelines is important because adherence to guidelines improves clinical outcomes.

Despite the research supporting the use of evidence-based practice recommendations, clinical practice guidelines are rarely universally implemented in routine clinical care, resulting in gaps between recommendations and actual clinical practice. For example, despite the potential deaths prevented with implementation of cardiovascular disease guidelines, only 50-60% of patients with cardiovascular disease risk factors receive recommended treatment.  Only 50% of primary care physicians are aware that there are chronic obstructive pulmonary disease (COPD) guidelines; even among those who are aware of the clinical practice guidelines, only 25% actually use them. The reasons for the failure to implement guidelines are clearly multi-faceted. 

The guideline-to-practice gap is even greater for racial and ethnic minorities, and other medically underserved groups.  In 2001, the Institute of Medicine highlighted the need for active dissemination and implementation efforts of health guidelines in the report “Crossing the Quality Chasm: A New Health System for the 21st Century”.   Progress has been made by educational campaigns and other programs promoting evidence-based medicine.  However, improvements are uneven by race and ethnic group, income, and by geographic region. Practice guidelines are not consistently being implemented by providers across the range of health care delivery systems and practices.  Nowhere is this more apparent than in low income and rural health care facilities, where health disparities remain high. Patients being served by these facilities also have disproportionate risk factor profiles for cardiovascular disease (CVD), hypertension, diabetes, hemoglobinopathies, sarcoidosis, and asthma. For example, racial and ethnic minorities and low income populations have greater rates of hospitalization and re-hospitalization for angina, hypertension, and congestive heart failure, and are more likely to have chronic conditions which are uncontrolled or poorly controlled.  Despite ongoing declines in age-adjusted cardiovascular mortality in the US over the last several decades, CVD remains the leading cause of health disparities in the nation.

Research suggests that targeted, team-based and multi-level strategies need to be developed regarding how to effectively and efficiently improve delivery of guideline-based care in real-world settings by providers. Strategies to identify the factors that impact quality, accessibility, and sustainability of these practices among healthcare providers who serve patients with an excess burden of disease are especially needed.

Purpose

The purpose of this Funding Opportunity Announcement (FOA) is to encourage the development of innovative, multi-level studies to test systems, infrastructures, and strategies that will accelerate the adoption of guideline-based recommendations into clinical care relevant to HLBS disorders.  Proposed strategies that focus on providers who care for clinical populations with excess burden of HLBS diseases and disorders, in concert with the health care delivery systems in which they practice and the patients themselves, are the focus of this initiative.

Systematic reviews of research on guideline implementation strategies find that approaches are most effective when consideration of the unique needs and resources available within specific care settings are taken into account.  For this FOA, practice settings could include Federally Qualified Health Centers (FQHC), safety-net facilities, community health centers, public hospitals, and other practice settings treating populations with disparities in HLBS diseases and disorders. Examples of such vulnerable populations include, but are not limited to, medically underserved individuals, racial and ethnic minorities, low income groups, and rural-dwelling patients.

Health disparities are the result of a complex interplay of patient, provider, and environmental factors.  Characteristics such as poor access to health care, low socioeconomic status, insufficient health literacy, inadequate adherence to care, high obesity rates, and increased environmental exposure all play a role.  However, the significant health disparities that exist across settings and patient populations are due in part to the lack of uniformity in guideline-based treatment delivery and to lower levels of provider and patient adherence to recommended guidelines. This FOA addresses the providers’ and healthcare system contributions to ongoing disparities.

Specific Areas of Research Interest

Examples of studies that are of interest include, but are not limited to, the following:

  • Randomized controlled trials testing the impact of multi-level clinical decision support strategies on implementation of cholesterol management guidelines among practitioners providing care in FQHC settings.
  • Trials testing provider acceptability, uptake, adoption, and spread of guidelines with the use of tools that incorporate innovative strategies using a team approach and emerging technologies to  enable providers to actively and efficiently engage with patients.
  • Studies testing electronic health record (EHR)-based tools to alert primary care physicians working in low resource clinics of the potential for a patient to have sleep-disordered breathing, and provide detailed feedback regarding guidelines for diagnosis, management and care, including developing ways to effectively assist patients in adhering to recommended treatment.
  • Randomized controlled trials of different tailoring strategies for guideline implementation in health centers that may be at different stages of organizational readiness to change, and that may have diverse strengths, weaknesses, organizational contexts, and patient populations.
  • Randomized controlled trials of multi-level strategies to remediate gaps in clinician adherence to best-practice guidelines for outpatient venous thromboembolism (VTE) risk assessment and care.
  • Investigations testing strategies for successful guideline-based care among patients with sickle cell disease, thalassemia and other non-malignant blood diseases.
  • Trials testing optimal sequencing (e.g., timing, order, specific combinations) for implementation of two or more guidelines to treat patients with multiple HLBS risk factors or conditions.
  • Studies to identify barriers among providers and healthcare systems to implementing guideline-based lifestyle treatment for obesity, and strategies to overcome these barriers. 
Section II. Award Information
Funding Instrument

Grant: A support mechanism providing money, property, or both to an eligible entity to carry out an approved project or activity.

Application Types Allowed

New
Renewal
Resubmission
Revision

The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.

Funds Available and Anticipated Number of Awards

The number of awards is contingent upon NIH appropriations and the submission of a sufficient number of meritorious applications.

Award Budget

Application budgets are not limited but need to reflect the actual needs of the proposed project.

Award Project Period

The scope of the proposed project should determine the project period. The maximum project period is 5 years.

NIH grants policies as described in the NIH Grants Policy Statement will apply to the applications submitted and awards made in response to this FOA.

Section III. Eligibility Information
1. Eligible Applicants
Eligible Organizations

Higher Education Institutions

  • Public/State Controlled Institutions of Higher Education
  • Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for NIH support as Public or Private Institutions of Higher Education:

    • Hispanic-serving Institutions
    • Historically Black Colleges and Universities (HBCUs)
    • Tribally Controlled Colleges and Universities (TCCUs)
    • Alaska Native and Native Hawaiian Serving Institutions
    • Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

  • Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
  • Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

  • Small Businesses
  • For-Profit Organizations (Other than Small Businesses)

Governments

  • State Governments
  • County Governments
  • City or Township Governments
  • Special District Governments
  • Indian/Native American Tribal Governments (Federally Recognized)
  • Indian/Native American Tribal Governments (Other than Federally Recognized)
  • Eligible Agencies of the Federal Government
  • U.S. Territory or Possession

Other

  • Independent School Districts
  • Public Housing Authorities/Indian Housing Authorities
  • Native American Tribal Organizations (other than Federally recognized tribal governments)
  • Faith-based or Community-based Organizations
  • Regional Organizations
Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.
Foreign components, as defined in the NIH Grants Policy Statement, are not allowed.

Required Registrations

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. The NIH Policy on Late Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

  • Dun and Bradstreet Universal Numbering System (DUNS) - All registrations require that applicants be issued a DUNS number. After obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
  • System for Award Management (SAM) (formerly CCR) – Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
  • eRA Commons - Applicants must have an active DUNS number and SAM registration in order to complete the eRA Commons registration. Organizations can register with the eRA Commons as they are working through their SAM or Grants.gov registration. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
  • Grants.gov – Applicants must have an active DUNS number and SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account.  PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

2. Cost Sharing

This FOA does not require cost sharing as defined in the NIH Grants Policy Statement.

3. Additional Information on Eligibility
Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

The NIH will not accept duplicate or highly overlapping applications under review at the same time.  This means that the NIH will not accept:

  • A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
  • A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
  • An application that has substantial overlap with another application pending appeal of initial peer review (see NOT-OD-11-101).
Section IV. Application and Submission Information
1. Requesting an Application Package

Applicants must download the SF424 (R&R) application package associated with this funding opportunity using the “Apply for Grant Electronically” button in this FOA or following the directions provided at Grants.gov.

2. Content and Form of Application Submission

It is critical that applicants follow the instructions in the SF424 (R&R) Application Guide, including Supplemental Grant Application Instructions except where instructed in this funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

For information on Application Submission and Receipt, visit Frequently Asked Questions – Application Guide, Electronic Submission of Grant Applications.

Letter of Intent

Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows IC staff to estimate the potential review workload and plan the review.

By the date listed in Part 1. Overview Information, prospective applicants are asked to submit a letter of intent that includes the following information:

  • Descriptive title of proposed activity
  • Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
  • Names of other key personnel
  • Participating institution(s)
  • Number and title of this funding opportunity

The letter of intent should be sent to:

Director, Office of Scientific Review
Division of Extramural Research Activities
National Heart, Lung, and Blood Institute
National Institutes of Health
6701 Rockledge Drive, Room 7214
Bethesda, MD 20892-7924 (Express Mail Zip: 20817)
Telephone: 301-435-0270
Fax: 301-480-0730
Email: nhlbichiefreviewbranch@nhlbi.nih.gov

Page Limitations

All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.

Instructions for Application Submission

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this FOA.

SF424(R&R) Cover

All instructions in the SF424 (R&R) Application Guide must be followed.  

SF424(R&R) Project/Performance Site Locations

All instructions in the SF424 (R&R) Application Guide must be followed.  

SF424(R&R) Other Project Information

All instructions in the SF424 (R&R) Application Guide must be followed.

Facilities & Other Resources. Describe any infrastructure support that will be used to implement the planned study within the proposed setting and population.

SF424(R&R) Senior/Key Person Profile

All instructions in the SF424 (R&R) Application Guide must be followed. 

Biographical sketch. Include relevant information that confirms that the PD(s)/PIs and key personnel have the necessary expertise in design and implementation of the proposed study, and have a track record of successful investigative collaborations or partnerships with the healthcare delivery organizations and/or systems proposed in the application

R&R or Modular Budget

All instructions in the SF424 (R&R) Application Guide must be followed.

R&R Subaward Budget

All instructions in the SF424 (R&R) Application Guide must be followed.

PHS 398 Cover Page Supplement

All instructions in the SF424 (R&R) Application Guide must be followed.  

PHS 398 Research Plan

All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions:

Research Strategy:

Interventions: Describe strategies that take a systems approach by including healthcare systems or organizations and community resources to enable providers to improve care, that help providers to efficiently navigate the healthcare systems in which they work, and that include provider interaction with patients to improve adherence to care. Identify key barriers at the provider, healthcare system, and patient levels that impede implementation efforts, and identify potential methods to facilitate the improved wide-scale adoption of practice guidelines in FQHCs, community clinics, and other relevant healthcare organizations. Describe plans for investigators to partner closely with the health care systems in which they work to develop the necessary support to carry out the implementation strategy. Proposed strategies should be innovative and move beyond single level tools and strategies to incorporate multi-level methods to enable practitioners to effectively and efficiently adopt guidelines.  Provide a compelling justification for the guidelines that are targeted, as well as the need for improvements in delivery of care. Guidelines should be relevant to heart, lung, and blood diseases, and sleep disorders. If relevant, including plans for extending the reach of the intervention(s) to communities with different cultural values are encouraged. Tools that incorporate education and decision support into routine care, promote a team approach, and encourage an active but efficient interaction with patients using innovative technologies is an example of a multi-level implementation strategy that might be tested.

Target Population: Clearly describe the study population. Implementation strategies to be developed and tested must target providers and health care delivery systems that serve vulnerable patient populations, specifically adults and children who are medically underserved, racial/ethnic minorities, low income, and/or rural dwelling patients in either primary care or specialty care. Demonstrate access to and ability to recruit from a sufficient pool of eligible participants.

Study Design: Applications must utilize the most rigorous study design possible for the strategies to be tested.  In most cases these will be randomized controlled trials, including cluster-randomized trials.  Other design approaches may also be appropriate, including systems and population-based approaches, quasi-experimental strategies, mixed-methods designs, and the use of adaptive treatments. Describe plans to document and evaluate the fidelity, quality, and delivery of the implementation strategy.

Study Team:  Describe plans for the multi-disciplinary teams of scientists and practice stakeholders to work together to develop and test models of implementation that are feasible and applicable across diverse community and practice settings and populations of patients. Identify the process for engagement and involvement of stakeholders. If relevant, describe how the expertise and resources of the Clinical and Translational Science Award (CTSA) will be leveraged.

Outcomes:  Clearly describe primary outcomes. Appropriate outcomes include process-focused measures such as provider acceptability, uptake and adoption of guidelines, cost analysis, and provider assessments of suitability and feasibility of the guideline for settings in which there are significant health disparities. Clinical outcomes are desirable.  Identify key factors at the provider, healthcare system, and patient levels that determine successful implementation of specific guideline-based practices.

Letters of Support: To be considered complete, an application must include a letter of support from relevant healthcare provider(s) or other healthcare organization(s) related to the proposed project indicating their commitment to participate.

Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide.

Appendix:  Do not use the Appendix to circumvent page limits. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.

Planned Enrollment Report

When conducting clinical research, follow all instructions for completing Planned Enrollment Reports as described in the SF424 (R&R) Application Guide. 

PHS 398 Cumulative Inclusion Enrollment Report

When conducting clinical research, follow all instructions for completing Cumulative Inclusion Enrollment Report as described in the SF424 (R&R) Application Guide.

3. Submission Dates and Times

Part I. Overview Information contains information about Key Dates. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission.

Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH’s electronic system for grants administration. NIH and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date.  If a Changed/Corrected application is submitted after the deadline, the application will be considered late.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.

4. Intergovernmental Review (E.O. 12372)

This initiative is not subject to intergovernmental review.

5. Funding Restrictions

All NIH awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Pre-award costs are allowable only as described in the NIH Grants Policy Statement.

6. Other Submission Requirements and Information

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide.  Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit Applying Electronically. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Guidelines for Applicants Experiencing System Issues.

Important reminders:

All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile Component of the SF424(R&R) Application Package. Failure to register in the Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to NIH. See Section III of this FOA for information on registration requirements.

The applicant organization must ensure that the DUNS number it provides on the application is the same number used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.

See more tips for avoiding common errors.

Upon receipt, applications will be evaluated for completeness and compliance with application instructions by the Center for Scientific Review, NIH. Applications that are incomplete or non-compliant will not be reviewed.

Requests of $500,000 or more for direct costs in any year

Applicants requesting $500,000 or more in direct costs in any year (excluding consortium F&A) must contact a Scientific/ Research Contact at least 6 weeks before submitting the application and follow the Policy on the Acceptance for Review of Unsolicited Applications that Request $500,000 or More in Direct Costs as described in the SF424 (R&R) Application Guide.

Post Submission Materials

Applicants are required to follow the instructions for post-submission materials, as described in NOT-OD-13-030.

Section V. Application Review Information

Important Update: See NOT-OD-16-006 and NOT-OD-16-011 for updated review language for applications for due dates on or after January 25, 2016.

1. Criteria

Only the review criteria described below will be considered in the review process. As part of the NIH mission, all applications submitted to the NIH in support of biomedical and behavioral research are evaluated for scientific and technical merit through the NIH peer review system.

Overall Impact

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).

Scored Review Criteria

Reviewers will consider each of the review criteria below in the determination of scientific merit, and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.

Significance

Does the project address an important problem or a critical barrier to progress in the field? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field?

Does the proposed study address providers and health care delivery systems that serve vulnerable patient populations?  

Investigator(s)

Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project? If Early Stage Investigators or New Investigators, or in the early stages of independent careers, do they have appropriate experience and training? If established, have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approach, governance and organizational structure appropriate for the project?

Does the project include multi-disciplinary teams of scientists, clinicians and stakeholders. Does the application identify the process for engagement and involvement of stakeholders?

Does the application provide appropriate evidence that the PD(s)/PIs and key personnel have the necessary expertise in design and implementation of the proposed study and have a track record of successful investigative collaborations or partnerships with the healthcare delivery organizations and/or systems proposed in the application?

Innovation

Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?

Does the proposed implementation strategy incorporate multi-level methods to facilitate the effective and efficient adoption of guidelines?  

Is the proposed research likely to improve delivery of care among populations experiencing health disparities? 

Approach

Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? 

Does the study propose strategies that 1) take a systems approach by including healthcare systems/organizations to enable providers to improve care, 2) help providers to efficiently navigate the healthcare system in which they work, and 3) include provider interaction with patients to improve adherence to care?

Does the application clearly identify  key barriers at the provider, healthcare system, and patient levels that impede current implementation efforts, as well as methods to facilitate improvements in wide-scale adoption of practice guidelines in relevant healthcare organizations?

Is the research team closely partnered with the relevant healthcare systems to develop the necessary support to carry out the implementation strategy or strategies? 

Does the application provide a compelling justification for 1) the guidelines that are targeted and 2) the need for improvements in delivery of care for the identified population(s) and relevant heart, lung, and blood diseases, and sleep disorders??

Does the project target providers and healthcare delivery systems that serve medically underserved, racial/ethnic minority, low income, and/or rural-dwelling patients or other groups who experience health disparities?

How strong are the plans to document and evaluate the fidelity, quality, and delivery of the implementation strategy?

If the project involves human subjects and/or NIH-defined clinical research, are the plans to address 1) the protection of human subjects from research risks, and 2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of children, justified in terms of the scientific goals and research strategy proposed?  

Environment

Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements?

Is there sufficient infrastructure, support, and expertise to implement the proposed study within the proposed setting and population?

Are sufficient numbers of potentially eligible patients available for inclusion in the study? 

Additional Review Criteria

As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.

Protections for Human Subjects

For research that involves human subjects but does not involve one of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the six categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.

Inclusion of Women, Minorities, and Children 

When the proposed project involves human subjects and/or NIH-defined clinical research, the committee will evaluate the proposed plans for the inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion (or exclusion) of children to determine if it is justified in terms of the scientific goals and research strategy proposed. For additional information on review of the Inclusion section, please refer to the Guidelines for the Review of Inclusion in Clinical Research.

Vertebrate Animals

The committee will evaluate the involvement of live vertebrate animals as part of the scientific assessment according to the following five points: 1) proposed use of the animals, and species, strains, ages, sex, and numbers to be used; 2) justifications for the use of animals and for the appropriateness of the species and numbers proposed; 3) adequacy of veterinary care; 4) procedures for limiting discomfort, distress, pain and injury to that which is unavoidable in the conduct of scientifically sound research including the use of analgesic, anesthetic, and tranquilizing drugs and/or comfortable restraining devices; and 5) methods of euthanasia and reason for selection if not consistent with the AVMA Guidelines on Euthanasia. For additional information on review of the Vertebrate Animals section, please refer to the Worksheet for Review of the Vertebrate Animal Section.

Biohazards

Reviewers will assess whether materials or procedures proposed are potentially hazardous to research personnel and/or the environment, and if needed, determine whether adequate protection is proposed.

Resubmissions

For Resubmissions, the committee will evaluate the application as now presented, taking into consideration the responses to comments from the previous scientific review group and changes made to the project.

Renewals

For Renewals, the committee will consider the progress made in the last funding period.

Revisions

For Revisions, the committee will consider the appropriateness of the proposed expansion of the scope of the project. If the Revision application relates to a specific line of investigation presented in the original application that was not recommended for approval by the committee, then the committee will consider whether the responses to comments from the previous scientific review group are adequate and whether substantial changes are clearly evident.

Additional Review Considerations

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

Applications from Foreign Organizations

Not Applicable

Select Agent Research

Reviewers will assess the information provided in this section of the application, including 1) the Select Agent(s) to be used in the proposed research, 2) the registration status of all entities where Select Agent(s) will be used, 3) the procedures that will be used to monitor possession use and transfer of Select Agent(s), and 4) plans for appropriate biosafety, biocontainment, and security of the Select Agent(s).

Resource Sharing Plans

Reviewers will comment on whether the following Resource Sharing Plans, or the rationale for not sharing the following types of resources, are reasonable: 1) Data Sharing Plan; 2) Sharing Model Organisms; and 3) Genomic Wide Association Studies (GWAS) /Genomic Data Sharing Plan.

Budget and Period of Support

Reviewers will consider whether the budget and the requested period of support are fully justified and reasonable in relation to the proposed research.

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by the Center for Scientific Review, in accordance with NIH peer review policy and procedures, using the stated review criteria. Assignment to a Scientific Review Group will be shown in the eRA Commons.

As part of the scientific peer review, all applications:

  • May undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.
  • Will receive a written critique.

Applications will be assigned on the basis of established PHS referral guidelines to the appropriate NIH Institute or Center. Applications will compete for available funds with all other recommended applications. Following initial peer review, recommended applications will receive a second level of review by the National Heart, Lung, and Blood Advisory Council. The following will be considered in making funding decisions:

  • Scientific and technical merit of the proposed project as determined by scientific peer review.
  • Availability of funds.
  • Relevance of the proposed project to program priorities.
3. Anticipated Announcement and Award Dates

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons

Information regarding the disposition of applications is available in the NIH Grants Policy Statement.

Section VI. Award Administration Information
1. Award Notices

If the application is under consideration for funding, NIH will request "just-in-time" information from the applicant as described in the NIH Grants Policy Statement.

A formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the grants management officer is the authorizing document and will be sent via email to the grantee’s business official.

Awardees must comply with any funding restrictions described in Section IV.5. Funding Restrictions. Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.

Any application awarded in response to this FOA will be subject to terms and conditions found on the Award Conditions and Information for NIH Grants website.  This includes any recent legislation and policy applicable to awards that is highlighted on this website.

2. Administrative and National Policy Requirements

All NIH grant and cooperative agreement awards include the NIH Grants Policy Statement as part of the NoA. For these terms of award, see the NIH Grants Policy Statement Part II: Terms and Conditions of NIH Grant Awards, Subpart A: General  and Part II: Terms and Conditions of NIH Grant Awards, Subpart B: Terms and Conditions for Specific Types of Grants, Grantees, and Activities. More information is provided at Award Conditions and Information for NIH Grants.

Cooperative Agreement Terms and Conditions of Award

Not Applicable

3. Reporting

When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually and financial statements as required in the NIH Grants Policy Statement.

A final progress report, invention statement, and the expenditure data portion of the Federal Financial Report are required for closeout of an award, as described in the NIH Grants Policy Statement.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later.  All awardees of applicable NIH grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over $25,000.  See the NIH Grants Policy Statement for additional information on this reporting requirement.

Section VII. Agency Contacts

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

Application Submission Contacts

eRA Service Desk (Questions regarding ASSIST, eRA Commons registration, submitting and tracking an application, documenting system problems that threaten submission by the due date, post submission issues)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)
Finding Help Online: https://grants.nih.gov/support/index.html
Email: commons@od.nih.gov

Grants.gov Customer Support (Questions regarding Grants.gov registration and submission, downloading forms and application packages)
Contact CenterTelephone: 800-518-4726
Email: support@grants.gov

GrantsInfo (Questions regarding application instructions and process, finding NIH grant resources)
Email: GrantsInfo@nih.gov (preferred method of contact)
Telephone: 301-710-0267

Scientific/Research Contact(s)

Catherine M. Stoney, PhD
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-6670
Email: stoneyc@mail.nih.gov

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Charmaine Parsad
National Heart, Lung, and Blood Institute (NHLBI)
Telephone: 301-435-0152
Email: parsadrc@nhlbi.nih.gov

Section VIII. Other Information

Recently issued trans-NIH policy notices may affect your application submission. A full list of policy notices published by NIH is provided in the NIH Guide for Grants and Contracts. All awards are subject to the terms and conditions, cost principles, and other considerations described in the NIH Grants Policy Statement.

Authority and Regulations

Awards are made under the authorization of Sections 301 and 405 of the Public Health Service Act as amended (42 USC 241 and 284) and under Federal Regulations 42 CFR Part 52 and 45 CFR Part 75.

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