and Human Services (HHS)
EXPIRED
This Program Announcement expires on:
Expiration Date for R01 Non-AIDS Applications: November 2, 2006
Expiration Date for R01 AIDS and AIDS-Related Applications: January 3, 2007
AHRQ HEALTH SERVICES RESEARCH
Release Date: June 22, 2000
PA NUMBER: PA-00-111
(March 9, 2007 - The R18 portion of this FOA has been reissued as PA-07-247.
(January 11, 2007 - The R01 portion of this funding
opportunity has been replaced by PA-07-296, which now uses the electronic SF424 (R&R)
application for February 5, 2007 submission dates and beyond.)
Agency for Healthcare Research and Quality
PURPOSE
The mission of the Agency for Healthcare Research and Quality (AHRQ),
formerly known as the Agency for Health Care Policy and Research
(AHCPR), is to enhance the quality, appropriateness, and effectiveness
of health services, and access to such services, through the
establishment of a broad base of scientific research and through the
promotion of improvements in clinical and health systems practices,
including the prevention of diseases and other health conditions. AHRQ
achieves this mission through health services research designed to (1)
improve clinical practice, (2) improve the health care system’s ability
to provide access to and deliver high quality, high-value health care,
and (3) provide policymakers with the ability to assess the impact of
system changes on outcomes, quality, access to, cost, and use of health
care services. Consistent with a broad view of health, healthcare
practices, and systems, ARHQ considers oral health to fit within the
framework of this Program Announcement (PA).
AHRQ’s research agenda is designed to be responsive to the needs of
consumers, patients, clinicians and other providers, institutions,
plans, purchasers, and public policymakers for the evidence-based
information they need to improve quality and outcomes, control costs,
and assure access to needed services.
This PA expresses AHRQ priority interests for ongoing extramural grants
for research, demonstration, dissemination, and evaluation projects to:
o Support improvements in health outcomes. Drawing from literature on
variations in clinical practice and associated outcomes, the documented
increase in the prevalence of chronic disease, and growing interest in
the impact of different delivery modalities and financing arrangements
on the outcomes of care, AHRQ seeks to support research to understand
and improve decision-making at all levels of the health care system,
the outcomes of health care, and, in particular, what works, for whom,
when, and at what cost.
o Strengthen quality measurement and improvement. AHRQ is interested
in a broad array of research topics, including studies to develop valid
and reliable measures of the process and outcomes of care, causation
and prevention of errors in health care, strategies for incorporating
quality measures into programs of quality improvement, and
dissemination and implementation of validated quality improvement
mechanisms.
o Identify strategies to improve access, foster appropriate use, and
reduce unnecessary expenditures. This area focuses on issues
pertaining to the types of health care services Americans use, the cost
of these services and sources of payment, determinants of access to
care, and whether particular approaches to health care delivery and
financing, or characteristics of the health care market, alter
behaviors in ways that improve access and promote cost-effective use of
health care resources.
AHRQ recognizes that a number of populations experience persistent
disparities in health status, access to care, quality of care, and poor
health care outcomes. The AHRQ research agenda includes a special
focus for health services research on these populations, which include
low-income groups, racial and ethnic minority groups, women, children,
the elderly, individuals with special health care needs, including
individuals with disabilities and those who need chronic care and end-
of-life health care, and individuals living in inner-city, rural, and
frontier areas. AHRQ encourages research, demonstration,
dissemination, and evaluation projects for these priority populations
to address outcomes, quality, access to, cost, and use of services.
AHRQ encourages research using data from the Medical Expenditure Panel
Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and
other AHRQ data. Information on MEPS and HCUP is available from the
Data section of the AHRQ website and from AHRQ staff (see Inquiries ).
AHRQ also encourages partnerships with private and public organizations
to facilitate development and sharing of scientific knowledge and
resources, including cost-sharing mechanisms, projects that will
produce results within 2-3 years, and results that can be integrated
rapidly in practice and policy.
The program areas outlined in this PA are also applicable to AHRQ
grants for small projects, dissertation support, health services
research training and career development, and large and small
conferences (see Mechanism of Support ).
AHRQ’s new legislative reauthorization Healthcare Research and Quality
Act of 1999," which provides more information on the Agency’s mission
is available at http://www.ahrq.gov.
This PA updates and supersedes AHCPR Health Services Research, PA-98-
049, published in the NIH Guide for Grants and Contracts (NIH Guide) on
March 26, 1998.
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://www.health.gov/healthypeople.
ELIGIBILITY REQUIREMENTS
Applications may be submitted by domestic and foreign, public and
private nonprofit organizations including universities, clinics, units
of State and local governments, firms, and foundations. For the
purpose of this PA, AHRQ will make grants only to nonprofit
organizations, however, for-profit organizations may participate in
grant projects through consortium arrangements or as subcontractors.
Organizations described in section 501(c)4 of the Internal Revenue Code
that engage in lobbying are not eligible.
AHRQ encourages women, members of racial and ethnic minority groups,
and persons with disabilities to apply as Principal Investigators.
MECHANISM OF SUPPORT
The mechanism of support for this PA will generally be the research
project grant (R01), although research demonstration, evaluation, and
dissemination projects (R18), as well as other mechanisms, may also be
supported. Responsibility for the planning, direction, and execution
of the proposed project will be solely that of the applicant.
Research applications requesting total costs of $100,000 or less
("small project grants" or R03s) should follow the application
procedures in the "AHRQ Small Project Grant Program" PA, published in
the NIH Guide for Grants and Contracts (NIH Guide), February 23, 1996
and AHRQ Small Project Grant Program - Addendum, published in the NIH
Guide, January 29, 1999. AHRQ also supports conference and
dissertation grants (NIH Guide: small conference grants, January 26,
1996, large conference grants, May 31, 1991, dissertation research
grants, March 13, 2000), and training and career development through
National Research Service Award grants and fellowships and the
Independent Scientist Award grants (K02) and Mentored Clinical
Scientist Development Award grants (K08).
Program Announcements and grants policy statements listed above are
available through the AHRQ Web site http://www.AHRQ.gov (Funding
Opportunities) and from the AHRQ Publications Clearinghouse (see
Inquiries).
For research applications requesting $500,000 or more in direct costs
for any year, investigators must receive written agreement from AHRQ
prior to submission that it will accept the applications (NIH Guide,
August 22, 1997).
RESEARCH OBJECTIVES
AHRQ seeks research on a wide range of topics under the Priority
Program Areas:
1) Supporting Improvements in Health Outcomes, 2) Improving Quality and
Patient Safety, and 3) Identifying Strategies To Improve Access and
Foster Appropriate Use and Reduce Unnecessary Expenditures.
A continuing challenge to health services research is to improve the
translation, dissemination, and use of research findings for
clinicians, other providers, patients, consumers, policy makers, and
other decisionmakers to effect needed health care changes, and to
measure the impact of changes at all levels of health care delivery.
AHRQ is especially interested in projects across its program areas that
demonstrate innovative strategies for effecting systemic and sustained
behavior changes to improve outcomes, quality, access, cost, and use,
and document the impact of changes at systems, state, and community
levels.
PRIORITY PROGRAM AREAS
o Supporting Improvements in Health Outcomes
Research on clinical outcomes examines the effectiveness of different
strategies for preventing, diagnosing, treating, or managing conditions
that are common, expensive, and for which significant variations in
practice or outcomes exist, or opportunities for improvement have been
demonstrated. Research in this area also includes improving our
understanding of how outcomes data can be incorporated into informed
decision-making at the patient, provider, and organizational levels of
the health care system. Outcomes of clinical interventions include
functional status, quality of life, patient satisfaction, and costs, in
addition to morbidity and mortality. A particular emphasis is on the
outcomes of care provided to the elderly and those with chronic
illnesses, including studies that assess when in the course of illness
intervention is most effective. Research may focus on the type of
delivery system or financial arrangements by which care is provided and
the effects of these on clinical outcomes. Interests include:
1. Effectiveness and cost effectiveness of clinical and organizational
interventions, including trials of interventions across the spectrum of
health care settings (including sources of alternative and
complementary medicine) and those used for multiple conditions, or
innovative approaches to health care delivery to improve outcomes.
2. Assessment of the impact of diagnostic and other health care
technologies on cost and patient outcomes, and how to prioritize such
assessments.
3. Development and testing of practical, ready-to-use outcomes
measures addressing functional status, quality of life, and severity
and risk adjustment, as well as general measurement issues, and
strategies for improving outcome measures for patients with multiple
comorbid conditions, including incorporation of an individual patient"s
values and preferences. In particular, increased use of patient-
reported outcome measures as dependent variables in clinical trials
offers new opportunities for ancillary studies that can enhance our
understanding of the characteristics and use of these measures.
4. Development and evaluation of strategies for informed decision-
making, including evaluation of alternative strategies for implementing
an infrastructure for collection, analysis and presentation of data,
and real-time incorporation of outcomes and evidence into decision-
making for patients, providers, and policy-makers.
5. Development and evaluation of strategies for the use of outcome
measures including patient-oriented measures in practice (e.g., shared
decisionmaking), or development, validation and use of measures that
incorporate patient values and preferences.
6. The relationship between processes and outcomes of care, including
timing of services.
7. Evaluation of, and development of measures for outcomes,
effectiveness, and cost effectiveness of clinical preventive services
for all ages.
8. Analysis of the causes of variations in clinical practice and the
use of health care technologies, including the clinical behaviors of
primary care and specialty providers, provider training, patient
characteristics and preferences, or other factors.
9. Observational studies using Medicare, Medicaid, or managed care
data to answer discrete questions related to the outcomes,
effectiveness, cost, cost-effectiveness or quality of medical care.
10. The impact of models of undergraduate, graduate, and continuing
education on the knowledge, skills, and attitudes of providers and
associated patient outcomes.
11. Therapeutic outcomes, including:
a. Relative safety, effectiveness, and cost effectiveness of available
pharmaceuticals or combinations of therapies, as well as comparison to
other treatment options.
b. Relationships among prescribing decisions, pharmaceutical services,
use of prescription drugs, and patient outcomes.
Methodological approaches may include quasi-experimental studies using
existing data or experimental studies.
o Improving Quality and Patient Safety
The Agency encourages research to improve the capacity of the health
care system to deliver quality care and protect patients from medical
errors. There is increasing emphasis on understanding how to measure
quality and prevent errors across the full spectrum of care, in various
settings and in transition across settings, and for different
population groups. Key to this understanding is the ability to
describe the influence of organizational as well as clinical factors on
levels of quality and occurrence of errors. Of special interest are
efforts to develop and test interventions to improve quality and
patient safety in these varying contexts, especially where evidence can
be presented that the interventions have widespread applicability.
A. Quality Measurement and Improvement. Interests include:
1. Innovative approaches to measuring quality, including the
perspectives of providers, patients, and consumers.
2. Methods to identify, understand the causes of, and prevent medical
errors and improve patient safety.
3. Adaptation of existing measures as well as development and
validation of new measures for use with diseases, conditions, and
procedures and in settings where gaps in knowledge exist, including the
impact of comorbidities on measurement of quality of end-
of-life care.
4. General quality measurement methods, including risk and severity
adjustment, and methods for measuring functional status and quality of
life.
5. Evaluation of the kinds of quality improvement systems that promote
systemic and sustainable changes in clinical practice to improve the
quality of care.
6. Evaluation of the appropriateness of different data sources for
quality measurement, and development and evaluation of methods for
using data to improve quality of care.
7. Description and testing of the effects of (1) computerized
decision-support systems, (2) integrated information systems, (3)
electronic medical records, (4) Internet-based information and
consultation for use by patients, and (5) other information technology
applications on improving quality of care.
8. Development and validation of methods for changing the behavior of
clinicians, provider institutions, employers, plans, and patients to
improve quality of care and patient safety.
9. Evaluation of strategies for integrating quality measurement and
improvement and patient safety into office-based, worksite-based, and
primary care settings, as well as acute and long-term care settings.
10. Formulation of strategies for improving the delivery of clinical
preventive services (CPS), including research on quality measurement
for CPS and on system changes in primary care that enhance the access
to and quality of CPS.
11. Studies of the impact of public policy and other system changes,
and organizational and financial arrangements, on health care quality
at the national, State, and subpopulation levels.
12. Development and evaluation of typologies and measurement
techniques that allow study of the effects of organizational and
communication strategies on quality improvement.
13. Research on patient and consumer issues. AHRQ is particularly
interested in: (1) the perceptions of care of priority populations,
including those cognitively impaired, institutionalized or living with
complex care decisions such as people with chronic illness or
disability, including HIV/AIDS, (2) innovative ways to present
information on quality to patients and consumers that increase
salience, usefulness and use, and (3) strategies to assist patient and
consumer communication with health professionals and participation in
health care decisionmaking.
B. Evidence-based Practice. Integral to improving quality of care is
the development, use, and evaluation of evidence-based tools and
information. Interests include:
1. Methods for optimal systematic reviews of evidence, including
methodologic research on meta-analysis, decision analysis, and
cost-effectiveness analysis.
2. Evaluation and comparison of different methods to implement
evidence-based information and tools in diverse health care settings
and/or among practitioners or various populations, including:
a. Assessment of the role of organizational structure, capacity, and
culture in effective use of the tools.
b. Effectiveness of different types of evidence-based information and
specific tools in changing behavior of practitioners, patients, and
organizations.
3. Evaluation of the effects of specific evidence-based guidelines or
other tools on access, utilization, quality, outcomes, costs, and/or
patient satisfaction.
4. Studies of the cost effectiveness/cost benefit of important new or
existing health care technologies.
5. Assessment of the extent to which evidence-based information is
used in determinations of medical necessity and coverage decisions.
6. The role of informatics in dissemination of evidence-based
information, and its impact on patient and clinician behavior.
7. The role of evidence-based information in the development of
informatics tools and information sources, the impact of evidence-based
decision making and increasing role of just-in-time information
systems, and how evidence is incorporated into these systems.
C. Clinical Preventive Services. Interests include:
1. Interventions to address specific patient barriers to preventive
care, with specific focus on vulnerable populations, including older
women, who may receive fewer or lower quality services.
2. Interventions to improve quality of screening services, including
reducing false-positive and false-negative rates, improving follow-up
procedures, and improving patient satisfaction.
3. Improving cost-effectiveness of preventive care through
interventions to reduce overuse of services, target interventions more
effectively to high-risk groups, or reduce adverse effects and costs of
screening (including costs and consequences of followup in persons with
positive screening results).
4. Identifying elements of preventive counseling interventions that
have greatest impact on behavior change, developing more comprehensive
quality measures for counseling services and other preventive care that
extend beyond utilization rates.
5. Interventions to improve patient involvement in preventive care and
to improve communication between clinicians and patients around
screening results.
o Identifying Strategies to Improve Access, Foster Appropriate Use,
and Reduce Unnecessary Expenditures
Research is needed on the impact of system changes on access to, cost,
and use of health care services. Research is also needed to examine
expenditures, cost and financing, and organizational arrangements, and
to assess the effects of these interrelated factors on the delivery of
health care, including preventive services, that is accessible and
equitable, and that demonstrates high quality.
A. Access, Costs, and Use of Health Services. Interests include:
1. Studies that use MEPS and other AHRQ data sources to assess the
cost and utilization of health resources (See "AHRQ Data").
2. Impact of the trends in health care prices, costs, and sources of
payment for services on access, expenditures, and outcomes.
3. Development of new and more effective ways to measure the range of
health care costs and to organize and analyze data on costs by clinical
condition, sociodemographic factors, site of care, and payment sources.
4. Studies assessing the impact of different outreach and social
marketing strategies to increase enrollment in public insurance (e.g.,
Medicaid, SCHIP) among persons eligible for coverage.
5. Assessment of the determinants of access to care and strategies to
improve access, especially for underserved populations.
6. The development and use of policy-relevant models to simulate and
understand behavior governing the use, cost, financing, and
organization of care.
B. Organization, Financing, and Delivery. Interests include studies
of major changes in health care markets and studies examining how
variations in health care organization, structure, and delivery affect
the outcomes, quality, access to, cost, and use of care, such as:
1. New purchasing activities by employers, coalitions, and
governments, and their impact on managed care organizations, providers,
employees, and communities.
2. The aggregate impact of major changes in public programs and health
care markets on health care costs and quality, including the impact on
providers and beneficiaries.
3. Dynamics and impact of recent major changes in financial and legal
arrangements such as consolidations, conversions to for-profit status,
development of national ownership links among facilities, new
relationships among acute, subacute, and long-term care facilities, and
new methods of sharing financial risk and contracting for services on
quality, cost, access, and use of services.
4. The impact of the movement of care from inpatient to outpatient
settings, and from nursing homes to home care on cost and outcomes.
5. The effects of disease management and "carve-in" and "carve-out"
arrangements on health care costs, accessibility, and quality of care,
particularly for persons with chronic conditions.
6. Conceptual models, measures, and financial and organizational
factors supporting clinical integration of health care services and
studies of the impact of clinical integration on access, quality, and
cost of care.
7. The implementation and use of new staffing and other clinic-level
configurations, and evaluations of the effectiveness of particular
models in improving access, quality, and cost of care.
8. The use of information technology applications in providing and
supporting the delivery of health care and their effects on cost,
quality, and access.
9. The role of nonfinancial incentives and organizational
characteristics, such as organizational structure and culture, in
affecting the behavior of health care organizations and units and
individuals within them.
10. Evolving definitions of medical necessity used by managed care
organizations to determine when and under what circumstances services
will be covered, and the impact of different methods and processes for
medical decisionmaking by health plans.
Methods can include rigorous qualitative studies as well as
quantitative research, and conceptual and methodological as well as
empirical work. Research partnerships using private sector data
sources, such as managed care data, are particularly encouraged.
C. Primary Care Practice. The characteristics of primary care
practice play a crucial role in facilitating access to and use of
services, influencing health costs, and the resulting outcomes and
levels of quality. Interests include:
1. Characteristics of primary care practice that lead to improvements
in outcomes and quality of care.
2. Effective models of organizing, financing, and managing primary
care services.
3. Factors that influence access to primary care services, including
socioeconomic, cultural, and geographic factors.
4. Optimal delivery of health care, including primary care services,
in low-income inner-
city and rural areas.
5. Access to and availability of clinical preventive services.
6. Effects of information technology applications in primary care
practice, such as computerized decision-support systems, remote
monitoring of patient conditions, and electronically secure exchange of
patient health data, on access to care and the costs and quality of
health care.
7. Clinical decision-making in primary care, including an emphasis on
facilitating shared patient-clinician decision-making.
8. Strategies for integrating quality measurement and improvement into
office-based, worksite-based, and primary care settings.
9. Strategies for reducing medical errors and improving patient safety
in office-based, worksite-based, and primary care settings.
10. Strategies for facilitating the integration of research findings
into office-based, worksite-based, and community primary care
practices.
11. Improving the quality, value, and access to health care for
American workers and individuals with disabilities.
12. Effective strategies in primary care settings for eliminating
racial and ethnic disparities in health-related outcomes.
13. Issues related to the outcomes, costs, and delivery of primary
care services to the elderly.
14. Improved care for those at the end of life.
15. Organizational and other factors affecting the cost and quality of
transitions between ambulatory and other settings, including home,
hospital, and long-term care settings.
16. Health care workforce organization, including communication and
coordination of services among primary care clinicians and other
members of the health care team.
17. The readiness of the health care system, in particular its entry
points such as emergency rooms and primary care, to recognize and
respond to the effects of exposure to agents of biological or chemical
terrorism.
To enhance generalizable results, primary care research may involve
large data bases or primary care practice-based research networks.
PRIORITY POPULATIONS
A number of populations are particularly vulnerable to impaired access
to and suboptimal quality of care and experience poor health care
outcomes. These groups, which warrant a special focus for health
services research, include low-income groups, racial and ethnic
minority groups, women, children, the elderly, individuals with special
health care needs, including individuals with disabilities and those
who need chronic care and end-of-life health care, and individuals
living in inner-city, rural, and frontier areas. Persistent
disparities in health status and access to appropriate health care
services continue to be documented for certain groups, particularly
racial and ethnic minority populations. Gender-based differences in
access, quality, and outcomes are also widespread with little
understanding of the reasons for these differences. Health services
research must do a better job of bringing science-based information to
bear on these variations so that effective solutions may be found for
improving health.
AHRQ encourages research to address population-specific health issues
of outcomes, quality, access to, cost, and use of services in each of
the Priority Program Areas. Interests include:
Minority Populations
1. Understanding factors that underlie disparities in utilization and
outcomes for racial and ethnic minorities including epidemiology,
patient preferences and behavior, education, access, health insurance,
environment, interactions with the health care system, provider
expertise, preferences, and bias.
2. Evaluation of effective service delivery methods for eliminating
disparities in treatment between minority and non-minority populations.
3. Effect of cultural competence on improving access to and outcomes
of care for racial and ethnic minority patients.
4. Eliminating differences in outcomes and health status for racial
and ethnic minority populations in six clinical areas: infant
mortality, cancer screening and management, cardiovascular disease,
diabetes mellitus, HIV, and immunizations for both children and adults
(President’s Initiative to Eliminate Racial and Ethnic Disparities in
Health).
5. Enhancing meaningful community participation in health services
research projects.
Women
1. Assessment of the effectiveness of services and treatment
approaches for common, high-cost conditions in women in various age,
racial/ethnic, and income groups. Research to understand and eliminate
inappropriate disparities in health outcomes associated with race or
ethnicity, geography, insurance status, or other non-medical factors is
particularly needed.
2. Analysis of the cost, use of, and access to primary and specialty
health care services among women, including the impact of changes in
health systems on women’s health.
3. Development and assessment of women-specific and culturally-
appropriate measures of quality, outcomes, and patient satisfaction.
4. Study of health issues related to older women, including the impact
of specific clinical and organizational interventions on functional
status and quality of life, with special attention given to mediating
factors such as co-morbidity, fragmentation of care, and caregiver
stress.
5. Research on prevention and health services with relevance to
particular populations of women, including victims of family violence,
lesbian women, and women with HIV/AIDS.
6. Research on women and pharmaceuticals, including gender differences
in therapeutic outcomes, prescribing practices, occurrence of adverse
events, and medical errors.
Children
Dramatic changes are occurring in the organization and financing of
children"s health services, however, the knowledge base for guiding
these changes or assessing their impact is not well developed.
Researchers are strongly encouraged to include children in all
applications and studies, as scientifically and ethically appropriate.
Children"s health care research raises some distinct methodological
issues that studies are encouraged to address. These include: the
need for a development perspective that takes into account the
variation and rapid changes in development that are characteristic of
children, especially in the neonatal, infancy, early childhood, and
adolescent periods, the need for considering a range of perspectives
(e.g., child, family, community, society at large), the fact that
children generally are much more resilient physically than are older
individuals, the need to identify large sample sizes for research with
children with specific conditions and/or specific developmental stages,
the need to consider the child-relevant range of health care topics
(e.g., preventive services through end of life care) and health care
settings (including community health clinics, school and other
community-based health care delivery sites, ancillary services, as well
as health care settings such as community-based offices and hospital
inpatient and emergency departments), the fact that many children live
in poverty, the need to consider in more detail long-term outcomes and
the need for longitudinal research, and ethical issues surrounding the
delivery of health care to children (e.g., to adolescents).
Applications with innovative and efficient research designs that can
address these child-relevant issues are encouraged. Specific research
interests include:
1. The urgent need for outcomes and effectiveness research in many
areas of children’s health care is well documented. Specific areas of
interest in outcomes and effectiveness research include: 1) developing
valid and useful measures of health, functional status, quality of
life, satisfaction with care, processes of care, and costs and cost-
effectiveness of care applicable to children of different ages and with
different health conditions, 2) assessing interventions that are unique
to children, and that may involve the children’s caregivers (e.g.,
health promotion and disease and disability prevention services such as
anticipatory guidance and counseling), 3) assessing treatments that are
commonly administered to children but that may have been evaluated for
safety and effectiveness only in adult populations, 4) documenting
long-term effects (or lack thereof) associated with health
interventions in populations of mothers, infants, and children, and 5)
evaluating costs, benefits, and cost-effectiveness of care to children.
2. The development of quality measures for children that can be used
to enhance accountability, support consumer choice, and develop, test,
and implement quality improvement strategies in children"s health care.
3. Evidence-based research translation and quality improvement
strategies are needed to form the basis of efforts to improve practice
at the policy, health systems, and clinical practice levels.
4. The U.S. health care system provides the occasion for many "natural
experiments" in organizational and financial arrangements for care.
In addition to examining the effects of these variations and changes on
children"s health outcomes (see above), there is a need to continue to
carefully examine their impact on quality, cost, use, and access.
5. Local, federal, and private efforts to increase children"s
enrollment in Medicaid and the State Child Health Insurance Program
(Titles XIX and XXI of the Social Security Act, respectively) can be
enhanced by providing an evidence base for effective strategies. There
is a critical need for rigorous research on what works in outreach and
other strategies.
6. AHRQ encourages researchers to address the needs of children living
in inner-city, rural, and frontier areas, low-income children, minority
children, female children, and children with special health care needs.
7. AHRQ encourages researchers to include adolescents and the health
care settings that are used by adolescents in research about children
and children"s health care.
Additional guidance on AHRQ"s previous activities and current interests
in children as a priority population can be found in AHRQ"s 1999 GPRA
report on children as a priority population
(http://www.ahrq.gov/about/gpra2001/gpra01app6.htm) and in AHRQ"s
strategic plan for children as a priority population
(http://www.ahrq.gov/about/stratpln.htm).
Elderly
Providing health care to the aging U.S. population is one of the most
pressing health care challenges confronting the nation. Although the
scientific knowledge base exists to extend the years of active life and
prevent the onset of disability with age, current clinical practice
falls far short in delivering these interventions to older people. The
underuse of effective interventions, the overuse of interventions shown
to be ineffective, and the misuse of others (especially polypharmacy)
have all been well documented in the elderly. There is a need for
studies that focus on interventions aimed at reducing well-documented
disparities in health status, access, use of services, and health
outcomes by gender, race/ethnicity, and socioeconomic status among the
elderly. Interests include:
1. Developing cost-effective models of acute, preventive, chronic,
rehabilitative, and long-term care delivery (including informal care)
that improve the health and functioning of the elderly.
2. Assessing the outcomes and effectiveness of clinical,
organizational, and social interventions that improve or delay decline
of functional status.
3. Improving our ability to measure change in functioning across the
broad range of functional levels for a diverse aging population and
developing strategies to incorporate these functional status measures
routinely in clinical practice.
4. Understanding the impact of comorbidities (physical and mental) on
disease management, clinical decisionmaking, preventive care, and
health and functional outcomes, and how best to adjust clinical
practice to account for them.
5. Assessing models of collaborative care so that patients and their
families can be active participants in the decision making process and
age bias in clinical decision makings is minimized.
6. Understanding how best to integrate preventive, acute, chronic, and
long-term care (formal and informal care), and to coordinate the
delivery of care across multiple sites and settings of care, including
out-patient, hospital, rehabilitation, subacute care, home care, long-
term care (institutional and community care), and community-based
social services.
7. Understanding the impact of financial incentives ( including
health-based payments) on health care decisions and their subsequent
effect on the health and outcomes of elderly.
End-of-Life Health Care
Further research is needed on how to provide appropriate health
services for patients living with fatal or serious chronic illness
(such as cancer, stroke, dementia, congestive heart failure, lung
failure). While increased life span may be desirable, the goals of
medical interventions for these patients also include a greater focus
on preventing excess disability and assuring symptom reduction (e.g.,
pain and dyspnea control) or palliative care. Specific research
interests include:
1. Optimal processes for advance care planning.
2. Methods of maximizing connectivity and continuity between different
providers and systems of health care (e.g., nursing home, hospice, home
care, acute care, ambulatory care).
3. Evaluation of the comparative costs and quality of care at
different sites of end-of-life care.
4. Methods of using severity data to identify those patients in need
of more extensive services.
5. Studies of ways to expand access to appropriate sites of end-of-
life care (e.g., hospice, home or community-based).
6. Research on the financial and social burden of family caregivers.
7. Development of methods to improve joint patient/family/provider
decision-making at the end of life.
Research priorities are being developed for the additional populations
listed including: individuals living in inner-city, rural, and frontier
areas, individuals with special health care needs, individuals with
disabilities, and low-income groups.
EMERGING RESEARCH INTERESTS
Two additional areas of health services research that have become
increasingly important in today"s rapidly changing market-driven
delivery system are research on methodologic advances, especially
cost-effectiveness analysis (CEA) and research on ethical issues, which
may be related to decisions based on cost effectiveness, but which also
cut across the spectrum of health care delivery. Interests include:
A. Cost-Effectiveness Analysis (CEA) and Other Methodological Advances
that will enhance the capacity of health services research to provide
needed information. Interests include:
1. Production of standardized analytical components (e.g., cost
components, general population health profiling, national health
utility index, and incidence-based illness burdens) to facilitate the
comparability of CEA findings.
2. Exploration of the use of CEA as a framework for guiding decisions,
both clinical and organizational.
3. Systematic reviews, meta-analyses, and other methods that enhance
the generalizability of clinical and other research for application to
practice.
B. Ethical Issues raised by changes in the health care delivery system
that need to be addressed. Interests include:
1. Studies on ethical issues across the spectrum of health care
delivery, including equity in access to all levels of care.
2. Studies on the impact of genomics on the organization and delivery
of health services.
3. Studies on changing values regarding the provision of care, from
the provision of all possible care without cost considerations, to the
provision of less costly care.
4. Studies to emphasize and clarify tradeoffs related to resource
allocation and the tension between individual and population or
societal needs.
SPECIAL REQUIREMENTS
AHRQ Data
To the extent feasible, AHRQ applicants are encouraged to submit
projects that build on available data, will generate early results, and
are modest in time, scale, and cost.
AHRQ encourages research applications that will use data from the
Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and
Utilization Project (HCUP), and other AHRQ data.
The MEPS is a rich data source for health care utilization,
expenditure, and insurance information, directly linking data about
persons and their families with information obtained from their
employers, insurers, and health care providers. It is the third in a
series of nationally representative surveys of medical care use and
expenditures in the U.S. The 1996 MEPS updates previous survey data to
reflect the changes that have occurred over the past decade. MEPS
collects data on the specific health services that Americans use, how
frequently they use them, the cost and source of payment for services,
and information on the types and costs of private health insurance held
by and available to the U.S. population. It provides a foundation for
estimating the impact of changes in sources of payment and insurance
coverage on different economic groups or special populations of
interest, such as the poor, elderly, uninsured, and racial and ethnic
minorities.
Some data from the Household and Nursing Home Components of the 1996
MEPS became available for use by researchers beginning Spring 1997.
The release schedule for other data through calendar year 1998 is
available from the MEPS section under Data of the AHRQ Web site
(http://www.ahrq.gov).
The HCUP includes databases covering 1988-1997, with 1998 and 1999 data
available in 2001. These all-payer databases were created through a
Federal-state-industry partnership to build a multistate health care
data system. The main HCUP databases contain discharge-level
information for inpatient hospital stays in a uniform format with
privacy protections. The Nationwide Inpatient Sample (NIS) is a
nationwide probability sample of about 1000 hospitals. The State
Inpatient Databases (SID) contain inpatient records for all community
hospitals in 22 states. Other HCUP databases contain ambulatory
surgery data from nine states. These databases can be directly linked
to county-level data from the Health Resources and Services
Administration"s Area Resource File and to hospital-level data from the
Annual Survey of the American Hospital Association.
Information on MEPS and HCUP is available from the Data section of the
AHRQ Web site http://www.ahrq.gov and AHRQ staff (See INQUIRIES).
CONDITIONS OF AWARD
Data Privacy
Pursuant to section 924(c) of the Public Health Service Act (42 USC
299c-3(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 possible
uses and purposes of the data collection. In the Human Subjects
section of the application, applicants must describe 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 restricted and 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 confidentiality and security standards to
subcontractors and vendors 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 worldwide
irrevocable Federal government license to use and permit others to use
these products and materials for government purposes. In accordance
with its legislative dissemination mandate, AHRQ purposes may include,
subject to statutory confidentiality protections, making research
materials, data bases, results, 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 research results 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
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.
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 Web site http://grants.nih.gov/grants/guide/index.html.
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).
AHRQ Program staff may also provide additional information concerning
these policies (see INQUIRIES).
APPLICATION PROCEDURES
The research grant application form PHS 398 (rev. 4/98) is to be used
in applying for these grants. Applications will be accepted at the
standard application deadlines as indicated in the form PHS 398. State
and local government applicants may use PHS 5161-1, Application for
Federal Assistance (rev. 5/96), and follow those requirements for copy
submission. Applicants are encourage to read all form PHS 398
instructions prior to preparing an application in response to this PA.
The PHS 398 type size requirements (p.6) will be enforced rigorously
and non-compliant applications will be returned.
AHRQ is not using the Modular Grant Application and Award process.
Applicants for funding from AHRQ should ignore application instructions
concerning the Modular Grant Application and Award process, and prepare
applications according to instructions provided in form PHS 398
(revised 4/98).
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, E-mail: [email protected].
AHRQ applicants are encouraged to obtain application materials from the
AHRQ Publications Clearinghouse (see INQUIRIES).
The PA title and number must be typed on line 2 of the face page of the
application form and the YES box must be marked.
Complete and signed, typewritten original of the application, including
the Checklist and five legible signed photocopies, must be submitted in
one packet 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)
Application Preparation
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 HCFA, AHRQ will use this information to
develop a cost estimate for obtaining the data. This estimate will be
included in the estimated total cost of the grant at the time funding
decisions are made.
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 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.
In carrying out its stewardship of human resource related programs, the
AHRQ, at some point in the future, may begin requesting information
essential to an assessment of the effectiveness of Agency research
programs. Accordingly, grant recipients are hereby notified that they
may be contacted after the completion of awards for periodic updates on
publications resulting from AHRQ grant awards, and other information
helpful in evaluating the impact of sponsored research. AHRQ expects
grant recipients to keep the Agency informed of publications or the
impact from Agency sponsored research.
REVIEW CONSIDERATIONS
Applications that are complete will be evaluated for scientific and
technical merit by an appropriate peer review group convened in
accordance with AHRQ peer review procedures. As part of the initial
merit review, all applications will receive a written critique, and
also may undergo a process in which only those applications deemed to
have high scientific merit will be discussed and assigned a priority
score.
General Review Criteria
Review criteria for grant applications are: consistency with the
Agency’s mission and research priorities, significance and originality
from a scientific or technical viewpoint, adequacy of the method(s),
availability of data or adequacy of the proposed plan to collect data
required for the project, adequacy and appropriateness of the plan for
organizing and carrying out the project, qualifications and experience
of the Principal Investigator and proposed staff, reasonableness of the
proposed budget and the time frame for the project in relation to the
work proposed, adequacy of the facilities and resources available to
the applicant, the extent to which women, minorities, and if applicable
children, are adequately represented in study populations, and as
applicable, the adequacy of the proposed means for protecting human
subjects.
AWARD CRITERIA
Applications will compete for available funds with other
investigator-initiated applications requesting AHRQ support. The
following will be considered in making funding decisions: quality of
the proposed project as determined by peer review, how well it fits
AHRQ priorities, program balance, and availability of funds.
INQUIRIES
Copies of this PA and copies of the grant application form PHS 398
(rev. 4/98) are available from:
AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone: 1-800-358-9295
TDD Service: 888-586-6340
The PA 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 PA number). The PA 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 read the PA. Written and telephone
inquiries concerning this PA are encouraged. Direct inquiries
regarding program matters to the contacts listed below by specific
program areas:
Improving Health Outcomes
Carolyn Clancy, M.D.
Director
Center for Outcomes and Effectiveness Research
Telephone: 301/594-1485
E-mail: [email protected]
Quality of Care
Gregg Meyer, M.D.
Director, Center for Quality Measurement and Improvement
Telephone: 301/594-6672
E-mail: [email protected]
Evidence-based Practice and Technology Assessment
Douglas B. Kamerow, M.D.
Director
Center for Practice and Technology Assessment
Telephone: 301/594-4026
E-mail: [email protected]
Primary Care
Helen Burstin, M.D.
Director
Center for Primary Care Research
Telephone: 301/594-1357
E-mail: [email protected]
Cost and Financing
Steven B. Cohen, Ph.D.
Acting Director
Center for Cost and Financing Studies
Telephone: 301/594-6171
E-mail: [email protected]
Organization, Delivery, and Markets
Irene Fraser, Ph.D.
Director
Center for Organization and Delivery Studies
Telephone: 301/594-6824
E-mail: [email protected]
Minority Health
Francis D. Chesley, M.D.
Director, Office of Research Review, Education, and Policy
Telephone: 301/594-6410
E-mail: [email protected]
Women’s Health
Marcy Gross, Women"s Health Coordinator
Telephone: 301/594-2429
E-mail: [email protected]
Children’s Health
Denise Dougherty, Ph.D., Child Health Coordinator
Telephone: 301/594-2051
E-mail: [email protected]
Clinical Preventive Services
David Atkins, M.D.
Medical Officer
Center for Practice and Technology Assessment
Telephone: 301/594-4016
E-mail: [email protected]
Cost-effectiveness Analysis and Other Methodological Advances
Joanna Siegel, Sc.D.,R.N.
Center for Outcomes and Effectiveness Research
Telephone: 301/594-0667
AHRQ Data Sources:
MEPS Household Component
Nancy Krauss
Center for Cost and Financing Studies
Telephone: 301/594-0846
E-mail: [email protected]
MEPS Nursing Home Component
Jeffrey Rhoades
Center for Cost and Financing Studies
Telephone: 301/594-0891
E-mail: [email protected]
HCUP-3
Kelly Carper
Telephone: 301/594-3075
E-mail: [email protected] or
[email protected] or [email protected]
Direct inquiries regarding fiscal matters to:
Mable L. Lam
Director, Division of Grants Management
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20852
Telephone: 301/427-1448
Fax: 301/427-1462
E-mail: [email protected]
AUTHORITY AND REGULATIONS
This program is described in the Catalog of Federal Domestic
Assistance, Number 93.226. Awards are made under authorization of
Title IX of the Public Health Service Act (42 USC 299-299c-7) as
amended by P.L. 106-129 (1999). Awards are administered under the PHS
Grants Policy Statement and Federal Regulations 42 CFR 67, Subpart A,
and 45 CFR Parts 74 or 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.
Weekly TOC for this Announcement
NIH Funding Opportunities and Notices
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