MAKING QUALITY COUNT FOR CONSUMERS AND PATIENTS

Release Date:  January 5, 2000

RFA:  HS-00-002
 
Agency for Healthcare Research and Quality (formerly AHCPR)
National Cancer Institute

Letter of Intent Receipt Date: February 11, 2000
Application Receipt Date: March 24, 2000

PURPOSE

The Agency for Healthcare Research and Quality (AHRQ), formerly known as the
Agency for Health Care Policy and Research (AHCPR), and the National Cancer
Institute (NCI) at the National Institutes of Health invite applications for
demonstrations that facilitate consumer and patient use of information about
quality.  We are seeking demonstrations that: (1) develop and test methods and
models for developing information on quality for consumer and patient use in
health care decisions; and (2) evaluate the impact of strategies to provide
information about quality to consumers and patients.  AHRQ and NCI are
especially interested in projects that focus on vulnerable populations as
defined by the President's Advisory Commission on Consumer Protection and
Quality in the Health Care Industry (Quality Commission).  The final report of
the Quality Commission recognizes individuals made vulnerable by ".... their
financial circumstances or place of residence; health, age or functional
developmental status; or ability to communicate effectively (and) .....
personal characteristics such as race, ethnicity, and sex" (Quality First,
1998).

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 health improvement priorities for the United States. 
AHRQ and NCI encourage 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 "Healthy People 2000" (Summary Report:  Stock No.
017-001-00473-1) through the Superintendent of Documents, Government Printing
Office, Washington, D.C. 20402-9325 (telephone 202-512-1800).

ELIGIBILITY REQUIREMENTS
 
Applications may be submitted by domestic or foreign, public or private
nonprofit organizations, including universities, clinics, units of State and
local governments, and eligible agencies of the Federal government.  AHRQ by
statute, can make grants only to nonprofit organizations; however, for-profit
organizations may participate in grant projects as members of consortia or as
subcontractors.  NCI can make grants to for-profit organizations. 
Organizations described in section 501(c)4 of the Internal Revenue Code that
engage in lobbying are not eligible.

AHRQ and NCI encourage investigators who are women, members of minority groups
and persons with disabilities to apply as Principal Investigators.  

MECHANISM OF SUPPORT

This RFA will use the research demonstration and dissemination projects (R18)
grant mechanism. Responsibility for the planning, direction, and execution of
the proposed project will be solely that of the applicant.

The focus of the R18 applications should be on evaluation.  It is not the
intent of this RFA to support extensive development of databases, or
computerized information systems, but rather to demonstrate and evaluate the
application of strategies to assist consumers and patients to use information
about quality. 

We are interested in funding 2-3 year projects, but will consider projects of
up to 5 years. The anticipated award date is September 29, 2000.

This RFA is a one-time solicitation.  There are no plans to reissue this RFA
at any future time.

FUNDS AVAILABLE
 
AHRQ expects to award up to $1.0 million and NCI expects to award up to $ 0.5
million in fiscal year 2000 to support the first year total costs of
approximately 3 to 4 projects under this RFA.

The actual number of applications funded is dependent on the number of high
quality applications and their individual budget requirements; it is not our
intent that the awards be equal in size.

Funding beyond the initial budget period will depend upon annual progress
reviews by AHRQ and NCI as well as the availability of funds.

RESEARCH OBJECTIVES

Background

Changes in health care delivery have stimulated unprecedented interest in the
importance of the individual's role in health decisions.  This interest
reflects the convergence of several currents in health care. 

Changes in health care purchasing have shifted the focus of health care
delivery from an individual or visit-based model to a population model that
seeks to maximize health for a defined group.  This population focus blurs the
distinction between "consumers" and "patients."  It also creates new
incentives to understand and anticipate factors that affect individual and
family decisions to seek care and to select health insurance plans,
facilities, and clinicians.  Without reliable, usable information regarding
the issues most relevant to them, consumers and patients cannot make
meaningful choices.  

Expanded tools for disseminating health information, and interest among
Americans to participate in their care, offer the potential for individuals to
assume a more active role in their health decisions.  The content and
availability of consumer information are also changing. Comparative reports of
hospitals, health insurance plans, and medical groups are expanding public
access to information that compares quality, while technological advances such
as the world wide web and web TV have the potential for making information
easier to find and interpret.  Moreover, there is increasing evidence that
decision aids and other tools may decrease overuse and overcome underuse of
health services.   
                                                            
An effective health care market for individuals requires information about
price and quality of care.  Asymmetries of information among individuals,
providers and purchasers hinder genuine competition.  Increasing demands of
purchasers for evidence of value, combined with the recent focus on using
quality assessments that include the patient's perspective, mandate the
collection of information that may help individuals and families choose.  

Several specific groups within the U. S. population have been shown to be
affected disproportionately by these changes.  These individuals are
vulnerable to health care quality problems due to demographic factors (health,
age, race or ethnicity), financial circumstances or place of residence.  They
may be hindered from receiving and using health care information by language
or cultural differences, level of education or development, or physical or
mental disabilities.  Finally, characteristics of the evolving health system –
such as eroding safety nets – can interact with personal characteristics to
contribute to vulnerability. 

This RFA is based on research gaps identified by several initiatives.  In
particular, The Quality Commission recommended further research to "enhance
understanding of how information on quality is and can be used by the public
in purchasing decisions; how people value and use different types of quality
information; differences in values among populations, (e.g., with different
educational, cultural, socioeconomic and health status); and effective
dissemination strategies for consumer information" (Quality First, 1998).  The
Quality Commission was particularly interested in research that evaluates
information for consumers and patients and assistance programs for vulnerable
individuals (those with low literacy, complex chronic conditions, language or
cultural barriers).  In addition to these gaps, we are also interested in
research that will improve our understanding of ways in which the public uses
quality information to make decisions about their use of health care services
from disease detection through treatment.

In February 1998, in response to the Quality Commission's recommendations, the
President ordered all Federal Agencies with responsibilities for health care
to coordinate activities to measure and improve quality.  One of the five
action areas of this group of agencies involved in health care, called the
Quality Interagency Coordination Task Force (QuIC), is "Providing Patient and
Consumers Information about Quality."  To further the agenda in this area, the
QuIC sponsored a national conference on consumer health information, "Making
Quality Count. Helping Consumers Make Better Health Care Choices" in December
1998.  This RFA has been informed by that conference and by its cosponsors,
the Health Care Financing Administration (HCFA) and the Office of Personnel
Management (OPM).  (To obtain copies of related publications see INQUIRIES).  

This RFA also requests applications responsive to elements of the mission of
AHRQ.  This includes research which identifies: strategies for enhancing
patient participation in their own care and for facilitating shared patient-
physician decision-making; ways in which patients, consumers, purchasers, and
practitioners acquire new information about best practices and health
benefits, and the determinants and impact of their use of this information;
and mechanisms for the integration of information on quality into purchaser
and consumer decision-making processes.  

Objectives and Scope

AHRQ and NCI seek demonstrations that: (a) develop and test methods and models
for developing information on quality for use by the public in health care
decisions and behaviors; and (b) evaluate the impact of strategies to provide
information on quality.  These two priority areas are described below.

1.   Methods and Models: 

Improved methods and models are essential to understand how consumers and
patients value and use information about quality in health care decisions and
behaviors.  Recent studies have found that, although consumers and patients
want information about quality (KFF-AHRQ, 1996), they do not find current
quality indicators useful (Tumlinson, 1997) or understandable (Hibbard, 1996). 
As a result, the information is rarely used (KFF-AHRQ, 1996; Chernew, 1998;
Wicks, 1999). 
 
Reasons postulated for why consumers and patients do not use information on
quality include: 

a)  Current information focuses on health insurance plans while consumers and
patients are more interested in doctors (NCQA, 1995; KFF-AHRQ, 1996; Chernew,
1998); 
b)  People are interested in a wider range and different set of attributes
than those currently provided in comparative reports (Chernew, 1998);
c)  The measures are not about "people like them;" that is, people of similar
ethnic, socioeconomic, or cultural backgrounds  (Edgman-Levitan, 1996;
Hibbard, 1997);
d)  The link between quality indicators and quality care is not immediately
apparent (Gibbs,1996; McCormack,1996); 
e)  People do not think that health insurance plans influence quality (McGee,
1996); 
f)  The statistical information presented is difficult to understand (Gibbs,
1996);
g) Using unfamiliar quality and performance indicators to support decision-
making is a cognitively difficult task (Hibbard, 1997); and,
h)  Although the information provided is based on what people say is
important, preferences change with exposure to more information (Slovic 1995;
Sainfort, 1996).   

The Consumer Assessment of Health Plans Study (CAHPS) reporting and evaluation
projects (McGee, 1999) and a small number of other efforts are underway to
design and test consumer reports, but many questions remain.  AHRQ is
interested in demonstrations of methods and models that address deficiencies
in current approaches. 

Possible Study Questions:

What is known about the factors that predispose consumers and patients to seek
information about quality and to use that information in health care decision
making?  What is the effect of family characteristics (presence of children,
elderly, people with disabilities) on the role of decision maker?  What are
the models for assisting different types of decision makers?

What can be learned about the timing factors that need to be considered when
disseminating information about quality?  How can this knowledge be translated
into methods and models for more effective communications?  

How do consumers and patients process and use information on quality in health
decisions?  How does this vary for vulnerable populations, such as frail
elderly, persons with disabilities or sensory impairments, limited education?  
How do personal characteristics, such as age, gender, race and ethnicity or
presence of chronic conditions, affect decision making? 

What can be learned about the number of tradeoffs among access, cost, and
quality that can be integrated into decision making while keeping the process
as cognitively simple as possible?  

What are the effective models for collecting, summarizing, organizing,
formatting and presenting quality data at different levels of health system
aggregation (health insurance plan, facility, clinician, groups of
clinicians)?  How can the models reduce the information processing burden on
people?  Which strategies are optimal for consumers and patients of varying
characteristics, particularly those with communication limitations such as
differences in language or culture, sensory impairments or disabilities?

What are the models to balance the need of the majority of consumers for
general quality information and the needs of many smaller groups (such as
individuals with chronic conditions) for more specific information?

What can be learned about the validity of aggregating measures of quality to
create index scores?  What methods should be used to assign quality ratings
and rankings?  Do summaries and indices of quality data assist public
understanding and promote the use of quality data in decision making? 

What modifications to existing quality measures and reporting methods are
needed to ensure relevance to, and impact upon, vulnerable groups?  What are
the methods and technologies for tailoring quality information to language,
cultural, developmental, sensory and physical needs?

What are the models for using community organizations and intermediaries to
support use of information?  How and under what circumstances is assistance in
interpreting and using quality data most effectively delivered - particularly
to the frail elderly, individuals with disabilities or sensory impairments and
those with limited education?

What are the methods for adapting materials as the public's knowledge and
preferences change with exposure to information about health care quality? 
What are the best practices for addressing the needs of different segments of
the public at varying stages of awareness and preference development?

What can be learned about the usefulness of emerging information technologies
(e.g., the Internet, web TV, interactive video technologies, and information
kiosks) in assisting consumer use of information about quality?  Which types
of individuals and families use these technologies and why?  How do peoples'
information needs differ according to health status?  Do healthy individuals
have different information needs than do those with chronic illnesses, or
those who care for family members who have chronic illnesses?

2.   Impact of Information Strategies

There is a widespread movement in the United States to publish "report cards"
for the public that compare the quality of health care organizations, but very
little is known about whether or how consumers and patients respond to this
information (Scanlon, 1997; Wicks 1999;  Lubalin, 1999).  

In recent years, a wide range of organizations including consumer groups,
patient advocacy groups, private companies, states, health insurance plans,
and Federal agencies have produced comparative quality reports. These have
largely focused on health insurance plans, but some have focused on hospitals
and medical groups. Only a few of these efforts have been formally evaluated -
the report card for Minnesota state employees (Knutson, 1998), the Oregon
model scorecard project (Hanes, 1996), the NCQA report card evaluations (NCQA,
1996), and the current CAHPS evaluations (McGee, 1999).  Demonstrations are
needed to understand the impact of information about quality on consumer and
patient awareness, knowledge, decisions, and behaviors.

AHRQ and NCI are particularly interested in demonstrations that shed light on
the impact of efforts that assist health care decisions by using
intermediaries and community organizations and with new and emerging
technologies, including informatics.  These strategies and technologies may be
particularly useful for people with poor cognitive skills or cognitive skills
impaired by disease; chronic conditions, sensory impairments, language or
cultural barriers, including the need for materials in languages other than
English.  Within the area of chronic disease, we are especially interested in
the development and evaluation of products to assist cancer patients
throughout the continuum of care, from screening through long-term
survivorship.  We are also interested in the development and evaluation of
products for families and care givers of cancer patients.

Possible Study Questions:

What is the effect of information about quality on consumer and patient
awareness of health care delivery, quality and costs issues, understanding of
the health care system, and purchase of health insurance?

When consumers and patients have access to information about quality of care,
what is the impact on knowledge, decision making, and behaviors?  Do
expectations and resource utilization change based on the availability of
information about access, quality and effectiveness?  Do impacts vary across
population groups? 
  
What is the impact of efforts to tailor information about quality for
vulnerable populations?  In particular, what is the effect of efforts to
develop and deliver culturally appropriate information about quality?  What
are the characteristics of successful intermediaries and community
organizations? 

What are the measures for assessing "improved" or "better" decisions?  How is
the impact measured and evaluated over time?  Over what time period should
these evaluations occur?

What is the relative impact of quality factors on decisions such as choosing
among practitioners, providers, plans or coverage?  How do the factors vary by
characteristics of the individual?  What are the methods for considering these
factors in presenting information on quality to consumers and patients?

How do benchmarks or standards (such as Healthy People 2010) affect
purchasers' use of information?   

What can be learned from subgroups of consumers and patients that use
information about quality more readily and successfully than others?  Are
there specific formats or media approaches that best fit the needs and
preferences of particular subgroups, especially vulnerable populations?  What
can be learned about the effectiveness of newer technologies and informatics
in providing information about quality that assists decisions?

SPECIAL REQUIREMENTS

Data Privacy

Pursuant to section 903(c) of the Public Health Service Act (42 USC 299a-
1(c)), information obtained in the course of any AHRQ-study that identifies an
individual or entity must be treated as confidential in accordance with any
promises made or implied regarding the use and purposes of the data
collection.  Applicants must describe in the Human Subjects section of the
application procedures for ensuring the confidentiality of such identifying
information.  The description of the procedures should include a discussion of
who will be permitted access to the information, both raw data and machine
readable files, and how personal identifiers and other identifying or
identifiable data will be safeguarded.

The grantee should ensure that computer systems containing confidential data
have a level and scope of security that equals or exceeds those established by
the Office of Management and Budget (OMB) in OMB Circular No. A-130, Appendix
III - Security of Federal Automated Information Systems.  The National
Institute of Standards and Technology (NIST) has published several
implementation guides for this circular.  They are: An Introduction to
Computer Security: The NIST Handbook; Generally Accepted Principals and
Practices for Securing Information Technology Systems; and Guide for
Developing Security Plans for Information Technology Systems.  The circular
and guides are available on the web at 
http://csrc.nist.gov/publications/nistpubs/800-12/handbook.pdf.     

The application of these standards to subcontractors should be addressed as
necessary.

Rights in Data

AHRQ 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 AHRQ funds.  Such
copyrights and patents are subject to a Federal government license to use and
permit others to use these products and materials for AHRQ purposes.  In
accordance with its legislative dissemination mandate, AHRQ purposes may
include, subject to statutory confidentiality protections, making research
materials, data bases, and algorithms available for verification or
replication by other researchers; and subject to AHRQ budget constraints,
final products may be made available to the health care community and the
public by AHRQ, or its agents, if such distribution would significantly
increase access to a product and thereby produce public health benefits. 
Ordinarily, to accomplish distribution, AHRQ publicizes research findings but
relies on grantees to publish in peer-reviewed journals and to market grant-
supported products.

Important legal rights and requirements applicable to AHRQ grantees are set
out or referenced in the AHRQ's grants regulation at 42 CFR Part 67, Subpart A
(Available in libraries and from the GPO's website
http://www.access.gpo.gov/nara/cfr/index.html).
 
INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS

To be funded by AHRQ, applicants must follow AHRQ guidelines for inclusion of
women, children and minorities in research.  It is the policy of AHRQ that
women and members of minority groups be included in all AHRQ-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. 

AHRQ also encourages investigators to consider including children in study
populations, as appropriate.  AHRQ 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
AHRQ Website http://www.AHRQ.gov (Funding Opportunities) and InstantFAX (see
instructions under INQUIRIES).

To be funded by NCI, applicants must follow NIH guidelines for inclusion of
women, children and minorities in research.  It is the policy of the NIH that
women and members of minority groups and their subpopulations must be included
in all NIH-supported biomedical and behavioral research projects involving
human subjects, unless a clear and compelling rationale and justification is
provided that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This policy results from the NIH
Revitalization Act of 1993 (Section 492B of Public Law 103-43).

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 have been published in the Federal Register of March
28, 1994 and in the NIH Guide for Grants and Contracts of March 18, 1994 .  To
the extent possible, AHRQ requires adherence to these NIH Guidelines. 

Investigators may obtain copies from the above sources or from the AHRQ
Publications Clearinghouse, listed under INQUIRIES, or from the NIH Guide
Website http://grants.nih.gov/grants/guide/index.html.

AHRQ and NCI program staff may also provide additional information concerning
these policies (see INQUIRIES).

LETTER OF INTENT 

Prospective applicants are asked to submit, by February 11, 2000, a letter of
intent that includes a descriptive title of the proposed research, the name,
address, and telephone number of the Principal Investigator, the identities of
other key personnel and participating institutions, and the number and title
of the RFA in response to which the application may be submitted.  

Although a letter of intent is not required, is not binding, and does not
enter into consideration of any subsequent application, the information allows
government staff to estimate the potential review workload and avoid conflict
of interest in the review.  Neither AHRQ nor NCI will  provide responses to
letters of intent.

The Letter of Intent is to be sent to Christine Crofton, Ph.D. (see address
under INQUIRIES)

APPLICATION PROCEDURES
 
The research grant application form PHS 398 (rev. 4/98) is to be used in
applying for these grants.  State and local government applicants may use PHS
5161-1, Application for Federal Assistance (rev. 5/96), and follow those
requirements for copy submission.  

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, E-mail:
grantsInfo@nih.gov.

AHRQ applicants are encouraged to obtain application materials from the AHRQ
Publications Clearinghouse  (see INQUIRIES).

The RFA label and line 2 of the application from PHS 398 (rev. 4/98) should
both indicate RFA number.  The RFA label must be affixed to the bottom of the
face page.  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 must also be typed on line 2 of the face
page and the YES box must be marked.  The sample RFA label available at
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has been modified to
allow for this change.  Please note this is in pdf format.

Applicants are encouraged to read all PHS Form 398 instructions prior to
preparing an application in response to this RFA.

The PHS 398 type size requirements (p.6) will be enforced rigorously and non-
compliant applications returned.

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
(20817 for express/courier service)
 
At the time of submission, two additional copies of the application, labeled
"Advanced Copy (s)" must also be sent to:

Lisa Krever
Center for Quality Measurement and Improvement
Agency for Healthcare Research and Quality
2101 E. Jefferson St, Suite 502
Rockville, MD  20852
Telephone:  (301) 594-6625
FAX:  (301) 594-2155
E-mail Address: lkrever@ahcpr.gov

Applications must be received by March 24, 2000.  An application received
after the deadline may be acceptable if it carries a legible proof-of-mailing
date, assigned by the carrier, and the proof-of-
mailing is not later than 1 week prior to the deadline date. If an application
is received after that date, it will be returned to the applicant without
review.  

Application Preparation (for Using HCFA Data) 


Applicants to AHRQ who plan to use HCFA data should follow these procedures:

For applications that propose to use Medicare or Medicaid data that are
individually identifiable, applicants should state explicitly in the Research
Design and Methods section of the Research Plan (form PHS 398) the specific
files, time periods, and cohorts proposed for the research.  In consultation
with the Health Care Financing Administration (HCFA), AHRQ will use this
information to develop an estimate of the cost of borrowing the data.  This
estimate will be included in the estimated AHRQ cost of funding the grant and
may affect the fundability of the application.  To avoid double counting,
applicants should not include the cost of the data in the budget. 

Applicants should be aware that for individually identifiable Medicare and
Medicaid data, Principal Investigators and their grantee institutions will be
required to enter into a Data Use Agreement (DUA) with HCFA to protect the
confidentiality of data in accordance with standards set out in OMB Circular
A-130, Appendix III–Security of Federal Automated Information Systems.  The
use of the data is restricted to the purposes and time period specified in the
DUA.  At the end of this time period, the grantee is required to return the
data to HCFA or certify that the data have been destroyed.  

Grantees must also comply with the confidentiality requirements of Section
903(c) of the PHS Act.  See the Data Privacy Section for details on these
requirements as well as references to Circular A-130 and its implementation
guides from the National Institute of Standards and Technology.

In developing research plans, applicants should allow time for refining,
approving, and processing their data requests.  Requests may take 6 months
from the time they are submitted to complete.  Applications proposing to
contact beneficiaries or their provider require the approval of the HCFA
Administrator and may require meeting(s) with HCFA staff.

HCFA data are provided on IBM mainframe tapes using the record and data
formats commonly employed on these computers.  Applicants should either have
the capability to process these tapes and formats or plan to make arrangements
to securely convert them to other media and formats.

Applicants to NCI who plan to use HCFA data should only include the cost of
those data in their budgets.

Questions regarding HCFA data should be directed, as appropriate, to the AHRQ
or NCI program officials listed under INQUIRIES.

REVIEW CONSIDERATIONS
 
Upon receipt, applications will be reviewed for completeness and
responsiveness.  Incomplete applications will be returned to the applicant
without further consideration.  If the application is not responsive to the
RFA, AHRQ Referral staff may contact the applicant to determine whether to
return the application to the applicant or hold it for review in competition
with unsolicited applications at the next review cycle.  Applications that are
complete and responsive to the RFA will be evaluated for scientific and
technical merit by an appropriate peer review group convened by AHRQ in
accordance with the review criteria stated below.

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. 
 
General Review Criteria 
 
The criteria to be used in the evaluation of grant applications are listed
below. 

The goals of AHRQ-supported research are to enhance the quality,
appropriateness, and effectiveness of health care services, and access to such
services.  The reviewers will comment on the following aspects of the
application in their written critiques in order to judge the likelihood that
the proposed research will have a substantial impact on the pursuit of these
goals.  Each of these criteria will be addressed and considered by the
reviewers in assigning the overall score, weighting them as appropriate for
each application.  Note that the application does not need to be strong in all
categories to be judged likely to have a major scientific impact and thus
deserve a high priority score.  For example, an investigator may propose to
carry out important work that by its nature is not innovative but is essential
to move a field forward.
 
1.  Significance.  Does this study address an important problem? If the aims
of the application are achieved, how will scientific knowledge be advanced? 
What will be the effect of these studies on the concepts or methods that drive
this field?
 
2.  Approach.  Are the conceptual framework, design, methods, and analyses
adequately developed, well-integrated, and appropriate to the aims of the
project?  Are the proposed data sources appropriate and adequate?  Does the
applicant acknowledge potential problem areas and consider alternative
tactics?
 
3.  Innovation.  Does the project employ novel concepts, approaches or method? 
Are the aims original and innovative? Does the project challenge existing
paradigms or develop new methodologies or technologies?
 
4.  Investigator.  Is the investigator appropriately trained and well suited
to carry out this work?  Is the work proposed appropriate to the experience
level of the principal investigator and other researchers (if any)?  Is the
project (or work plan) well organized?
 
5.  Environment.  Does the scientific environment in which the work will be
done contribute to the probability of success?  Do the proposed experiments
take advantage of unique features of the scientific environment or employ
useful collaborative arrangements? Is there evidence of institutional support?

The initial review group will also examine: the appropriateness of proposed
project budget and duration; the adequacy of plans to include both genders,
children, and minorities and their subgroups as appropriate for the scientific
goals of the research and plans for the recruitment and retention of subjects;
the provisions for the protection of human and animal subjects; and the safety
of the research environment.

Special Review Criteria  

In addition to the general review criteria above, the reviewers will assess
the application's responsiveness to the RFA and other critical aspects such
as:

1)  Extent to which the findings will be generalizable to other settings, and
situations; 
2)  Feasibility of answering the proposed research question(s) within the
project period;
3)  Extent to which the research design and methods integrate clinical,
behavioral, social and decision sciences; and,
4)  Extent to which and immediacy with which the research findings and
products can be expected to be used in practice.  This may be evidenced by the
direct involvement and investment in the demonstration project by insurer,
provider, or consumer groups whose participation heightens the probability of
application in practice.

AWARD CRITERIA
 
Applications will compete for available funds with all other applications
under this RFA.  The following will be considered in making funding decisions:
1) quality of the proposed project as determined by peer review; 2)
availability of funds; 3) program balance with respect to types of health care
insurance and organizational delivery system features, enrollee versus
community studies, populations studied, geography including rural/urban mix,
regional representation, and targeting understudied areas with unmet
evaluation needs; 4) compatibility with other awardees with respect to
cooperative activities; and 5) policy relevance. 

INQUIRIES
 
Copies of the RFA and the "Quality First: Better Health Care for All
Americans, Final Report to the President" may be obtained from:

AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone 1-800-358-9295

The RFA is also available on AHRQ's Web site, http://www.AHRQ.gov, and through
AHRQ 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 table of contents, which has the document order number
(not the same as the RFA number).  The RFA will be sent at the end of the
ordering process.  AHRQ InstantFAX operates 24 hours a day, 7 days a week. 
For comments or problems concerning AHRQ InstantFAX, please call (301) 594-
6344.

The "Making Quality Count: Helping Consumers Make Better Health Care Choices"
Report may  be obtained from the HCFA web site at
http://www.hcfa.gov/events/qualsum.htm.  The full-text of the Institute of
Medicine report from the National Cancer Policy Board, "Ensuring Quality
Cancer Care," is available on a read-only basis at 
http://books.nap.edu/catalog/6467.html  This web site also provides
instructions for ordering a hard copy of the report.

AHRQ and NCI welcome the opportunity to clarify any issues or questions from
potential applicants who have read the RFA.  Written and telephone inquiries
concerning this RFA are encouraged.   Direct inquiries regarding programmatic
issues, including information on the inclusion of women, minorities, and
children in study populations to:
 
Christine Crofton, Ph.D.
Center for Quality Measurement and Improvement
Agency for Healthcare Research and Quality
2101 E. Jefferson Street, Suite 502
Rockville, MD  20852
Telephone:  (301) 594-2003
FAX: (301) 594-2155
Email: ccrofton@ahcpr.gov

Gary L. Kreps, Ph.D., Chief
Health Communication and Informatics Research Branch
Behavioral Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
Executive Plaza North, Room 239
6130 Executive Blvd., MSC 7326
Bethesda, Maryland 20892-7326
Telephone:  (301) 496-7984
FAX:  (301) 496-8675
Gary.Kreps@NIH.Gov

Direct inquiries regarding fiscal and eligibility matters to:
 
Al Deal
Grants Management Specialist
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone: (301) 594-1843
FAX: (301) 594-3210
Email: adeal@ahcpr.gov

Brian Albertini
Grants Administration Branch
National Cancer Institute
6120 Executive Boulevard, Room 243
Bethesda, MD 20892-7399
Rockville, MD 20852 (for express/courier service)
Telephone: (301) 496-7244

AUTHORITY AND REGULATIONS
 
This program is described in the Catalog of Federal Domestic Assistance No.
93.226 (AHRQ) and No. 93.399 (NCI).  Awards are made under authorization of:
For AHRQ, Title IX of the Public Health Service Act (42 USC 299-299c-6). 
Awards are administered under the PHS Grants Policy Statement and Federal
Regulations 42 CFR 67, Subpart A,  and 45 CFR Parts 74 and 92.  For NCI,
section 301 and 405 of the Public Health Service Act (42 USC 241 and 284) and
administered under NIH Grant policies and Federal Regulations 42 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.

REFERENCES

Chernew M, Scanlon DP, 1998. Health Plan Report Cards and Insurance Choice. 
Inquiry, 35:9-
Edgman-Levitan S, Cleary P, 1996. What Information Do Consumers Want and Need?
Health Affairs, 15(4):42-55.

Gibbs D, Sangl J, Burrus B, 1996. Consumer Perspectives on Information Needs
and Health Plan Choice.  Health Care Financing Review, 18(1):55-73.

Hanes P, Greenlick M, 1996. Oregon Consumer Scorecard Project Final Report.
Agency for Healthcare Research and Quality, Pub No. 97-N008.

Hibbard JH, Jewett JJ, 1996. What Type of Quality Information Do Consumers
Want in a Health Care Report Card? Medical Care Research and Review, 53:28-47.

Hibbard JH, Slovic P, Jewett J, 1997. Informing Consumer Decisions in Health
Care: Implications from Decision-Making Research. Milbank Quarterly,
75(3):395-413.

Kaiser Family Foundation and the Agency for Health Care Policy and Research
(AHCPR), 1996. Americans as Health Care Consumers: The Role of Quality
Information. A National Survey. Highlights. Menlo Park, Calif: Kaiser Family
Foundation.

Knutson DJ, Kind EA, Fowles JB, Adlis S, 1998.  Impact of Report Cards on
Employees: A Natural Experiment. Health Care Financing Review, 20(1):5-27.

Lubalin JS, Harris-Kojetin LD, 1999. What Do Consumers Want and Need to Know
in Making Health Care Choices? Medical Care Research and Review, 56:67-102.

McCormack, L., Garfinkel, S., Schnaier, J., Lee, A.J., Sangl, J., 1996.
Consumer Information Development and Use, Health Care Financing Review,
18(1):15-30.

McGee J, Sofaer S, Kreling B, 1996. Findings from Focus Groups Conducted for
the National Committee for Quality Assurance (NCQA) Medicare and Medicaid
Consumer Information Projects. Washington, DC: NCQA.

McGee J, Kanouse DE, Sofaer S, Hargraves JL, Hoy E, Kleimann S, 1999. Making
Survey Results Easy to Report to Consumers: How Reporting Needs Guided Survey
Design in CAHPS. Medical Care Supplement, 37(3):32-40.

National Committee for Quality Assurance (NCQA), 1995. NCQA Consumer
Information Project: Focus Group Report. Executive summary, Washington, DC.

National Committee for Quality Assurance (NCQA), 1996. Testing the "Choosing
Quality Health care" report card results from Denver: a final report.
Washington, DC: NCQA.

National Committee for Quality Assurance (NCQA), 1996. Testing the "Choosing
Quality Health Care' report card results from St. Louis: a final report.
Washington, DC: NCQA.

Quality First; Better Health Care for all Americans, 1998.  Final Report of
the President's Advisory Commission on Consumer Protection and Quality in the
Health Care Industry.  Washington, DC:  U.S. Government Printing Office.

Sainfort F, Booske BC, 1996. Role of Information in Health Plan Choice.  
Health Care Financing Review, 18(1):31-54.

Scanlon DP, Chernew M, Lave JR, 1997. Consumer Health Plan Choice: Current
Knowledge and Future Direction.  Annual Review of Public Health, 18:507-528.

Slovic P, 1995. The Construction of Preference.  American Psychologist,
50:364-71.

Tumlinson A, Bottigheimer H, Mahoney P, et al., 1997. Choosing a Health Plan:
What Information will Consumers Use? Health Affairs, 16(3):229-238.

Wicks EK, Meyer JA, Rybowski LS, Perry MJ, 1999. Report on Report Cards.
Washington, DC:Economic and Social Research Institute in collaboration with
MBGH.


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