Full Text HS-96-004 EXPANSION OF QUALITY MEASURES (Q-SPAN) NIH GUIDE, Volume 25, Number 8, March 15, 1996 RFA: HS-96-004 P.T. 34 Keywords: Health Services Delivery Agency for Health Care Policy and Research Letter of Intent Receipt Date: April 26, 1996 Application Receipt Date: June 12, 1996 PURPOSE The Agency for Health Care Policy and Research (AHCPR) announces the availability of cooperative agreements to develop and test quality of care measures. The projects undertaken as a result of this Request for Applications (RFA) will (1) expand the conceptual and methodological basis for developing quality measures, and (2) produce relevant, feasible, reliable, valid, and rigorously tested sets of new quality measures for comparison across different sites. The fundamental long term goal of this effort is to strengthen the science base underlying the evolution of performance measures while expanding the range of available, ready-to-use measures which address the continuum of care. To complement current efforts underway in the field, development of measures for clinical conditions and populations where measures are lacking will have a high priority. Applicants are encouraged to form consortia that provide (1) the technical capabilities to develop quality of care measures, and (2) access to delivery settings in which to test the utility of these measures. Potential consortia participants include: health care plans, purchasers, State health agencies (particularly those involved with Medicaid managed care), Peer Review Organizations (PROs), horizontally and vertically integrated delivery systems, and academic health science centers. Consortia participants should include appropriate multidisciplinary expertise in clinical, scientific, information systems, and administrative areas. Both consortia members and project staff should include individuals from academic and delivery settings with expertise in research and evaluation. 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 urges applicants to submit 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). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic non-profit organizations, associations, public or private, including universities, units of State and local governments, non- profit firms, and non-profit foundations; or a consortium of organizations. If the application is submitted by a domestic, non-profit, public or private organization, a consortium may include other types of organizations, such as for-profits. Racial/ethnic minorities, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT The administrative and funding instrument will be the cooperative agreement (U18), in which substantial AHCPR scientific and programmatic involvement with the awardee(s) is anticipated during the performance of the project. The total project period for each application submitted in response to the RFA may not exceed five years. This is a one-time solicitation. The anticipated award date is September 1, 1996. FUNDS AVAILABLE The AHCPR expects to award up to $3 million in Fiscal Year 1996 for several short and long term projects, dependent upon the overall availability of funds. Funded projects will reflect a balance between short time projects (one to three years), which can rapidly produce performance measures using existing knowledge and instruments, and projects that require a longer developmental period (three to five years). The number of awards is dependent on the number of high quality applications and their individual budget requirements; it is not the intent of AHCPR that the awards be equal in size. Funding beyond the initial budget period will depend upon annual progress reviews by AHCPR and the availability of funds. RESEARCH OBJECTIVES Background The AHCPR is charged with enhancing the quality, appropriateness, and effectiveness of health care services; and access to such services. The AHCPR accomplishes this through a broad program of scientific research and promotion of improvements in clinical practice and in the organization, financing, and delivery of health care services. As efforts are made to increase the efficiency with which health care is provided and to curtail unnecessary expenditures, accountability demands the ability to assess clinical performance and maximize health care value (AHCPR, 1995). In March 1992, AHCPR convened a conference to examine research priorities in quality improvement and quality assurance. The conference provided a forum for discussion among health care providers, researchers, policymakers, and quality management professionals, working in both the public and private sectors (AHCPR, 1993). Based on that conference, AHCPR issued a Program Announcement in May 1993 entitled, "Health Care Quality Improvement and Quality Assurance Research," which delineated the general parameters of AHCPR's support for investigator-initiated research in this area. AHCPR also supports more applied activities intended to assist providers, payers, and quality management professionals in using the results of research. A recently completed effort supported by AHCPR developed a typology for classifying and assessing existing clinical performance measures (Center for Health Policy Studies/Center for Quality of Care Research and Education, 1995). The project has collected clinical quality measures developed by public and private organizations and created a summary description of each measure. Information on the measures is recorded in linked data bases. The data bases can be searched to identify and compare measures; for example, measures related to ambulatory care or a particular clinical condition. AHCPR is building on the valuable work currently underway in the area of performance measurement through private and public sponsorship. These efforts include: o Continued evolution of the Health Plan Employer Data and Information Set by the National Committee for Quality Assurance directed at purchasers for evaluating health maintenance organizations and identifying gaps in measurement by the Committee on Performance Measurement; o The Foundation for Accountability's effort to develop performance measures which can be used by purchasers to evaluate the broad range of health insurance products; o Performance measurement development and an initiative to develop a framework for the selection of performance measurement systems by the Joint Commission on Accreditation of Healthcare Organizations, which addresses several delivery settings; o The Practice Assessment Quality Improvement Program by the American Medical Association directed to physicians' offices; o Development of a Nursing Care Report Card for hospital services by the American Nurses Association; o Development of result statements and related performance measures for selected public health concerns by the Department of Health and Human Services with State and local health departments and a range of public and private partners; and o Numerous purchasing coalitions and related "report card" projects (e.g., the Pacific Business Group on Health). This solicitation for the Expansion of Quality Measures (Q-SPAN) supports current public and private sector initiatives by focusing on complementary content areas and issues related to developing and testing new measures of the technical quality of care. (Note: the terms "quality of care measures," "technical quality of care measures," "quality measures," "clinical quality measures," and "performance measures" are used interchangeably in this document, while recognizing that some terms are more broadly used to encompass measures related to consumer satisfaction surveys). Applications are invited for a wide variety of measurement development and testing efforts. Examples of the types of projects to be funded through this RFA include: 1. Development of quality measures for specific clinical conditions and health delivery settings or services in which there has been limited performance measurement development and use to date (e.g., care for chronic illnesses, emergency and urgent care services, child and adolescent health, behavioral health, home health care, and rehabilitation services). 2. Development of measures or sets ("families") of measures appropriate for different levels of analysis, perhaps targeted for specific preventive care and clinical conditions, and uses. Levels of analysis could focus on provider, practice site (hospital, home care agency, etc.) and/or financing/delivery system. (Note: While the community level is also an important emerging area for quality measures, it is excluded from the scope of this solicitation, although conceptual attention to the level of analysis may be appropriate in developing the application.) Examples of questions which could be addressed include: o Within a specific clinical area, what measure is most valid and reliable when the health care plan is the level of analysis? Is that measure also appropriate at the individual practitioner/practice site level of analysis, or is there a related measure better suited to that level? As one example, a measure of the rate of mammography screening might be appropriate at the practitioner/practice site level. On the other hand, a measure of the stage of breast cancer when found might be inappropriate at the practitioner and/or practice site level due to the small numbers problem, but reasonable at the level of the plan. A response to this solicitation could include creation of a systematic method for approaching the level of analysis and the development of one or more families of measures. (Note: Clearly, the patient or the practitioner is the usual unit of analysis for gathering data about such measures. In the above example for mammography screening, the status of each patient is obtained with respect to having or not having a mammogram in a given period of time so that the unit of analysis is each individual woman. Whether the data should then be aggregated to the population of the practitioner/practice site, the insuring entity, or even, perhaps, the employer, is the level of analysis which needs explication.) o Are there measures that can be applied across payment systems (e.g., fee for service, point-of-service plans, health maintenance organizations)? Much of the current measurement effort focuses on managed care because of the relative ease of identifying the population for which the health care plan is responsible. An important contribution to the field would be made by the development of measures which can be applied regardless of the financing/delivery system. o What determines whether a measure can be applied across a spectrum of uses, ranging from internal quality improvement within an organization, to externally reported information to purchasers (who may eventually link performance with varying levels of compensation), to publicly reported information in the media? 3. Development of "families" of measures which cross service sites (e.g., hospital, home care, rehabilitation, ambulatory care, and long term care), allowing for longitudinal analyses of processes of care, outcomes, and functional capacities across total enrolled populations or specific clinical/diagnostic cohorts. 4. Creation and implementation of outcomes measures appropriate to assess quality of care can present several challenges. Iezzoni (1994) notes that the meaningful assessment of patients' outcomes requires two basic methodologies: (1) a measure of the outcome itself, and (2) a way to adjust for patients' risks for various outcomes. Further, development of risk adjustment strategies is critical to more widespread use of appropriate outcomes measures for comparisons. Additionally, measurement of outcomes is further complicated by the length of time that may need to elapse between the provision of care and the evaluation of specific outcomes. Little systematic information is available about the optimal time that should elapse for linking various outcomes with their antecedent care events. Do the methods for evaluating and validating measurements of outcomes differ from those for other types of measures? What level of risk adjustment and calibration is needed for a measure to be useful for the various purposes of, for example, internal quality improvement vs. public reporting? In addition, are there measures that might be classified as process measures for one provider/practice setting level, but are outcomes measures for another provider/practice setting or for the organized delivery system level? For example, is readmission to the hospital for a particular condition within a specified time frame an outcome measure for the hospital but a process measure for the ambulatory care? While the absolute assignment of a measure to the traditional categories of structure, process, and outcome (Donabedian, 1966) is not the focus of this solicitation, current discussions of "outcomes" would benefit from further consideration of these categories along with the development of linked or nested measures among and between the various levels of analysis. Performance measures have been evolving without accompanying conceptual frameworks. Therefore, a requirement for every application in response to this RFA will be the inclusion of the conceptual framework(s) that will be used to guide the development and testing of the quality measures. For example, how does one determine the "best" indicator? The conceptual frameworks are expected to figure prominently in work-in-progress and final reports. Thus, it is expected that the field will be the beneficiary of rich and diverse conceptualizations concerning the measurement of quality, as well as rigorously tested measures. Objectives and Scope The objectives of this RFA are to: (1) develop technical measures of quality of care for selected conditions, diagnoses, or enrolled populations (which may also address the continuum of care across delivery settings); (2) test and evaluate the measures in multiple evaluation sites. The fundamental long term goal of this effort is to strengthen the science base underlying the evolution of performance measures while expanding the range of available, ready-to-use measures that address the continuum of care. To complement current efforts underway in the field, development of measures for clinical conditions and populations where measures are lacking will have a high priority. Also of great importance are measures that include the care provided to Medicaid and Medicare recipients. Measures developed under this solicitation are intended for the comparative assessment or evaluation of clinical care provided to groups of patients in various settings or delivery systems. Measures may be designed for application within a specific type of setting (e.g., measures addressing the quality of care provided in nursing homes) or may address the assessment of clinical quality within a continuum of care and across different types of settings (e.g., diagnosis and treatment of conditions that are seen by both internists and specialists; assessment of care that is provided in both ambulatory and inpatient settings). While technical quality of care measures developed under this RFA may be derived from information obtained from consumers, consumer satisfaction measures (e.g., overall satisfaction with care) are excluded from this announcement. Development of diagnostic tools, instrumentation, or health status measures per se are excluded; however, applications focusing on use of existing diagnostic tools, instrumentation, and health status measures for comparative quality assessment are encouraged. Applicants may propose a narrow or broad project in responding to this RFA. For example, a relatively narrow project may focus on the development of measures for a specific clinical condition or diagnosis in one type of practice setting (e.g., hospital, home care). A broader project may develop a longitudinal set of measures for a specific clinical condition and may specify the level of analysis for each measure in the set. Another broad project may address the longitudinal assessment of the well population or a specific age cohort within it (e.g., adolescents). A rationale and conceptual framework for the selected focus must be presented. It is anticipated that the resulting quality measures will be rates or ratios with rigorously specified numerators and denominators, sampling parameters, data collection procedures, and data analysis procedures. Because of the latitude for awardees to select the focus and scope, there is not a requirement for the data to come exclusively from a specific type of data source. Projects that explore how best to use existing State, Peer Review Organization (PRO), and employer sources of data for comparable quality measures are of interest. For measures to be applied in settings other than those in which they were developed, and in order for the field to develop in an additive and logical manner, there needs to be a commonly shared template for writing the specifications for performance measures. Therefore, it is anticipated that there may be some linkage between other AHCPR projects and the Q-SPAN projects in order to develop and apply such a specifications template. If available by the time of their final reports, awardees will be asked to employ the developed specifications template in documenting their measures. Study Design Awardees will need to accomplish a number of objectives in two major phases: 1) development of the measures, and 2) testing/evaluation of the measures. Throughout these phases, awardees will collaborate with AHCPR staff. Awardees are expected to prepare interim reports for each of the phases identified below and a final report that summarizes all activities. Elements of these reports will be determined jointly by the awardees and AHCPR. Applicants may propose the length of time to be spent in each phase. Although each of the phases is discrete, their specific time frames may overlap. If appropriate to the scope of the project, applicants may propose a rolling schedule where some measures have moved into the testing phase while others are still under development. Phase I: Development of Measures The major goal of Phase I is to produce measures which have a sound conceptual framework and strong scientific basis while being relevant and feasible in terms of standardized data collection across plans, employers, States, etc. and which provide comparable information to guide quality improvement efforts. For this phase, the application needs to clearly 1) identify the focus or scope of the work which will be undertaken; 2) provide the conceptual framework for how measurement development will be approached; 3) describe the organizations participating in the application; 4) submit background information on proposed steering committee members' and their roles and responsibilities; 5) detail the project management mechanisms which will be employed; 6) describe a pilot-test phase establishing the relevance, feasibility, reliability, validity, and appropriate calibration of the measures; and 7) develop an initial management plan for Phase I which addresses the preceding items. Applicants should provide information in the application which demonstrates their ability to: o Use existing research, clinical practice guidelines, literature summaries, etc., to provide a basis for developing the quality measures. o Specify elements needed for the quality measures from existing or proposed sources of data. o Specify alternative approaches for gathering the data for the quality measures (e.g., administrative data bases, medical records, patient reports). o Related to 3. above, explore innovative data collection strategies (e.g., linking with employer data to obtain time- off-from-work information). o Work with the sources of data (e.g., health care plans, States) to ascertain feasibility, costs, and related data as the measures are being developed. o Develop the specifications for calculating the quality measures in both narrative and flowchart forms. o Identify the pilot test sites at which preliminary assessments of the reliability and validity of measures will occur. o Conduct preliminary assessments of the relevance, feasibility, reliability, validity, and appropriate calibration of the measures. o Update as necessary the measures under development to incorporate emerging scientific findings. Phase II: Testing and Evaluation The major goal of Phase II is to test, evaluate, and refine the measures so that at the end of the project the measures are ready to be used by the health care field at large. For this phase, the application needs to clearly (1) identify a preliminary set of evaluation sites in which to implement and evaluate the developed measures; (2) describe the mechanisms to be used to assess the integrity of the data obtained at the evaluation sites; (3) propose the formative and summative evaluations to be conducted of the feasibility, costs, and utility of the measures; (4) identify mechanisms to revise the measures as needed; (5) detail the project management mechanisms which will be employed; and (6) develop an initial management plan for Phase II which addresses the preceding items. Applicants should provide information in the application that demonstrates their ability to: o Develop an initial evaluation plan for this phase which includes appropriate quantitative and qualitative methods. o Develop an initial evaluation site management plan. The evaluation site management plan should clearly specify both awardee and site personnel roles and responsibilities and should include a time table listing key decisions/activities related to and dates for all demonstration components. o Assist evaluation sites' staffs in all phases of the evaluation activity. o Collect and process evaluation data at pre-specified times. o Utilize the specifications template developed in conjunction with other AHCPR projects as available and provide specifications for the developed measures consistent with that template. o Update as necessary the measures under development to incorporate new scientific findings along with the results of this comprehensive evaluation phase. SPECIAL REQUIREMENTS Applicants should respond to the following requirements of the RFA: Conceptual Framework As discussed above, a conceptual framework(s) is expected to guide the development and testing of the quality measures. Steering Committee Creation of a steering committee is necessary for the purpose of coordination and communication among project participants. The committee should include appropriate clinical expertise. Project Organization If a consortium of institutions responds to this RFA, the application should describe a practical structure for consortium decisionmaking and governance, and the mechanisms designed to ensure that effective collaboration will occur among sites. Unanticipated disagreements about methods, resource allocations, standardization, authorship, etc., may arise during the course of any project. A consortium must be able to make unified decisions on the merits of these issues, without dissolving or routinely relying upon outside arbitration. Consortium arrangements typically take the form of a formal agreement between an applicant and other organization(s). In the grant application, a separate budget page and budget justification must be included for each organization involved in the proposed consortium arrangement. Applicants should develop a timeline for project activities, including percentage of effort for key staff for all years. Confidentiality of Data Information obtained in the course of this study that identifies an individual or entity must be treated as confidential in accordance with section 903(c) of the Public Health Service Act. Applicants must describe in the Human Subjects section of the application form procedures for ensuring the confidentiality of identifying information. This should include a discussion of who will be permitted access to the information, both the raw data and machine readable files, and how personal identifiers will be safeguarded. Terms and Conditions of Award This cooperative agreement anticipates substantial AHCPR scientific and programmatic involvement with the awardees throughout the initiation, implementation, and close-out phases. Awardee Responsibilities The awardee(s) will have primary responsibilities for all activities including: o Formation of a project steering committee, including the convening of meetings and documenting of activities. o Design of organizational and communication mechanisms for the development and evaluation of the measures congruent with the activities and budget. o Measurement development processes. o Identification of pilot test sites and evaluation sites. o Provision of training and technical assistance to pilot test sites and evaluation sites. o Identification of methods for the formative and summative evaluations of the measures. o Submission to AHCPR of interim and final reports, including discussion of difficulties encountered in planning, implementing, and evaluating the products of this project. o Provision to AHCPR of the precise specifications for all the measures on disk and other formats, using, if available, the template devised in conjunction with other AHCPR projects. o Provision to AHCPR, upon request, of copies of all data generated under the award. o Cooperation with other key parties in the Q-SPAN and complementary AHCPR initiatives. o In cooperation with the AHCPR Project Officer, dissemination of the quality measures and other research findings as they become available. AHCPR Responsibilities The AHCPR Project Officer and other AHCPR staff will have substantial scientific and programmatic involvement during the conduct of this activity. Specifically, AHCPR's role in the cooperative agreement is to provide technical assistance, advice, and support to the Principal Investigator and to ensure that related AHCPR supported projects complement one another. AHCPR will participate in all key project decisions, including but not limited to: o Provide guidance on the selection of aspects of the conditions or other foci on which measures will be developed. o Approve the management plans and evaluation plan. o Work with the awardee to finalize pilot test sites and evaluation sites. o Review and approve interim and final reports. o Provide collaboration with and information from other relevant Federal agencies and programs. o Disseminate the quality measures and other research findings as they become available. o Participate in or coordinate periodic strategy sessions to review progress. Prior written approval from AHCPR will be required for the addition or deletion of a participating or collaborating institution, site, or other organizational component. The AHCPR reserves the right to terminate or curtail the study in the event of: o Insufficient progress toward completion of study goals within an agreed-upon timeframe. o Inability to work in a collaborative manner with pilot test sites, evaluation sites, the steering committee, or other necessary organizations and projects. o Inability to successfully address key methodological issues. Rights in Data AHCPR awardees may copyright or seek patents, as appropriate, for final and interim products and materials including, but not limited to, methodological tools and measures, software with documentation, literature searches, and analyses, which are developed in whole or in part with AHCPR funds. Such copyrights and patents will be subject to a Federal Government license to use these products and materials for AHCPR purposes. AHCPR purposes may include, subject to statutory confidentiality protections, making research materials including data bases and algorithms available for verification or replication by other researchers; and subject to AHCPR 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 awardee efforts to market grant or cooperative agreement 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 cooperative agreement supported in whole or in part by AHCPR funds are to be made available to AHCPR promptly and without restriction, upon request by AHCPR. These special terms of award are in addition to and not in lieu of otherwise applicable PHS grants policies and Federal regulations. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH STUDY POPULATIONS INVOLVING HUMAN SUBJECTS It is the policy of AHCPR that women and members of minority groups be included in all AHCPR supported research projects involving human subjects, unless a clear and compelling rationale and justification are provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. The NIH policy resulting from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) supersedes and strengthens NIH's previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations), which were in effect since 1990 and which AHCPR had adopted. The new NIH policy contains provisions that are substantially different from the 1990 policies. 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 printed in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume 23, Number 11. AHCPR follows the revised NIH Guidelines, as applicable. Investigators may obtain copies from those sources or from the AHCPR contractor, Global Exchange, listed under INQUIRIES. AHCPR program staff may also provide information concerning this policy (See INQUIRIES). LETTER OF INTENT Prospective applicants are asked to submit, by April 26, 1996, a letter of intent that includes the names, addresses, and telephone numbers of the proposed Principal Investigator and other key personnel; the identities of proposed consortia members, including any other participating organizations or institutions; a descriptive title of the proposed project; and the number and title of this RFA. Although a letter of intent is not required, is not binding, and does not enter into the consideration of any subsequent application, the information allows AHCPR to estimate the potential review workload and avoid conflicts of interest in the review. AHCPR will not provide responses to letters of intent. The letter of intent is to be sent to the Q-SPAN Project Officer at the address listed under INQUIRIES. APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 5/95) is to be used in applying for these grants. State and local government applicants may use form PHS-5161-1, Application for Federal Assistance (rev. 9/92), and follow those requirements for copy submission. These forms are available at most institutional offices of sponsored research and may be obtained from the Office of Extramural Outreach and Information Resources, Office of Extramural Research, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267 or email: girg@drgpo.drg.nih.gov. AHCPR applicants are encouraged to obtain application materials from the AHCPR contractor: Global Exchange, Inc. (SEE INQUIRIES). The RFA label available in the PHS 398 (rev. 5/95) application form must be affixed to the bottom of the face page of the original application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 on 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, legible photocopies in one package to: DIVISION OF RESEARCH GRANTS NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for express/courier services) At the time of submission, two additional copies of the application must be sent to the Q-SPAN Project Officer at the address under INQUIRIES. Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by June 12, 1996. If an application is received after that date, it will be returned to the applicant without review. REVIEW CONSIDERATIONS Applications that are complete and responsive to this RFA 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 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 and assigned a priority score. Recommendations of the peer review committee may be reviewed subsequently by AHCPR's National Advisory Council. General Review Criteria Review criteria for all AHCPR grant applications are: significance and originality from a scientific and technical viewpoint; adequacy of the method(s); availability of data or proposed plan to collect data required for the project; qualifications and experience of the Principal Investigator and proposed staff; adequacy of the plan for organizing and carrying out the project; reasonableness of the proposed budget; and adequacy of the facilities and resources available to the applicant (See also Special Review Criteria). Special Review Criteria In addition to the general review criteria above, the reviewers will assess to the extent to which the application addresses the Requirements of the RFA, including SPECIAL REQUIREMENTS and the following: o Understanding of issues related to completing the activities outlined in OBJECTIVES AND SCOPE and STUDY DESIGN. o Demonstrated ability to collaborate and cooperate with, provide technical assistance and training to, and/or monitor the progress of potential collaborating organizations, pilot test sites and evaluation sites; and particularly to develop productive and collegial interactions with other groups such as consortium members, subcontractors, consultants, data supplying organizations, site representatives, and AHCPR staff. o Understanding of all the issues related to the development of scientifically-based valid and reliable quality measures. o Demonstrated ability to apply appropriate methods required for testing, evaluating, and refining the quality measures including specification of evaluation questions as well as use of quantitative and qualitative data collection and analysis methods. AWARD CRITERIA Applications will compete for available funds with all other applications under this RFA. The following will be considered in making funding decisions: quality of the proposed project as determined by peer review; program balance, including the complementarity of topics for which measures will be developed and the likelihood of successful collaboration among projects based upon sufficient compatibility of features; and availability of funds. INQUIRIES Written and telephone inquires concerning this RFA are encouraged. Copies of this RFA are available from: Global Exchange Inc. 7910 Woodmont Avenue, Suite 400 Bethesda, MD 20814-3015 Telephone 301/656-3100 FAX 301/652-5264 Copies of the RFA and AHCPR Pub. No. 96-0036 can also be requested by e-mail at qspanrfa@po3.ahcpr.gov, and AHCPR InstantFAX at 301/594-2800. To use InstantFAX, you must call from a fax machine with a telephone handset. Use the key pad on the receiver when responding to prompts from InstantFAX. The RFA 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 AHCPR's Division of Communications at 301/594-1364 ext. 159. Direct inquires regarding programmatic issues, including information on the policy of inclusion of women and minorities in study populations, to: Joann Genovich-Richards, RN, Ph.D. Q-SPAN Project Officer Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 502 Rockville, MD 20852-4908 Telephone: (301) 594-1352 ext. 114 FAX: (301) 594-2155 Email: jrichard@po3.ahcpr.gov Direct inquires regarding fiscal matters to: Carol Roache Grants Management Staff Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 601 Rockville, MD 20852-4908 Telephone: (301) 594-1447 FAX: (301) 594-3210 Email: croache@po7.ahcpr.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.226. Awards are made under authorization of Title IX of the Public Health Service Act (42 U.S.C. 299- 299c-6), and 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 projects. 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. REFERENCES AHCPR. (1995). For a discussion of AHCPR's focus on quality, see "Promoting Quality and Accountability Through Public-Private Partnerships," an address to The Health Care Quality Alliance on February 14, 1995 by Clifton R. Gaus, Sc.D., Administrator, AHCPR. AHCPR. (1993). Summary Report: Putting Research to Work in Quality Improvement and Quality Assurance. Rockville: MD. AHCPR Publication NO. 93-0001. Center for Health Policy Studies/Center for Quality of Care Research and Education. (1995). Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology. Rockville, MD: Agency for Health Care Policy and Research. Contract No. 282-92-0038. AHCPR Reports #95-N001 and #95-N002. Donabedian, A. (1966). Evaluating the Quality of Medical Care. "Milbank Memorial Fund Quarterly." 44:166-203, (July, part 2). Iezzoni, L.I. editor (1994). "Risk Adjustment for Measuring Health Care Outcomes." Ann Arbor, MI: Health Administration Press, 3.2. .
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