Existing Infrastructures Supported by NIH Partner Agencies

This information is provided for academic health centers considering applying for RFA-OD-09-010, Building Sustainable Community-Linked Infrastructure to Enable Health Science Research (RC4). To ensure efficient use of Recovery Act funds as well as maximize the likelihood of sustainability beyond the funding period, projects should build upon existing infrastructure and resources wherever feasible. Of particular interest are collaborative projects that build on activities currently supported by NIH or other Health and Human Services resources and networks. Examples of these existing resources are provided below.

Agency for Healthcare Research and Quality (AHRQ)

ACTION (PDF - 495 KB): Accelerating Change and Transformation in Organizations and Networks (ACTION) includes 15 large, diverse partnerships nationwide that represent over 160 collaborating organizations that study, regulate and/or deliver health care that form networks focused on rapid-cycle, field-based implementation research. Organizations within ACTION provide care to a total of over 100 million persons and represent a wide array of care settings, providers, health conditions, care recipients and other stakeholders. ACTION networks include large integrated delivery systems, health plans, hospitals, physician practices (including very large as well as smaller practices), nursing homes, home health agencies, other care providers, as well as nationally-recognized researchers and implementation experts. ACTION supports research that provides evidence of positive change in the way all people receive and benefit from care in hospitals, physicians' offices, long term care facilities, pharmacies, safety nets and other health care settings and health plans nationwide.

Primary Care Practice-based Research Networks: PBRNs are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice (http://www.ahrq.gov/research/pbrn/pbrninit.htm). PBRNs engage primary care clinicians and the communities they serve in both research and quality improvement activities and strive to build an evidence-based culture in primary care practice to improve the health of all Americans. Many PBRNs involve active participation and leadership from Academic Health Centers. Over 100 PBRN networks participate in the AHRQ PBRN Initiative and are registered with the Agency.

Community Quality Collaboratives: The Agency for Healthcare Research and Quality has selected 24 local, multi-stakeholder regional quality improvement collaboratives to participate in an Agency-sponsored, evidence-based learning network. A fundamental requirement of the selected collaboratives is active participation by representatives from four key stakeholder groups: providers, private and public purchasers, health plans and consumer organizations committed to pursing a community-wide system of quality improvement. A corollary to this fundamental requirement is that any significant impact, including those in the CE domain, can best be accomplished and sustained by the active engagement of at least these 4 stakeholders, and particularly perhaps by consumer organizations. In aggregate, the 24 communities involve over 500 health care leaders and represent over 124 million lives, more that one-third of the US population.

Centers for Education and Research on Therapeutics: The CERTs program is a national initiative to increase awareness of the benefits and risks of new, existing, or combined uses of therapeutics (drugs, biologics and medical devices) through education and research. The program currently consists of 14 Research Centers, a Coordinating Center (CC) and a Steering Committee that includes members from the RCs, the private sector, and government. The CERTs Program is merit-based and peer-reviewed; it began in 1999 in response to a broad legislative mandate that includes a specific directive “to provide objective clinical information to: (1) health care practitioners and other providers of health care goods or services; (2) pharmacists, pharmacy benefit managers and purchasers; (3) health maintenance organizations and other managed health care organizations; (4) health care insurers and governmental agencies; and (5) patients and consumers.” As a consequence, the CERTs partner extensively with multiple organizations and groups, including community-based settings such as pharmacies, warfarin clinics, home health providers, and community health centers serving underserved and minority populations.

DEcIDE: The Developing Evidence to Inform Decisions about Effectiveness research network is a component of AHRQ’s Effective Health Care program that focuses on generating new scientific evidence and analytic tools to assist stakeholders with making health care decisions. The DEcIDE network is comprised of 13 academic research centers that conduct accelerated practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of health care interventions. Activities performed by the DEcIDE network reflect the general principle that providers, policy makers, and patients should have the best available evidence upon which to make choices about health care items and services. The program began in 2005 and represents the nation’s largest network devoted to clinical effectiveness research. DEcIDE centers form partnerships with multiple stakeholder groups to plan, develop, implement, and disseminate research that will provide actionable information for patients, communities, and health care providers, especially those affiliated with the Medicare, Medicaid, and the State Children's Health Insurance programs. Stakeholder groups include patients, providers, community health programs, pharmacies, practice-based research networks, state Medicaid Medical Directors, consumer organizations, professional societies, and others working in primary care settings.


Health Centers Program
For more than 40 years, HRSA-supported Health Centers have provided comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations. Health centers are community-based and patient-directed organizations that serve populations with limited access to health care. These include low income populations, the uninsured, those with limited English proficiency, migrant and seasonal farmworkers, individuals and families experiencing homelessness, and those living in public housing.

In 2007, funding to health center grantees was $1.7 billion. Health centers served over 16 million patients at an average cost per patient of about $562, and provided over 63 million patient visits. The Federal grant is about 20 percent of average Health Center revenues which total approximately $9 billion. Currently, nearly 1,100 health center grantees operate more than 7,000 service delivery sites in every State, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. More than half (53 percent) of all health centers serve rural populations.

Maternal and Child Health Services Block Grant Program
The Maternal and Child Health Services Block Program provides grants to States to reduce infant mortality, provide access to comprehensive prenatal and postnatal care for women, increase the number of children receiving health assessments and follow-up diagnosis and treatment, and provide access to preventive (including efforts to increase immunization rates) as well as rehabilitative services for children, including children with special health care needs (CSHCN). States are required to spend at least 30 percent of block grant funds for preventive and primary care services for children, and at least 30 percent for services for CSHCN. In FY 2008, $557 million was appropriated for the Block Grant Program.

More than 34 million individuals were served by Title V in 2007 including over 31 million infants and children. To assess the impact of its investment, the program tracks 18 national performance measures such as newborn metabolic and hearing screening rates, rates of low birth weight, rates of immunization, rates of children with special health care needs receiving coordinated care services, rates pf childhood overweight/obesity, and rates of prenatal care. In addition, State partners are required to identify their own State-specific priority performance measures.

National outcomes that reflect the impact of the MCH Block Grant funds on maternal and child health include the following: (1) the national rate of infant deaths per 1,000 live births, which has decreased steadily from 9.2 in 1990 to 6.9 in 2005; (2) the national rate of neonatal deaths per 1,000 live births, which has decreased from 6.5 in 1990 to 4.6 in 2005; (3) the number of uninsured children, which has decreased from 10.0 million in 1994 to 8.7 million in 2006; (4) the percent of pregnant women who receive prenatal care in the first trimester, which increased from 75.8 percent in 1990 to 83.9 percent in 2005; (5) the percent of very low-birth weight babies who are delivered at facilities for high-risk deliveries and neonates, which increased from 70.6 percent in 1998 to 73.4 percent in 2005; (6) the number of children receiving Title V services who are enrolled in and have Medicaid and SCHIP coverage, which increased from 4.0 million in 1998 to 11.0 million in 2006; and (7) the number of children served by the MCH Block Grant per $1 million in funding, which increased from 30,906 in 2002 to 41,868 in 2006.

Healthy Start Program
The Healthy Start program provides intensive services tailored to the needs of high risk pregnant women, infants and mothers in communities with exceptionally high rates of infant mortality. In FY 2008, 99 communities in 38 States, the District of Columbia, and Puerto Rico were served by Healthy Start grantees. Healthy Start supports community driven programs in these communities to reduce the incidence of risk factors that contribute to infant mortality.

Since its inception in 1991, Healthy Start has served hundreds of thousands of families. In Healthy Start projects in 1998, first trimester entry into prenatal care by project participants was only 41.8 percent; by 2006 it had increased to 68 percent, a 63 percent increase. From 2006-2007, 22 Healthy Start communities reported no infant deaths among program participants.

Ryan White HIV/AIDS Program (RWHAP)
The Ryan White HIV/AIDS Program addresses the disproportionate impact of HIV/AIDS on the poorest and most disenfranchised Americans, and the program helps to remedy the overwhelming strain on local health and social service resources by promoting the creation of more affordable and responsive HIV/AIDS care options. The Program funds care for individuals living with HIV disease; care for HIV-positive mothers, children, and their families; training for clinicians who treat HIV-positive individuals; the development of innovative programs that improve treatment outcomes; and technical assistance for organizations providing HIV/AIDS care and treatment services across the country.

RWHAP is able to reach people where many providers in America's healthcare system do not serve. In 2006, almost 60 percent of Ryan White HIV/AIDS Program clients lived below the Federal Poverty Level, and 32 percent had no insurance.

The RWHAP is comprised of five parts, including funding for Metropolitan Areas; States; Communities; Children and Families; and support for excellence in HIV/AIDS care, which includes a community-based dental partnership program, as well as AIDS education and training centers. Any of these components may be appropriate for building or expanding community infrastructures to enable health science research.

Rural Health Care Services Outreach Grant Program
Through the Rural Health Care Services Outreach grant program, HRSA aided more than 627,120 people in 2007. An evaluation study found that 80 percent of these demonstration projects continue after Federal funding stops. These projects help improve the local health care delivery system by providing new sources of clinical care of enhanced access to, and utilization of, existing services. In FY 2008 HRSA awarded 92 grants for a total of $9.6 million.

Rural Hospital Flexibility Grant Program
The Rural Hospital Flexibility Grant program has helped rural communities stabilize access to hospital services in close to 1,300 rural communities. The grant program provides support to Critical Access Hospitals (CAHs) in 46 States totaling $21.6 million for a variety of activities focusing on quality and performance improvement and the integration of emergency medical services into the hospital setting. CAHs are hospitals with fewer than 25 beds who serve the most remote rural communities. Through this investment, CAHs have been steadily improving financial and clinical performance.


Native American Research Centers for Health (NARCH Grants)
The Indian Health Service (IHS) and the National Institute of General Medical Sciences (NIGMS) of the National Institutes of Health have a joint partnership supporting the Native American Research Centers for Health (NARCH). The NARCH initiative supports partnerships between American Indian/Alaska Native (AI/AN) Tribes or Tribally-based organizations and institutions that conduct intensive academic-level biomedical, behavioral and health services research. This funding mechanism develops opportunities for conducting research, research training and faculty development to meet the needs of AI/AN communities. As a developmental process, Tribes and Tribal Organizations are able to build a research infrastructure, including a core component for capacity building and the possibility of reducing the many health disparities so prevalent in AI/AN communities.


Clinical and Translational Science Awards (CTSAs) Link to Non-U.S. Government Site - Click for Disclaimer
A national consortium of medical research institutions, funded through Clinical and Translational Science Awards (CTSA), is working together to improve the way biomedical research is conducted nationwide. Consortium members share a common vision to reduce the time it takes for laboratory discoveries to become treatments for patients, to engage communities in clinical research efforts and to train clinical and translational researchers. This consortium includes 46 medical research institutions located throughout the nation. When fully implemented by 2012, about 60 institutions will be linked together to energize the discipline of clinical and translational science. The CTSA consortium is funded by the National Center for Research Resources (NCRR), a part of the National Institutes of Health (NIH).


Addiction Technology Transfer Centers (ATTCs) Link to Non-U.S. Government Site - Click for Disclaimer
The ATTCs are a nationwide, multidisciplinary resource for professionals in the addictions treatment and recovery services field. Building on a rich history, the ATTC Network continuously strives to improve the quality of addictions treatment and recovery services by facilitating alliances among front line counselors, treatment and recovery services agency administrators, faith-based organizations, policy makers, the health and mental health communities, consumers and other stakeholders. By connecting them to the latest research and information through activities such as skills training, academic education, online and distance education, conferences, workshops, and publications, the ATTC Network responds to the emerging needs of the field. The network consists of a national headquarter site and 14 regional centers which together serve the 50 States, the District of Columbia, and the US territories.

Access to Recovery (ATR)

Screening, Briefing Intervention, and Referral to Treatment (SBIRT)
CSAT’s ATR and SBIRT are high priority SAMHSA programs, have strong community-based roots, and would greatly benefit from linkages to academic research centers. ATR involves the establishment of a voucher-based approach to enhance the delivery of treatment and recovery support services. The SBIRT initiative involves grants to States and Tribal Organizations to embed screening and brief intervention into various health care settings including primary care, emergency departments, and trauma centers in an effort to reduce the gap between those in need of substance abuse treatment and those receiving it. By forging closer linkages to research centers, many practice-based research issues could be addressed that continually emerge from both of these programs.

Primary and Behavioral Health Care Integration (PBHCI)
The purpose of CMHS’s PBHCI is to improve the physical health status of people with serious mental illnesses (SMI) by supporting communities to coordinate and integrate primary care services into publicly funded community mental health and other community-based behavioral health settings. By building the necessary partnerships and infrastructure to support this goal, the expected outcome is for grantees to enter into partnerships to develop or expand their offering of primary healthcare services for people with SMI, resulting in improved health status. These four-year grants were awarded to 13 community recipients in October 2009.

SAMHSA recently issued a press release including the list of awardees. More information is available by contacting SAMHSA’s Center for Mental Health Services.

Children’s Mental Health Initiative (CMHI)
CMHS’s CMHI supports States, political subdivisions within States, Territories, and tribal organizations in developing integrated home and community-based services and supports for children and youth with serious emotional disturbances and their families by encouraging the development and expansion of effective and enduring systems of care, in which a broad array of effective services, treatments and supports are provided; care is coordinated across child-serving systems, and a case management/wraparound team with an individualized service plan for each child is created. The CMHI represents the largest federal investment in children's mental health services, and researchers and evaluators have collaborated through various means to pursue research and evaluation studies of the CMHI program.

The Minority Educational Initiative (MEI)
MEI supports substance abuse prevention, HIV and Hepatitis prevention services on 16 campuses of minority-serving institutions, including Historically Black Colleges and Universities (HBCUs), Hispanic Serving Institutions (HSIs), and Tribal Colleges and Universities (TCUs). The prevention strategy is to build new and existing capacity on campus student health centers using Student Peer Educators to provide awareness and education to minority college students to prevent the onset of substance use/reduce substance abuse and reduce risks for transmission of HIV and Hepatitis.

The Sober Truth on Preventing Underage Drinking Act (STOP Act) Grant program
STOP Act aims to prevent and reduce alcohol use among youth in communities throughout the United States. It was created to strengthen collaboration among communities, the Federal Government, and State, local and tribal governments; to enhance intergovernmental cooperation and coordination on the issue of alcohol use among youth; to serve as a catalyst for increased citizen participation and greater collaboration among all sectors and organizations of a community that first demonstrates a long-term commitment to reducing alcohol use among youth; and to disseminate to communities timely information regarding state-of-the-art practices and initiatives that have proven to be effective in preventing and reducing alcohol use among youth.

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