PRIMARY CARE PRACTICE-BASED RESEARCH NETWORKS (PBRNs)

Release Date:  January 21, 2000

RFA:  HS-00-004

Agency for Healthcare Research and Quality (formerly AHCPR)

Letter of Intent Receipt Date:  March 10, 2000
Application Receipt Date:   April 27, 2000

PURPOSE

The Agency for Healthcare Research and Quality (AHRQ), formerly known as the 
Agency for Health Care Policy and Research (AHCPR), announces the availability 
of one-year exploratory grants to assist new or established practice-based 
research networks (PBRNs) in  planning for activities that will enhance their 
capacity to conduct research in primary care settings and translate research 
findings into practice.  Each grant will support the development of a PBRN-
specific plan to:  (1) establish or augment electronic collection and 
aggregation of practice-derived data, (2) increase network capacity to study 
the health care of racial and ethnic minority and/or underserved populations, 
(3) create systems to facilitate the implementation of research findings by 
network clinicians and practices, and, (4) identify potential sources of 
ongoing network support.  It is anticipated that after completion of these 
exploratory grants, recipient organizations will be in a position to compete 
for subsequent funds AHRQ expects to award in 2001 (contingent upon funding 
availability) to assist PBRNs in carrying out individually developed plans.  
The long-term goal of the overall initiative is to improve the capacity of 
PBRNs to expand the primary care knowledge base and to establish mechanisms to 
assure that new knowledge is incorporated into actual practice and that its 
impact is assessed.

For the purposes of this RFA, a PBRN is defined as a group of ambulatory 
practices devoted principally to the primary care of patients, affiliated with 
each other (and often with an academic or professional organization) in order 
to investigate questions related to community-based practice.  This definition 
includes a sense of ongoing commitment to the research endeavor, and an 
organizational structure that transcends a single study (see further details 
 Qualifications  under SPECIAL REQUIREMENTS).

HEALTHY PEOPLE 2010

The Public Health Service (PHS) is committed to achieving the health promotion 
and disease prevention objectives of  Healthy People 2010,  a PHS-led national 
activity for setting health improvement priorities for the United States.  
AHRQ encourages applicants to submit grant applications with relevance to the 
specific objectives of this initiative.  Potential applicants may obtain a 
copy of  Healthy People 2010" at http://odphp.osophs.dhhs.gov/pubs/hp2000.

ELIGIBILITY REQUIREMENTS

Applications may be submitted by new or existing primary care practice-based 
research networks located in the U.S. or by institutions affiliated with a 
PBRN, which can be public or private non-profit organizations including 
universities, clinics, firms, or units of State and local governments.  For 
the purpose of this RFA, AHRQ, by statute, can make grants only to non-profit 
organizations, however, for-profit organizations may participate in grant 
projects as members of a non-profit consortium or as subcontractors to a non-
profit entity.  Organizations described in section 501(c)4 of the Internal 
Revenue Code that engage in lobbying are not eligible.

AHRQ encourages women, members of minority groups, and persons with 
disabilities to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the Exploratory Grant (P20) mechanism.  Responsibility for 
the planning, direction, and execution of the proposed project will be solely 
that of the applicant.  The Center for Primary Care Research (CPCR) within 
AHRQ will serve as a Coordinating Center to facilitate the sharing of ideas 
and encourage collaborations among recipient PBRNs.  Representatives of 
recipient PBRNs will be expected to attend group meetings convened by CPCR 
during the funding period.

This RFA is a one-time solicitation.  The total project period for an 
application submitted in response to this RFA may not exceed one year.  The 
anticipated award date is September 29, 2000.  It is anticipated that after 
successful completion of these exploratory grants, recipient PBRNs will be in 
a position to compete for subsequent multi-year funds which AHRQ will offer, 
contingent upon funding availability, through a separate solicitation to be 
released in Fiscal Year 2001.

FUNDS AVAILABLE

AHRQ expects to award up to $1.5 million total costs in Fiscal Year 2000 to 
support up to 14 PBRNs under this RFA. 

The actual number of applications funded is dependent on the number of high 
quality applications received.  Budget requests for applications submitted 
under this RFA should not exceed $75,000 in direct costs.  Representatives of 
recipient PBRNs will meet with CPCR staff in Washington, D.C., as many as 3 
times during the planning year.  Budget requests should therefore include 
travel expenses for this purpose.  

Although the financial plan of AHRQ provides for this program, awards pursuant 
to this RFA are contingent upon the availability of funds for this purpose.

RESEARCH OBJECTIVES

Background

Legislation passed by the one hundred sixth U.S. Congress and signed by the 
President in December, 1999, amended Title IX of the Public Health Service Act 
(42 U.S.C.299 et seq.) to mandate the establishment within the new AHRQ of a 
Center for Primary Care Research to  serve as the principal source of funding 
for primary care practice research in the Department of Health and Human 
Services.   In addition, the AHRQ was directed to:  (1) support research and 
evaluations on the health care of priority populations, including low-income 
and minority groups, (2) develop and evaluate strategies for reducing medical 
errors and supporting clinical preventive services, (3) foster a range of 
innovative approaches to the management and communication of health 
information, (4) support efforts to speed the dissemination of research 
findings to community practice settings, and, (5) employ research strategies 
and mechanisms that link research directly with clinical practice in 
geographically diverse locations throughout the U.S., including  provider-
based research networks... especially (in) primary care.   This RFA, 
supporting the development of primary care PBRNs, is part of AHRQ’s response 
to these Congressional mandates.

Practice-Based Research Networks and Primary Care

Building collaborative networks of office-based practices for the purpose of 
research is a promising approach to the study of almost any type of ambulatory 
health care, since findings from such research may be significantly influenced 
by the practice setting(s).  This approach appears to be even more important, 
however, for the study of problems encountered in primary care, where the 
characteristics of the particular practice setting are often so influential 
that they  become a constellation of factors that themselves must be 
considered  in the research design (Starfield, 1992).  Whereas studies 
conducted in inpatient settings or hospital outpatient departments may have 
limited applicability to community-based primary care, research conducted 
within primary care PBRNs can readily consider such factors as practice 
organization and finances, and the community within which the practice is 
located.  These factors may be critical in the interpretation and 
generalizability of findings.

The applicability of research findings to primary care practice is also 
significantly influenced by the nature of the study population.  Primary care 
tends to deal with the management of unselected patients, many of whom present 
with undifferentiated clinical problems and/or have multiple problems at once. 
 Findings from research that focuses on single diseases among highly selected 
or referred patients may therefore have little, if any, relevance to problems 
encountered in primary care.  Moreover, such studies typically measure disease 
or condition-specific physiological outcomes while primary care clinicians are 
equally concerned about broader and more person-focused outcomes (AHCPR Task 
Force on Building Capacity in Primary Care Research, 1993).  Research 
conducted within primary care PBRNs can potentially overcome these limitations 
since the PBRN study population is very likely to be representative of the 
general public, and primary care clinicians are typically involved as 
investigators or consultants in defining the research design and the outcomes 
to be measured. 

The first primary care PBRNs were initiated in the U.S. in the late 1970s, and 
a recent report indicates a total of 28 active primary care research networks 
in North America (Nutting, 1996).  Although a few PBRNs are national in scope, 
the majority are local or regional in nature.  Most exist within the 
organizational structure of professional associations, although a few exist 
within academic departments, and others are independent organizations.  The 
number of PBRN practices participating in any study (ranging from 15 to more 
than 500) is usually sufficient to assure generalizability to average patient 
populations, providers, and practice settings.  Much of the early work of 
PBRNs provided descriptions of the content and practice patterns of primary 
care, while more recent research from a few networks has included 
effectiveness studies and randomized clinical trials.  The emerging body of 
research by PBRNs demonstrates the ability of networks to link relevant 
clinical questions with rigorous research methods in community settings to 
produce important scientific information that not only is externally valid 
but, in theory, is more easily assimilated into everyday practice (Nutting, 
1999).

Challenges to Primary Care PBRNs

Whereas PBRNs have advantages for studying the common phenomena of primary 
care in primary care settings, they also face a number of challenges.  
Collecting, transferring and managing data generated from multiple sites is 
often problematic, but is particularly challenging in the setting of diverse 
primary care practices.  Unlike the collection of data in most hospital 
settings, few if any standards currently exist for the coding of 
administrative/billing information routinely collected in primary care.  
Therefore, such data are often not compatible and cannot be easily aggregated 
for the purpose of analysis.  Moreover, few existing primary care PBRNs have 
managed to develop electronic data systems dedicated to collecting primary 
research data, and the collection, transfer and aggregation of large volumes 
of hand-written information from network practices that often are widely 
dispersed geographically can be a major challenge.  Of greater concern, 
however, is the integrity of such information, which is typically recorded by 
primary care clinicians or their staff in busy office settings.  More 
efficient and reliable data systems are needed to address the issue of 
accuracy, reliability and validity of data generated within PBRNs (Wasson, 
1997).

Since most PBRNs are composed of practices that are located predominantly in 
suburban or rural sites, their ability to study the delivery of primary care 
services to urban minority and underserved patient populations is often 
limited.  Very few published PBRN studies have specifically addressed the 
persistent, and often increasing, health disparities that have been correlated 
with race, ethnicity, poverty and insurance status, and the number of 
minority/underserved patients included in most PBRN research has been 
inadequate for meaningful subgroup analyses.  

One of the early promises of the organizers of primary care PBRNs was that 
research conceived and conducted in practice settings could follow a short 
feedback loop back into practice and thus shorten the usually laborious 
translation process of applying the research results to the practice of 
primary care (Green, 1990).  In the absence of methods to measure baseline and 
subsequent rates of compliance with recommended evidence-based practices, 
however, it is difficult to know whether this promise has in fact been 
fulfilled.  Information systems are needed to assist with prompt and 
appropriate dissemination of new research evidence and to measure subsequent 
changes in the processes of primary care practice.  Such systems can inform 
future research needs and enhance collective understanding of strategies to 
accelerate continuous quality improvement in routine practice.  In particular, 
improved computer-based information systems can contribute significantly to 
efforts aimed at reducing medical error rates and implementing clinical 
preventive recommendations in primary care settings.

Finally, most if not all primary care PBRNs share the serious challenge of 
sustaining an infrastructure capable of recruiting and retaining participating 
practices, supporting the network, and generating fundable research projects. 
 Although there is considerable variation in the status of current PBRN 
infrastructural support, few have significant, ongoing funding from any 
academic institution or other organization.   All appear to rely heavily on 
volunteerism for central staff support and the cooperation of participating 
practices and investigators.  Primary care PBRNs must begin to seek new 
avenues of funding from a variety of sources to provide support for PBRN 
infrastructural needs, especially in those periods between major funded 
research efforts.

SPECIAL REQUIREMENTS

Applications are encouraged from newly formed PBRNs as well as existing 
networks, including those that have received funds from AHRQ, other 
Governmental agencies, or private sources.  Each PBRN funded by AHRQ will be 
expected to develop, within twelve months, a detailed plan for network growth 
specific to its current state of development as well as its size, patient 
population served, and the practice styles of the group’s clinicians.  At the 
same time, AHRQ recognizes that the power of individual networks to study 
health care events of primary care can be multiplied through regular 
communication and research collaborations among PBRNs.  To encourage such 
collaborations and to assure the sharing of ideas across PBRNs during this 
planning phase, CPCR intends to serve as a Coordinating Center for PBRN 
planning activities.  In addition to hosting conference calls and list-serve 
discussions, CPCR will convene up to 3 meetings of representatives of 
recipient PBRNs during the year of funding.  The meetings will include initial 
discussions of standard data elements, standard coding of primary care 
processes, and the feasibility of aggregating certain data elements collected 
from numerous PBRNs into a  primary care database. 

Required Elements of Planning and Development Effort

During the funding period, each PBRN will be required to develop a plan for 
network growth in four key areas: (a) computerized data management and 
practice evaluation, (b) research of special relevance to minority and/or 
underserved populations, (c) translation of research into practice, and (d) 
predictable network funding.  The responsibility for directing the planning 
and development effort should be assigned to a senior level person familiar 
with PBRN research and competent in administration.  This person should devote 
a significant proportion (30% or more) of his/her time to this endeavor.  The 
PBRN may also choose to have an internal planning committee to assist the 
planning director.  The director/planning committee should evaluate the 
current strengths and weaknesses of the network in the key identified areas 
and consider all available resources in the planning process.  Appropriate 
consultants may be called upon to assist.
  
Specific required planning activities to be accomplished with funding through 
the present RFA are listed below, by Area of Focus.

I.   Data Management

o   Evaluation of existing data collection capacities within all network-
affiliated practices, including the ability to use current informatic systems 
to identify and follow eligible patients according to symptomatic or 
diagnostic criteria.

o   Development of options and specific methods to collect and aggregate 
electronically from affiliated practices both standard core clinical data and 
project-specific data.  PBRN plans should consider all viable computer-based 
options, including Internet-based data collection and the use of electronic 
medical records.  The final plan should include the projected cost of 
implementing each option.

o   Development of options and specific methods for ensuring data integrity 
and the confidentiality of identifiable personal health information.  The plan 
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 final plan should include the projected cost of each option.

o   Discussion of methods to coordinate appropriate review by institutional 
review boards of future network studies, especially those in which clinical 
data will be collected from multiple independent practices.

II.  Minority And/Or Underserved Population Research

o   Documentation that practices currently affiliated with the network serve 
sufficient numbers of minority and/or underserved patients to permit studies 
that have the statistical power to generate significant findings related to 
ethnic minority subgroups (Blacks/African-Americans, Hispanic Americans, 
American Indians, Alaskan Natives, Asian Americans and Pacific Islanders), OR

o   Development of formal network linkages with additional primary care 
practices that serve sufficient numbers of minority and/or underserved 
patients to permit such studies.

III.   Translation of Research Into Practice

o   Development of methods to use new or existing computer-based information 
systems to assess changes in clinical practice resulting from the 
dissemination of new research evidence into practices affiliated with the PBRN 
and to measure the impact of these changes on outcomes, cost and/or use of 
services.  The plan should specifically consider methods of using computer-
based information systems to assess strategies for reducing preventable health 
care errors.

o   Testing and implementation of appropriate tools developed by AHRQ and 
others (e.g., evidence reports, quality measures, etc.) for the purpose of 
translating research into practice.  The plan should specifically include a 
discussion of potential methods for evaluating the extent to which practices 
implement clinical preventive recommendations.

o   Development of specific strategies, including the use of computer-based 
information systems, to accelerate the diffusion of new research knowledge 
into actual practice.  The final plan should include a menu of strategies that 
the network has used successfully in the past or could be capable of using in 
the future.  To the extent possible, the plan should also include the 
projected costs of each strategy.

IV.  Predictable Network Funding

o   Exploration of potential sources of ongoing funding for the PBRN research 
infrastructure, including professional organizations, academic institutions, 
governmental sources, foundations and other private sources such as 
pharmaceutical companies and clinical research organizations.

o   Development of a five year  business plan  demonstrating how core 
administrative functions of the network can be supported even in the absence 
of major funding for project-specific research.

Qualifications

PBRNs should document in their applications that they meet, at minimum, the 
following qualifications:

o   The PBRN organizational structure includes, or will include, a core of at 
least 15 ambulatory practices and/or 15 clinicians located in the U.S. and 
devoted principally to the primary care of patients.
o   The network has an accepted statement of its purpose and research mission 
that includes an ongoing commitment to the research endeavor.
o   A director has been identified who is, or will be, responsible for most 
administrative, financial and planning functions.
o   The director is, or will be, supported by a staff of at least one person.
o   A mechanism (such as a community advisory board) is planned or in place to 
solicit advice/feedback from the communities of patients served by the PBRN.
o   An organizational structure exists, or will exist, that transcends a 
single study, including multiple systems of communication with and among 
participating practices in the form of regularly produced newletters, e-mail 
or list-serves, conference calls, and/or face-to-face meetings of various 
combinations of network members.

Data Privacy

Application materials will include citations for federal data security 
standards and background materials on the AHRQ confidentiality statute 
[section 903(c) of the Public Health Service Act (42 USC 299a-1(c)] that 
protects and restricts disclosure of identifiable information about 
individuals or entities collected in the course of any AHRQ-funded study.  
Should planning activities or pilot projects undertaken as part of this 
initiative involve confidential, identifiable data, the grantee must ensure 
that computer systems containing these 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. 

Rights in Data

To encourage dissemination of AHRQ products by grantees, application materials 
will include information on copyrighting or seeking patents, as appropriate, 
for final and interim products and materials.  Examples of such products and 
materials are methodological tools or measures or software with documentation, 
literature searches, and analyses, which are developed in whole or in part 
with AHRQ funds.  Such copyrights and patents will be subject to a Federal 
government license to use and permit others to use these products and 
materials for AHRQ purposes.

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

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 is also encouraging investigators to include children in 
study populations whenever appropriate.  Planning and development projects 
should consider how to facilitate the collection of data pertaining to these 
populations.  Further information about these inclusion policies is available 
through the AHRQ Website http://www.ahrq.gov (Funding Opportunities) and 
InstantFAX (see instructions under INQUIRIES).

LETTER OF INTENT

Prospective applicants are asked to submit, by March 10, 2000, a letter of 
intent that includes a descriptive title of their proposed project, the name, 
address, and telephone number of the Principal Investigator, 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 the consideration of any subsequent application, the information 
allow AHRQ staff to estimate the potential review workload and avoid conflict 
of interest in the review.  AHRQ will not provide responses to letters of 
intent.

The letter of intent is to be sent to Kelly Morgan (see address under 
APPLICATION PROCEDURES).

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 4/98) is to be used in 
applying for these planning and development 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) 710-0267, email:  
[email protected]

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

The RFA label available and line 2 in the PHS 398 (rev. 4/98) application form 
should both indicate RFA number.  The RFA label must be affixed to the bottom 
of the face page of the original application.  Failure to do so 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 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.  

Applicants are encouraged to read all PHS Form 398 instructions carefully 
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 will be returned.

Application Preparation

Complete information about the proposed planning effort must be submitted with 
the application.  The narrative portions of the PBRN application, described 
below under  Research Plan,  should be limited to twenty-five pages of text.  
The application should be a complete document that includes all essential 
information necessary for its evaluation.  While additional explanatory 
material may be submitted as appendices, such appendices should not be used to 
bypass page limitations in the application because only selected reviewers 
will receive copies of the appendices.  

Since the form PHS 398 was developed for research grant applications, the 
following supplemental instructions should be used as a guide in the 
preparation of the application.

1)  Under  Performance Sites  (page 2), list only the official name of the 
PBRN and the address of the PBRN office.  A complete listing of the clinicians 
and practice sites involved in the network should be attached to the 
application as an appendix.

2)  Detailed Budget.   In general, allowable budget items for these planning 
and development grants are limited to a portion of the salaries of the 
planning director, consultation fees, key administrative and clerical support 
personnel, travel and per diem expenses for outside consultants/advisors, 
supplies, travel and per diem expenses for the planning director and/or other 
key personnel to be involved in 3 meetings in Washington, D.C. with CPCR 
staff, and other justifiable operating expenses of the planning effort.  The 
level of effort of personnel should reflect the commitment of the individual 
to the planning process.  The purchase of equipment is discouraged, and any 
request for equipment must be well justified.  Budget requests submitted under 
this part of the RFA should not exceed $75,000 in direct costs.

3)  Biographical Sketches.   Include in this section a biographical sketch of 
the planning director (equivalent of Principal Investigator) and other key 
personnel to be involved in the planning effort.

4)  Resources available to the PBRN should be described once, either in a 
separate section following the biographical sketches or included in the 
narrative text (see below).

5)  Research Plan.  This narrative part of the application should contain the 
following elements:

Section I.  The Practice-Based Research Network

a)  Description of the existing or planned PBRN.  Describe the practices 
included in the current or developing network, including geographical 
distribution of practices, types of clinicians, and patient population served 
by the practices.  As noted above, a complete up-to-date listing of network 
clinicians and practice addresses should be included as an appendix to the 
application.

b)  Current or proposed infrastructure supporting the PBRN.   Describe and 
discuss the existing or planned infrastructure that supports the PBRN research 
effort.  This discussion (which may alternatively be included in the Resources 
section of the application) should include details of any computer-based or 
other information systems currently in use (or planned) to collect and 
aggregate research data or communicate with clinicians.  The current, or 
proposed, director and any network support staff should be identified, 
including a description of their qualifications and source of salary support 
(if any).  If the network is affiliated with an academic department or other 
research unit, the relationship with that institution should be described, 
including a list of consultants and other resources available to the network 
as a result of the affiliation.  Senior officials in any PBRN-affiliated 
organizations(s) should provide a letter documenting support for the proposed 
planning and development process. These and other letters of support should be 
included as an appendix and referenced in this section of the application.  
The discussion should also include references to the existing, or proposed, 
mechanism for obtaining advice/feedback from the communities of patients 
served by the network practices.

c)  Progress to date in conducting research.  Include a summary of the 
research completed to date by the PBRN, including sources and amounts of 
funding received for the research.  A complete list of publications (if any) 
resulting from PBRN research should be included as an appendix and referenced 
in this section of the application.  Emerging PBRNs should describe their 
research goals and objectives and provide examples of specific projects their 
networks are interested in (and capable of) pursuing.

d)  Progress to date in translating research into practice.  Describe any 
formal or informal systems or mechanisms within the PBRN, current or planned, 
to disseminate the results of research to network clinicians and evaluate the 
impact of this information on practices.

Section II.  The Proposed Planning Effort

a)  Description of the planning director and his/her responsibilities and 
authority to carry out the proposed planning process for the PBRN.  Discuss 
the selection of this individual as planning director (equivalent of principal 
investigator) and his/her future role in the PBRN.  This section should 
present an adequate description of his/her qualifications and administrative 
experience.

b)  Description of the planning committee.   If an internal planning committee 
is being proposed, list and discuss the membership.  List any external 
consultants to the planning committee.

c)  Description of other key personnel and their duties.  Discuss the 
selection and duties of the key personnel supporting the planning director and 
planning committee.

d)  Description of issues that will need to be resolved through the planning 
and development process.  Discuss the issues/obstacles that must be considered 
in the planning and development process.  An example of such an issue is 
anticipated change in the practice environment (e.g., managed care penetration 
in the area) affecting the practices involved in the network.

e)  Detailed description of the planning proposed.  Include discussions of the 
proposed approach to planning activities for each of the Areas of Focus.

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
Express/courier service zip code (20817)

At the time of submissions, two additional copies of the application, labeled 
 Advanced Copies  must also be sent to:

Kelly Morgan
Center for Primary Care Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Suite 201
Rockville, MD 20852-4908
Telephone: (301) 594-1782
FAX: (301) 594-3721
E-mail address: [email protected]

Applications submitted under this RFA must be received by April 27, 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 one week prior to the deadline date.  If an 
application is received after that date, it will be returned to the applicant 
without review.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness and 
responsiveness.  Incomplete applications will be returned to the applicant 
without further consideration.  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 AHRQ peer 
review procedures.  If the application is not responsive to the RFA, it will 
be returned to the applicant without review.  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

Applications will be assessed in two general areas: 1) technical merit of the 
proposed planning process, and 2) potential of the new or existing PBRN to 
enhance its capacity to conduct research and translate research findings into 
practice.  Peer reviewers will be asked to specifically comment in these two 
areas.  An unacceptable evaluation in either category can be grounds for 
disapproval of the application.  The final priority scores will reflect the 
peer reviewer’s overall assessment based on their judgements of the two review 
areas.

1.  The technical merit of the proposed planning process.

a)  Clarity and appropriateness of planning goals and objectives,

b)  Extent to which the application appropriately defines the problems that 
need to be resolved in the planning process,

c)  Extent to which the proposed detailed planning effort has clear and 
appropriate goals consistent with the stated goals of AHRQ and is of adequate 
scope with regard to the Areas of Focus,

d)  Qualifications of the proposed planning director to lead the planning and 
development effort and his/her leadership experience, administrative skills 
and research background,

e)  Qualifications and appropriateness of the key personnel designated to 
assist the planning director, and,

f)  Appropriateness of the membership and stated functions, as well as 
potential effectiveness, of the proposed internal planning committee (or 
advisors to the planning director).

2.  The potential of the PBRN to enhance its capacity to conduct primary care 
research and translate research findings into practice.

a)  Adequacy of the commitment of network practices to primary care research, 
as evidenced by published findings from PBRN studies or letters of support 
from participating clinicians,

b)  Adequacy of the patient populations served by the PBRN practices to 
support primary care research, and the potential for research that includes 
minority and/or underserved populations,

c)  Adequacy and stability of the PBRN’s administrative, organizational and 
management capabilities, and,

d)  Extent to which the award of grant funds will enhance the ability of the 
PBRN to plan future activities for enhancing primary care research and 
translating research findings into practice.

The initial review group will also examine the appropriateness of the proposed 
project budget.

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) program 
balance and the desire to fund a group of networks that capture the full scope 
of primary care practice, including providers from multiple disciplines and 
populations of all ages, and, (3) availability of funds.

INQUIRIES

Copies of this RFA and all currently active AHRQ grant announcements are 
available from:

AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone: 800-358-9295
TDD service: 888-586-6340
E-mail: [email protected]

This 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.

AHRQ welcomes the opportunity to clarify any issues or questions from 
potential applicants who have obtained and read the RFA.  Written and 
telephone inquiries concerning this RFA are encouraged.  Direct inquiries 
regarding programmatic issues should be addressed to:

David Lanier, M.D.
Center for Primary Care Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Suite 201
Rockville, MD 20852-4908
Telephone (301) 594-1489
FAX (301) 594-3721
E-mail address: [email protected]

Direct inquiries regarding fiscal and eligibility matters to:

George  Skip  Moyer
Grants Management Specialist
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Suite 601
Rockville, MD 20852
Telephone: (301) 594-1842
FAX: (301) 594-3210
E-mail address: [email protected]

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 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.  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

Starfield B.  Primary Care: Concept, Evaluation, and Policy.  New York:  
Oxford University Press, 1992.

AHCPR Task Force.  Putting Research into Practice.  Report of the Task Force 
on Building Capacity for Research in Primary Care.  AHCPR Publication No. 94-
0062.  August, 1993.

Nutting PA.   Practice-Based Research Networks: Building the Infrastructure of 
Primary Care Research.  Journal of Family Practice 42:199-203, 1996.

Nutting PA, Beasley JW, Werner JJ.  Practice-Based Research Networks Answer 
Primary Care Questions.  Journal of the American Medical Association 281:686-
8, 1999.

Wasson JH, Jette AM, Johnson DJ, et al.  A Replicable and Customizable 
Approach to Improve Ambulatory Care and Research.  Journal of Ambulatory Care 
Management 20(1):17-27, 1997.

Green LA, Lutz LJ.  Notions about Networks: Primary Care Practices in Pursuit 
of Improved Primary Care.  Conference on Primary Care Research: An Agenda for 
the 1990s.  J Mayfield and M Grady (eds), U.S. Department of Health & Human 
Services, September 1990.

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