July 28, 2021
PA-20-272 - Administrative Supplements to Existing NIH Grants and Cooperative Agreements (Parent Admin Supp Clinical Trial Optional)
National Institute on Minority Health and Health Disparities (NIMHD)
This Notice of Special Interest (NOSI) invites applications for administrative supplements to eligible NIMHD-funded Research Centers in Minority Institutions (RCMI) U54 awards to build research capacity to support a practice-based clinical research network addressing health care for populations that experience health disparities.
A practice-based clinical research network (PBRN) is a group of ambulatory care clinical practices devoted principally to the care of patients that investigates empirical research questions related to improving the quality of primary care, addressing questions on implementation of best practices, and addressing problems that often require multi-level approaches. PBRNs are uniquely positioned for dissemination and implementation research and comparative effectiveness research. The RCMI-supported PBRN is intended to provide research infrastructure that allows for systematic inquiry to improve the health care and health care systems that provide care for NIH-designated United States health disparity populations [e.g. racial and ethnic minority populations, sexual and gender minority groups, underserved rural populations, and socioeconomically disadvantaged populations (https://www.nimhd.nih.gov/about/overview/)], and support a network of clinicians with representation from backgrounds that are underrepresented in health-related sciences on a national basis (http://www.nsf.gov/statistics/wmpd/). PBRNs are ideal for conducting a wide variety of physician and patient studies and are a rich source of medical data. For the purposes of this FOA, the RCMI-supported PBRN will involve multiple RCMIs providing infrastructure to establish local or regional consortia of ambulatory primary care settings that serve patients from populations that experience health disparities to participate within the network. Of priority are primary care settings linked to the RCMI academic health centers and Federally Qualified Health Centers (FQHCs) that serve a high proportion of patients with public insurance (Medicare, Medicaid, CHIP) or no insurance.
PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions that can improve the practice of care. By linking these questions to rigorous research methods, PBRNs produce research findings that are immediately relevant to the primary care clinician and more easily translated into everyday practice and integrated into health care systems. To date, many of these PBRNs consist of practices within high resource health care settings. This initiative proposes to expand this capacity by enabling practices such as FQHCs and other practices that serve populations that experience health disparities to form a PBRN. The goal of forming the RCMI-supported PBRN is to frame research questions based on health equity and improve the practice of care to reduce and eliminate health disparities.
The health care systems and clinicians that provide care for patients from populations that experience health disparities should help drive the research questions based on urgent practice priorities, including addressing disparities in access, quality, and outcomes of treatment and services. Further, the RCMI-supported PBRN will support a network comprised of clinicians with representation from groups underrepresented in health-related sciences to examine important research questions about the patient-clinician communication and relationship as well as key constructs such as conscious and unconscious bias, trust, cultural competency, shared decision-making, the effects of interpreter-mediated visits compared to language concordant visits, the role of race or ethnic concordance in affecting interpersonal processes of care, and other aspects of the role of the clinician on health outcomes for populations affected by health disparities. Studies conducted through the RCMI-supported PBRN will be pragmatic and deployment-focused, incorporating stakeholder perspectives and criteria used for decision making. The goal of the studies conducted by the network is to inform, develop, and test interventions and service delivery strategies that are feasible, scalable, and sustainable, and will ultimately improve routine health care services for populations that experience health disparities.
Supplements awarded through this NOSI are intended to provide support to build capacity at RCMIs to provide scientific, administrative, infrastructure, and logistical support to enable regional and local consortia of health care practices and health care systems to participate in the RCMI-supported PBRN. The application should provide an overview of the target patient populations, clinician characteristics, and practice types and settings for which the RCMI will increase PBRN consortium capacity. The application should also identify potential health conditions intended to be the focus of the research questions their consortium will have the capacity to address.
The application should describe the approach to build the scientific and logistical capacity, as well as the needed resources necessary to establish an RCMI-supported PBRN consortium of primary care clinicians and health systems. A detailed description of the approach to develop collaborative agreements or memoranda of understanding, identifying capacity needs within each participating practice and health care system to enable research capacity and collaboration across systems, and strategies to inform research questions, recruit practices, execute studies, and disseminate successful practices and products developed through network studies should be included.
For each practice and health care system identified as potential member of the consortium, the application should provide data about patients cared for including the geographic service areas, key demographic characteristics including race/ethnicity and insurance status of patients, practice settings, and the demographic characteristics including race/ethnicity of the clinicians providing care (MDs/DOs, PAs, or NPs). Letters of support are required from these practices for their participation in this proposal.
Applicable PBRN sites are those that provide ambulatory primary care, including family medicine, general internal medicine, and general pediatrics, as well as cognitive subspecialties with a component of chronic disease such as rheumatology, endocrinology (especially diabetes), general cardiology, asthma/chronic lung disease, geriatrics, and general gynecology. Of particular interest are practices and health care systems that serve populations that experience health disparities, for example, FQHCs and the ambulatory care settings of academic institutions.
The RCMI-supported PBRN, eventually composed of multiple local and/or regional consortia of practice and health care systems, is expected to function as a resource to be able to support the conduct of research through robust infrastructures that can be leveraged to (1) efficiently and rapidly identify, recruit and enroll clinicians that serve diverse patient populations into health services and clinical research; (2) harmonize electronic health record (EHR) data across multiple integrated systems for common analyses, using common data elements and adhering to principles of data storage; (3) develop, test, and deploy interventions, workflows, and decision support systems; (4) develop and test strategies to address health care disparities within ambulatory primary care settings, including strategies for improving patient-clinician communication; and (5) facilitate research that addresses emergent health conditions in health disparity populations such as long term sequelae of COVID-19 as well as chronic diseases such as diabetes, asthma, osteoarthritis, and depression. At a future time, the RCMI-supported PBRN will increase capacity for the collection, storage, and analysis of biologic and/or genetic material.
Applications will propose a needs assessment and feasibility study necessary to design the capacity and infrastructure requirements to enable local or regional primary care providers and health systems to participate within the PBRN. For the purposes of this NOSI, the needs assessment and feasibility study can focus on one academic health center or one system plus some of the FQHCs in the area. These requirements include capacity and infrastructure to:
Projects must examine NIH-designated United States health disparity populations, e.g. racial and ethnic minority populations, sexual and gender minority groups, underserved rural populations, and socioeconomically disadvantaged populations (https://www.nimhd.nih.gov/about/overview/).
Applications not responsive to this NOSI:
Applications nonresponsive to these terms will be withdrawn for this NOSI initiative.
Description of circumstances for which administrative supplements are available.
Application and Submission Information
Applications for this initiative must be submitted using the following opportunity or its subsequent reissued equivalent.
Financial/Grants Management Contact(s)
National Institute on Minority Health and Health Disparities (NIMHD)