Full Text HS-93-02 NATIONAL RESEARCH SERVICE AWARD -- INSTITUTIONAL GRANTS NIH GUIDE, Volume 21, Number 38, October 23, 1992 RFA: HS-93-02 P.T. 44 Keywords: Health Services Delivery Biomedical Research Training Agency for Health Care Policy and Research Application Receipt Date: January 11, 1993 PURPOSE The Agency for Health Care Policy and Research (AHCPR) awards National Research Service Award (NRSA) institutional grants (T32) to eligible institutions to develop or enhance research training opportunities for qualified individuals selected by the institution who have demonstrated an interest in health services research and who seek to prepare for careers in the systematic examination of the organization, provision, and financing of health care services. The purpose of these awards is to assist domestic institutions in supporting predoctoral and postdoctoral academic training. The awards allow trainees to gain at least one year of experience in applying research methods to the evaluation of health services. The AHCPR does not support short-term training. AREAS OF TRAINING AHCPR-sponsored NRSA grants emphasize multidisciplinary health services research training. This training should provide the conceptual and methodological foundation for investigating some or all of the following health care areas: o Primary care issues, including the development of techniques to measure the effectiveness of managing health care conditions. o Appropriateness and effectiveness of alternative treatments in terms of patient outcomes and use of services. o Factors affecting the dissemination and assimilation of information on health care technologies and other aspects of clinical practice. o Determinants of successful health care market reform, including incentives for efficient choices by health care purchasers and for effective management by health care providers; o Alternative approaches to organizing, financing, and reimbursing for health care services and their effects on cost, quality, and access. o Application of medical informatics to the development of expert systems for treatment selection and diagnosis. o Practice-based research, including clinical practice variations and guideline development. o Availability, accessibility, effectiveness, and quality of care for low-income groups, minorities, and the elderly. o Medical malpractice and liability. o Delivery of health services to the medically underserved, especially in rural areas. o Cost-effectiveness and cost-benefit analysis, including the allocation of health care resources and relationship to health status. o Organizational structure, resource use, and costs of care for persons with HIV-related illnesses. o Alternative delivery systems, providers, and practice patterns in long-term care, including home and community- based care. ELIGIBILITY REQUIREMENTS For Institutions Domestic non-profit private and public institutions may apply for grants to support doctoral and postdoctoral health services research training programs. The applicant institution must have the staff and facilities required for the proposed program. The training program director at the institution will be responsible for the selection and appointment of trainees and for the overall direction of the program. Institutions may apply for support for predoctoral students, postdoctoral students, or a combination. Applicants should include a rationale for their proposed choice of supporting the level(s) of students requested. An applicant may request as many postdoctoral or predoctoral positions as the proposed program can adequately accommodate; but the number of positions awarded will be determined by the review process, program needs, and availability of funds. For Trainees Individuals to be trained must be citizens or noncitizen nationals of the United States or have been lawfully admitted for permanent residence (that is, in possession of the Alien Registration Receipt Card I-551 or I-151) at the time of appointment. Individuals on temporary or student visas are not eligible. A postdoctoral student, as of the beginning date of the NRSA appointment, must have a Ph.D., M.D., D.O., or other doctoral degree, or an equivalent degree from any accredited domestic or foreign institution. Certification by an authorized official of the degree-granting institution that all requirements for the doctoral degree have been met is acceptable. Predoctoral trainees must have received a baccalaureate degree as of the beginning date of the NRSA appointment and must be enrolled in a program leading to a Ph.D., Dr.P.H., or equivalent degree. Individuals working toward a medical or dental degree who wish to interrupt their studies for a year or more to engage in full-time research training before completing their degree are eligible for support. MECHANISM OF SUPPORT The mechanism of support will be the National Research Service Award institutional training grant (T32). General Provisions Levels and Types of Training Permitted National Research Service Awards may not be used to support studies leading to the M.D. or other similar professional degrees, or to support residencies, that is, postgraduate training for health professionals providing health care directly to patients where the majority of their time is spent in nonresearch clinical training. However, if a specified period of full-time research training is creditable toward specialty board certification, the NRSA may support such research training if the trainee has shown a strong interest in a research career. Trainees are required to pursue their research training on a full-time basis. Because of the close relationship between teaching and research in the academic environment, trainees are permitted, with the approval of AHCPR, to teach if it can significantly contribute to their academic training. Teaching by trainees may not take up more than 10 percent of work time during the year or exceed four hours each week. Research trainees who are clinicians are expected to devote full time to the proposed research training. Clinical duties are limited to those which are part of the training experience. Trainees appointed to the program are expected to carry out supervised health services research with the primary objective of extending their quantitative research skills and substantive knowledge in preparation for a career in academic health services research. Institutional training grants are a desirable mechanism for postdoctoral training of physicians and other individuals with health professional degrees whose doctoral training has usually involved limited health services research experience. For such individuals, the training may be part of a research degree program. In such cases, health professional postdoctoral trainees should agree to engage in at least two years of research training beginning at the time of appointment. Duration of Support Institutional grants are made for competitive segments of five years and are renewable; individual trainee appointments should be made in increments of 12 months. No individual trainee may receive more than five years of aggregate NRSA support at the predoctoral level and three years of aggregate NRSA support at the postdoctoral level, including any combination of support from institutional training grants and individual fellowship awards, except under certain circumstances. Any exception to this policy requires a waiver from the AHCPR. Recruitment of Trainees The primary objective of the NRSA program is to prepare qualified individuals for careers in health services research. Within the framework of the program's commitment to excellence and projected needs for investigators in particular areas of health services research, attention must be given to recruiting individuals from minority groups that are underrepresented nationally in health services research. Information on plans for the recruitment of trainees must include a description of steps to be taken for the recruitment of individuals from underrepresented minority groups. Competing continuation applications should include cumulative information on the recruitment of minority trainees and the subsequent career development of all trainees, including information about their minority status. Payback Provisions At the time of appointment, trainees must sign an agreement that they will fulfill the NRSA payback requirements. Recipients agree to engage in health services research and/or teaching for a period equal to the period of NRSA support in excess of 12 months. Once an individual has had 12 months of postbaccalaureate NRSA support, all subsequent NRSA support is subject to payback. Recipients must undertake the obligated service on a continuous basis within two years after termination of NRSA support. Individuals who fail to fulfill their obligation through service must pay back the total amount of NRSA funds paid to them for the obligation period plus interest at a rate determined by the Secretary of the Treasury. Financial payback must be completed within three years beginning on the date the United States becomes entitled to recover such amount. Under certain conditions, the Secretary of Health and Human Services may extend the period for starting service or for repayment, permit breaks in the period of service or repayment, or otherwise waive or suspend the payback obligation of an individual. Officials of the applicant organization responsible for recruitment of trainees should familiarize themselves with the terms of the service requirements and explain them carefully to prospective training candidates before an appointment at the institution is offered. Stipends and Other Training Costs For predoctoral trainees at all levels of experience, the stipend level (effective October 1, 1990) is $8,800 per year. For postdoctoral trainees, the stipend for the first year of support is determined by the number of years of relevant postdoctoral experience at the time of appointment. Relevant experience may include research experience (including industrial), teaching, internship, residency, clinical practice, or other time spent in full-time studies in a health-related field beyond that of the qualifying doctoral degree. The stipend for each additional year of NRSA support is the next level on the stipend scale. Current postdoctoral stipend levels, effective October 1, 1990, are as follows: Years of relevant experience Stipend 0 $18,600 1 19,700 2 25,600 3 26,900 4 28,200 5 29,500 6 30,800 7 or more 32,300 NRSA stipends may be supplemented by an institution from non-Federal funds. Federal funds may be used for stipend supplementation only if specifically authorized under the terms of the program from which the supplemental funds are derived. An individual may make use of Federal educational loan funds or VA benefits when permitted by those programs. Trainees may be permitted to receive compensation for work in some other position (for example, teaching or laboratory assistance) when the trainee is in an employee-employer relationship, the payments are for services rendered, and the situation otherwise meets conditions for student compensation as specified in the PHS Grants Policy Statement. Compensation may not be paid from a research grant that supports the trainee's dissertation or the same research as that of the training program. Compensation for services must occur on a limited, part-time basis apart from the normal full-time training activities that require a minimum of 40 hours per week. Under no circumstances may the conditions of stipend supplementation or student compensation for coincidental employment detract from or prolong the research training. The Tax Reform Act of 1986, Public Law 99-514, affects the tax liability of all individuals supported under the NRSA program. Degree candidates who, prior to the enactment of Public Law 99-514, were able to exclude all monies received under a NRSA award from their reported income, may now exclude only course tuition, fees, books, supplies, and equipment required for attendance. Nondegree candidates, who formerly were able to exclude from stipends $300 a month for a period not to exceed three years, are now required to report all stipends and any monies paid on their behalf for course tuition and fees required for attendance. These statutory requirements became effective January 1, 1987. The AHCPR is not in a position to advise students or institutions about their tax liability. In any event, changes in the taxability of stipends in no way alter the relationship between NRSA trainees and their institutions. NRSA stipends are not now, and never have been, salaries. Trainees supported under a National Research Service Award are not in an employer-employee relationship with the AHCPR or with the institution in which they are pursuing research training. Tuition and fees, including medical insurance for the trainee, are allowable trainee costs if such charges are required of all persons in a similar training status at the institution, regardless of their source of support; family medical insurance is not an appropriate charge to the NRSA grant. Tuition at the postdoctoral level, if justifiable, is limited to that required for specific courses in support of the approved training program. Annual increments in tuition costs beyond the first year of a multiyear award (generally five years) may not exceed six percent. Trainee travel, including attendance at scientific meetings, that the institution determines to be necessary to the individual's training is an allowable cost. Institutional costs of $1,500 per year for each predoctoral trainee and $2,500 per year for each postdoctoral trainee may be requested to defray the cost of other training-related expenses, such as staff salaries, consultant costs, equipment, research supplies, and staff travel. Also, the institution will receive indirect costs based on eight percent of total allowable direct costs (exclusive of tuition, fees, and health insurance) or their actual indirect cost rate, whichever is less. Applications from State and local government agencies may request full indirect cost reimbursement. FUNDS AVAILABLE AHCPR expects to fund approximately three to five awards in response to this RFA; the total amount available is not expected to exceed $1,000,000. This announcement is made subject to availability of funds. The AHCPR reserves the right to withdraw this announcement if funds do not become available. APPLICATION PROCEDURES Application are to be made on grant application form PHS 398 (rev. 9/91). This revision includes special instructions for institutional NRSA research training grants. Applicants are reminded that the 25-page limit on the narrative section must be observed. The application form is usually available at institutional offices of sponsored research or their equivalent. If forms are not available locally, send a request accompanied by a self-addressed mailing label to: Office of Scientific Review Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 602 Rockville, MD 20852 Telephone: (301) 227-8449 Applications must be received at the Division of Research Grants, NIH, on or before January 11, 1993. Late applications will be returned. An original and three copies of the completed application must be mailed to: Division of Research Grants National Institutes of Health Westwood Building, Room 240 Bethesda, MD 20892** Insert the title of this RFA, National Research Service Award--Institutional Grants, and the RFA number, HS-93-02, on line 2a of the application face page. The RFA label in the form PHS 398 must be affixed to the bottom of the face page of the original copy of the application. Failure to use this label could result in delayed processing of your application such that it will not reach the review committee in time for review. Two information copies must also be sent to: Director, Office of Scientific Review Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 602 Rockville, MD 20852 REVIEW CONSIDERATIONS Applications will be evaluated for merit by an AHCPR initial review group (IRG). The IRG will consider the following criteria in its review: o Objectives and design of the proposed training program and the probability of achieving stated goals; for renewal applications, documentation of past results in meeting goals. o Substantive content of the proposed program and its relevance to current health care concerns, including courses offered. o Qualifications and responsibilities of the program director. o Qualifications of the program's faculty, including ongoing health services research support. o Documentation of availability of qualified candidates and program's plans for recruitment and selection of trainees, including minority trainees. o Institutional commitment to providing a quality training environment, including availability of space and facilities, curriculum time, and research support. o Demonstration of cooperation by any collaborating facilities or institutions in providing experience and research training sites for trainees and mechanisms for integration of trainees. o Proposed methods for monitoring and evaluating performance of trainees and of the overall program. This includes tracking graduates after completion of training and record of trainees in establishing careers in health services research. o Record of the training program in retaining health professional postdoctoral trainees for more than 1 year of research training. o Reasonableness of the proposed budget, including number and levels of trainees, in relation to the research training. Also see "Modification of Existing Review Criteria for NRSA Institutional Research Training Grants," NIH Guide for Grants and Contracts, Volume 21, Number 11, March 20, 1992. Minority Recruitment Plan All applications must include a plan to recruit individuals from underrepresented minority groups. If an application is received without a plan, review may be deferred until a plan is provided. The plan to recruit minorities will be evaluated by the initial review group after the quality of the training grant application has been assessed and the priority score has been assigned. The comments of the review committee on the plan for attracting minority individuals will be presented in a note in the summary statement. For renewal applications, this note will also cover accomplishments in recruiting and retaining individuals from underrepresented minority groups during the previous award period. Funding of an application may be delayed if the plan for recruiting underrepresented minorities is considered inadequate or, in the case of competing continuation applications, if the report of efforts to recruit minorities during the previous award period is considered inadequate. Training in the Responsible Conduct of Research Applications must include a description of formal or informal instruction that addresses various aspects of scientific integrity and the responsible conduct of research. Specific elements of the plan might include the breadth of topics to be covered, qualifications of the faculty to be involved, quality of the materials to be used, and the format and/or schedule of instruction. Although the exact content of the plan is left to the individual training program, it is expected that the plan will be appropriate to the training program and will demonstrate commitment of the institution in both personnel and materials. The plan to provide instruction in the responsible conduct of research will not be considered in the assignment of a priority score. However, applications that do not contain such a plan will be considered incomplete and an award will not be made until an adequate plan is provided. Review Schedule The NRSA training grant receipt date and review cycle for all applications is indicated below. Application Initial review Council Earliest possible receipt date group meeting meeting start date Jan 11, 1993 May/Jun 1993 Sep 1993 Dec 1993 AWARD CRITERIA After IRG review, applications will be reviewed by the National Advisory Council for Health Care Policy, Research, and Evaluation. In addition to the recommendations of the initial review group, the Council will consider the application within the overall research and training goals of AHCPR. Funding decisions will be made based on the review groups' recommendations, the need for research personnel in specified program areas, and the availability of funds. INQUIRIES Program inquiries may be directed to: DonnaRae Castillo NRSA Project Officer Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 501 Rockville, MD 20852 Telephone: (301) 227-8362 Fiscal and administrative inquiries may be directed to: Ralph Sloat, Chief Grants Management Branch Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 601 Rockville, MD 20852 Telephone: (301) 227-8447 For additional information, see the document entitled "National Research Service Awards -- Guidelines for Individual Awards - Institutional Grants," NIH Guide for Grants and Contracts (special edition), Volume 13, Number 1, January 6, 1984, usually available at the applicant institution. Further information is also available in the program announcement "National Research Service Award Institutional Research Training Grants (T32)," NIH Guide for Grants and Contracts, Volume 21, Number 11, March 20, 1992. AUTHORITY AND REGULATIONS NRSA institutional research training grants are made under authority of Section 487 of the Public Health Service (PHS) Act as amended (42 USC 288). Title 42 of the Code of Federal Regulations, Part 66, is applicable to this program. The program is described under Catalog of Federal Domestic Assistance No. 93.225. This program is not subject to the intergovernmental review requirements of Executive Order 12372. .
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