GRANTS FOR HEALTH SERVICES DISSERTATION RESEARCH

Release Date:  September 15, 1998

PA NUMBER:  PAR-98-111

P.T.

Agency for Health Care Policy and Research

Application Receipt Dates:  May 5; November 15 (Annually)

PURPOSE

The Agency for Health Care Policy and Research (AHCPR) announces its continued
interest in supporting the Health Services Dissertation Research small grant
program.  This program supports research undertaken as part of an academic
program to qualify for a doctorate.

AHCPR supports and conducts research to improve the outcomes, quality, access to,
and cost and utilization of health care services.  AHCPR achieves this mission
through health services research designed to (1) improve clinical practice, (2)
improve the health system's ability to provide access to and deliver high
quality, high-value health care, and (3) provide policy makers with the ability
to assess the impact of system changes on outcomes, quality, access, cost and use
of health care services.  AHCPR programs and products are designed to be
responsive to the needs of consumers, patients, clinicians, and other providers,
institutions, plans, purchasers, and public and private policy makers at all
levels for evidence-based information they may need to improve quality and
outcomes, control costs, and ensure access to needed services.

AHCPR will accept applications from students seeking a doctorate in areas
relevant to health services research.  This program announcement describes the
procedures and criteria for the program.  It updates and supersedes "Grants for
Health Services Dissertation Research," PAR-96-016, published in the NIH Guide,
January 26, 1996.

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.  AHCPR encourages applicants to submit grant
applications with relevance to the specific objectives of this initiative. 
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 202-512-1800.

Nondiscrimination

The AHCPR Dissertation program is conducted in compliance with applicable laws
that provide that no person shall, on the grounds of race, color, national
origin, sex, disability, or age, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination.  Applicant organizations are
required to have appropriate Assurance of Compliance forms filed with the Office
of Civil Rights, Office of the Secretary, DHHS before a grant may be made to that
institution.  The Research Education Division, Office of Research Review,
Education, and Policy (ORREP), should be contacted with any questions concerning
compliance (See INQUIRIES).

ELIGIBILITY REQUIREMENTS

To qualify for an award under this program the student (Principal Investigator)
must be enrolled in an accredited doctoral degree program in the social,
economic, management, medical, or health sciences that requires a dissertation
based on original research.  To be eligible, the dissertation must be a major
part of the training program and be in an area of interest to AHCPR with
demonstrated relevance to the delivery of health care in the United States.  All
requirements for the doctoral degree, other than the dissertation and the
notification that the dissertation faculty committee has approved the
dissertation proposal(See Special Instructions under APPLICATION PROCEDURES for
details), must be completed by award date.

The applicant may be either a public or private nonprofit institution that will
administer the grant on behalf of the proposed Principal Investigator or the
proposed Principal Investigator who may apply as an individual.

A proposed Principal Investigator for dissertation research grant support must
be a registered doctoral candidate in resident or non resident status. An
investigator who is not a U.S. citizen and does not have a permanent resident
visa must apply through a public or private nonprofit institution.

AHCPR will make the final determination of eligibility for support.

A dissertation research grant is usually awarded for 12 months or less, but may
be awarded for up to 17 months.  The applicant is expected to devote a minimum
of 40 hours per week on dissertation work.  Clinical or other professional
pursuits in addition to work on the dissertation should not exceed 12 hours per
week.

An investigator who receives support for dissertation research under a grant from
the AHCPR may not simultaneously receive support under a predoctoral program
training grant, an individual fellowship grant, or any other dissertation grant
awarded by AHCPR or any other agency of the U.S. Department of Health and Human
Services.  Other current or pending sources of support should be explicitly
listed.

Awards are usually announced no earlier than four months after receipt of the
application.

MECHANISM OF SUPPORT

This Program Announcement (PA) will employ the small research grant (R03)
mechanism.  Responsibility for the planning, direction, and execution of the
proposed project will be solely that of the proposed Principal Investigator (the
doctoral candidate).

The total direct costs must not exceed $30,000 for the entire project period. 
AHCPR will return without review any application that exceeds this amount to the
applicant.  No supplemental funds will be awarded.

The proposed Principal Investigator may request support only for the time
necessary to complete the dissertation.

RESEARCH OBJECTIVES

Through the Dissertation Research Grant Program AHCPR seeks to expand the number
of researchers who conduct health services research in areas identified in the
"AHCPR Health Services Research Program Announcement published in the NIH Guide
on March 26, 1998. The PA outlines broad research interests in the following
areas: 1) Health outcomes at the clinical and system levels; 2) Quality
measurement and improvement including the use of evidence-based practice
information and tools; and 3) Organization, financing, and delivery of health
care and the characteristics of primary care practices with emphasis on improved
access, fostering appropriate use, and the reduction of unnecessary expenditures. 
A special focus is on health issues related to priority populations including
minority populations, women, and children.  The PA also identifies two additional
areas that are becoming increasingly important - methodologic advances in health
services research especially cost-effectiveness analysis, and ethical issues
across the spectrum of health care delivery.

Applicants who have questions regarding the relevance of their research topics
to AHCPR goals should contact by telephone, E-mail or letter staff listed under
INQUIRIES.

Applications judged by staff to be non-responsive to this program announcement
will be returned without review.

SPECIAL REQUIREMENTS

Allowable Costs

Expenses allowed under the AHCPR Health Services Dissertation Research program
follow the guidelines described in the Application for a Department of Health and
Human Services Grant (DHHS).  Allowable costs include the following: the
investigator's salary; direct project expenses such as travel, data purchasing,
data processing, and supplies.  Fees for maintaining matriculation or other fees
imposed on those preparing dissertations are allowable costs, provided the fees
are required of all students of similar standing, regardless of the source of
funding.

Although all of the above costs are allowable the following guidelines should be
followed:

o  No salary support will be given for the dissertation committee.

o  All data costs are to be included in the $30,000 total direct cost limit of
the solicitation.

o  Travel costs are allowable for one professional conference.

o  PC and statistical consultant service costs at a level not to exceed 80 hours
are allowable.

o  Support for a research assistant is generally not permitted.  In rare
circumstances it may be approved if the justification is acceptable to AHCPR
staff.

Applicants applying through institutions receive facilities and administrative
(F&A) costs in addition to the direct costs of the project.  For calculating F&A
costs, dissertation research grants are considered training grants.  Therefore,
according to DHHS policy, the institution will receive F&A costs based solely on
8 percent of the total allowable direct costs exclusive of: tuition and related
fees; health insurance; and expenditures for equipment.

Other Conditions

The following conditions apply to dissertation grants:

o  A Principal Investigator who discontinues or suspends a project during the
grant period must inform the AHCPR immediately in writing.  The AHCPR may suspend
or terminate the grant as requested by the Principal Investigator or on its own
initiative.

o  The dissertation and an Executive Summary of it constitutes the final report
of the grant.  The dissertation must be officially accepted by the faculty
committee or university official responsible for the candidate's dissertation and
must be signed by the responsible officials. Two copies of the dissertation must
be submitted to the AHCPR.

o  The dissertation and all financial status reports must be submitted in
English.

o  The grantee is encouraged to report all publications resulting from the grant
to AHCPR even after completion of the grant.  Further, the grantee should cite
AHCPR support in publications resulting from the dissertation grant.

AHCPR DATA

AHCPR encourages research applications that will use data from the Medical
Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project
(HCUP), and other AHCPR data.

The MEPS is a rich data source for health care utilization, expenditure, and
insurance information, directly linking data about persons and their families
with information obtained from their employers, insurers, and health care
providers.  It is the third in a series of nationally representative surveys of
medical care use and expenditures in the U.S.  The 1996 MEPS updates previous
survey data to reflect the changes that have occurred over the past decade.  MEPS
collects data on the specific health services that Americans use, how frequently
they use them, the cost and source of payment for services, and information on
the types and costs of private health insurance held by and available to the U.S.
population.  It provides a foundation for estimating the impact of changes in
sources of payment and insurance coverage on different economic groups or special
populations of interest, such as the poor, elderly, uninsured, and racial and
ethnic minorities.

Some data from the Household and Nursing Home Components of the 1996 MEPS became
available for use by researchers beginning in March 1997.  The release schedule
for other data through calendar year 1998 is available from the MEPS section of
the AHCPR Web site (See below).

The HCUP includes two data bases covering 1988-1995 with 1996 data available in
early 1999.  These all-payer databases were created through a
Federal-state-industry partnership to build a multi state health care data
system.  Both data bases contain patient-level information for inpatient hospital
stays in a uniform format with privacy protections.  The Nationwide Inpatient
Sample (NIS) is a national sample of about 900 hospitals.  The State Inpatient
Database (SID), available from the partner states, contains inpatient records for
all community hospitals in 17 states, and ambulatory surgery data from five
states.  These data bases can be directly linked to county-level data from the
Health Resources and Services Administration's Area Resource File and to
hospital-level data from the Annual Survey of the American Hospital Association.

Information on MEPS AND HCUP-3 is available from the Data and Methods section of
the AHCPR Web site, and AHCPR staff (See INQUIRIES).

CONDITIONS OF AWARD

Data Privacy

Information obtained in the course of AHCPR supported projects that identifies
an individual or entity must be treated as confidential in accordance with
section 903(c) of the Public Health Service Act.

Rights in Data

AHCPR grantees may copyright or seek patents, as appropriate, for final and 
interim products and materials including, but not limited to, methodological
tools, measures, software with documentation, literature searches, and analyses,
which are developed in whole or in part with AHCPR funds.  Such copyrights and
patents are subject to a Federal Government license to use and permit others to
use these products and materials for AHCPR purposes.  AHCPR purposes may include,
subject to statutory confidentiality protection, making research materials, data
bases, and algorithms available for verification or replication by other
researchers; and subject to budget constraints, final products may be made
available to the health care community and the public by AHCPR, or its agents,
if such distribution would significantly increase access to a product and thereby
produce public health benefits.  Ordinarily, to accomplish distribution, AHCPR
publishes research findings but relies on grantee efforts to market
grant-supported products.  In keeping with AHCPR's legislative mandates to make
both research results and data available, copies of all products and materials
developed under a grant supported in whole or in part by AHCPR funds are to be
made available to AHCPR promptly and without restriction, upon request by AHCPR.

INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS
INVOLVING HUMAN SUBJECTS

It is the policy of AHCPR that women and members of minority groups should be
included in all AHCPR-supported 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.

All investigators proposing research involving human subjects should read the
"NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical
Research," which was published in the Federal Register of March 28, 1994 (FR 59
14508-14513), and in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994. 
AHCPR follows the NIH Guidelines, as applicable.

Investigators may obtain copies from the AHCPR contractor, Equals Three
Communications, Inc., listed under INQUIRIES.

AHCPR also encourages investigators to consider including children in study
populations, as appropriate.  AHCPR announced in the NIH Guide of May 9, 1997,
that it is developing a policy and implementation plan on the inclusion of
children in health services research.  This Notice is available through the AHCPR
Web site http://www.ahcpr.gov  (Funding Opportunities) and InstantFAX (see
instructions under INQUIRIES).

AHCPR program staff may also provide information concerning these policies (See
INQUIRIES).

APPLICATION PROCEDURES

The application receipt dates are May 5 and November 15 annually.

Applications will be eligible for support only during the round for which they
are submitted.  AHCPR will notify the applicant if a decision to defer to a
subsequent round is made.  No application can be submitted more than once, even
in revised form.  An application that does not conform to the instructions
provided in this PA will be returned to the applicant without review.

Applicants are to use the research grant application form PHS 398 (rev. 5/95) in
applying for these grants. State and local government applicants may use form
PHS-5161-1, Application for Federal Assistance (rev. 5/96), and follow those
requirements for copy submission.  However, some instructions found in these
forms are superseded by special instructions for this PA as outlined below.

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

AHCPR applicants can also obtain application materials from the AHCPR contractor: 
Equals Three Communications, Inc., 7910 Woodmont Avenue, Suite 200, Bethesda, MD 
20814-3015; telephone 301/656-3100 or FAX 301/652-5264.

The PA title and number must be typed on line two of the face page of the
application form and the YES box must be marked.

Submit a signed, typewritten original of the application, including the
Checklist, and three signed photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service

At the time of submission two copies additional copies of the application must
be sent to:

Scientific Review Division
Office of Research Review, Education and Policy
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 400
Rockville, MD  20852-4908

Special Instructions

The proposed Principal Investigator for a dissertation grant is encouraged to
have the application administered through an institution whenever feasible.  This
may be either the degree-granting institution or another nonprofit institution
with which the proposed Principal Investigator is professionally affiliated.  In
determining which institution is more appropriate, the student must consider the
extent to which the resources of the designated institution are capable of
supporting the proposed research effort.

In addition to the instructions in the 398 form the following special
instructions should be followed:

o  The graduate student should be identified as the Principal Investigator;

o  The section entitled Research Plan may not exceed 20 pages;

o  A questionnaire may be included as an appendix if it is essential to evaluate
the proposal;

o  A list of literature cites is required.  The citations are counted as part of
the page limit;

o  Ideally, a letter from the faculty committee or the university official
directly responsible for supervising the dissertation research should be
submitted with the grant application. The letter should certify that: (1) the
dissertation faculty committee has approved the dissertation proposal; (2) the
grant application represents the dissertation proposal; and (3) the applicant
will complete all requirements for the doctoral degree, except the dissertation,
at time of award.  However, in rare instances the dissertation faculty committee
may not have had an opportunity to formally approve the dissertation proposal
prior to the dissertation grant application submission deadline.  In such
instances, the application should still be accompanied by a letter from the
faculty advisor or dissertation chair.  This letter should note that: (1) the
advisor or chairperson is confident that the dissertation faculty review
committee will approve the dissertation proposal; (2) the grant application will
coincide with the actual dissertation project to be reviewed and approved by the
dissertation faculty committee; and (3) the applicant will have completed all
requirements for the doctoral degree, except the defense of the dissertation
proposal and the actual dissertation.  The certification of the dissertation
proposal's defense and acceptance, signed by the faculty advisor or dissertation
chair, should be received by the Scientific Review Division, ORREP no later than
8 weeks after the dissertation application deadline submission date.  In cases
where the dissertation faculty committee review results in a modification to the
methodological design or substantive scope of the project, the application must
be withdrawn, but can be resubmitted for the subsequent dissertation application
round with the changes incorporated.

o  Section C of the application should be used as an extension of the literature
review or publications of the faculty committee as they relate to this research.

o  The application must identify all members of the faculty committee by listing
the names on Form BB.  A brief biographical sketch for each should be provided
as explained in form PHS 398, page FF.

o  Applicants should give special attention to the sections of the application
dealing with human subjects protection and gender and minority representation.
For those projects involving human subjects or individually identifiable data,
IRB approval at the time of application submission is expected.

REVIEW CONSIDERATIONS

Upon receipt, staff will review applications for completeness and relevance to
the AHCPR mission.  Incomplete applications and applications proposing research
in areas outside the mission of the Agency will be returned to the applicant
without further consideration.

Applications that are complete will be evaluated for scientific and technical
merit by an appropriate peer review group convened in accordance with AHCPR peer
review procedures.  As part of the initial merit review, all applications will
receive a written critique, and also may undergo a process in which only those
applications deemed to have the highest scientific merit will be discussed.

General Review Criteria

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

In evaluating the above criteria, strong emphasis is placed on the reviewers'
assessment of the applicant's potential as a future contributor to health
services research and the caliber of their support structure to provide necessary
guidance.

Summary Statements on applications are prepared by AHCPR staff using the comments
of the reviewers, and are generally completed and provided to the applicant
within 14 weeks of receipt of applications.

AWARD CRITERIA

AHCPR sets aside funds each fiscal year for the Dissertation Research Program. 
Applicants compete for awards with other applications submitted for this program.

Factors that influence the final funding decisions on applications for support
of dissertations include:  reviewers' evaluation of the application; the
potential of the applicant to contribute to the field; program balance and the
availability of funds.  The earliest anticipated date of an award will generally
be four months after the due date of the application.

INQUIRIES

Written and telephone inquiries concerning this PA are encouraged.  Copies of
this PA are available from:

Equals Three Communications, Inc.
7910 Woodmont Avenue, Suite 200
Bethesda, MD  20814-3015
Telephone:  (301) 656-3100
FAX:  (301) 652-5264

The PA is available on AHCPR's Web site http://www.ahcpr.gov (Funding
Opportunities) and through AHCPR InstantFAX at 301/594-2800.  To use InstantFAX, 
you must call from a facsimile (FAX) machine with a telephone handset.  Follow
the voice prompt to obtain a copy of the InstantFAX table of contents, which has
the document order number (not the same as the PA number).  The PA will be sent
at the end of the ordering process.  AHCPR InstantFAX operates 24 hours a day,
7 days a week.  For questions about this service, call Judy Wilcox, Office of
Health Care Information, at 301/594-1364, ext. 1389.

AHCPR welcomes the opportunity to clarify any issues or questions from potential
applicants.  Direct inquiries regarding programmatic issues, including
information on the inclusion of women, minorities, and children in study
populations, to:

Research Education Division
Office of Research, Review, Education, and Policy
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 400
Rockville, MD  20852-4908
Telephone:  (301) 594-1452
Email:  Training@AHCPR.gov

Direct inquiries regarding fiscal matters to:

Al Deal
Grants Management Specialist
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852-4908
Telephone:  (301) 594-1447, ext. 1170
FAX:  (301) 594-3210
Email:  Adeal@ahcpr.gov

Inquiries Concerning Data Sources:

MEPS Household Component
Nancy Krauss
Center for Cost and Financing Studies
Telephone:  (301) 594-1406, ext 1489
Email:  nkrauss@ahcpr.gov

MEPS Nursing Home Component
Jeffrey Rhodes
Center for Cost and Financing Studies
Telephone:  (301) 594-1407, ext 1473
Email:  jrhodes@ahcpr.gov

HCUP-3
Kelly Carper
Telephone:  (301) 594-1406, ext 1520
Email:  kcarper@ahcpr.gov
Email:  hcupnis@ahcpr.gov
Email:  hcupsid@ahcpr.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance Numbers
93.180 and 93.226.  Awards are made under authorization of Title IX of the Public
Health Service Act (42 U.S.C. 299-299c-6) and Section 1142 of the Social Security
Act (42 U.S.C. 1320b-12) as applicable.  Awards are administered under the PHS
Grants Policy Statement and Federal regulations 42 CFR 67, Subpart A, and 45 CFR
Parts 74 and 92.  This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or Health Systems Agency review.

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


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