Full Text PA-95-066 RESEARCH ON QUALITY OF CARE FOR MENTAL DISORDERS NIH GUIDE, Volume 24, Number 19, May 26, 1995 PA NUMBER: PA-95-066 P.T. 34 Keywords: Mental Disorders 0730057 National Institute of Mental Health PURPOSE The purpose of this program announcement is to encourage grant applications for research on the quality of care delivered in various settings for mental disorders. The goal is to further understanding of what contributes to quality of care and ultimately to ensure that people with mental disorders are provided the best care possible. This program announcement addresses recommendations set forth in the Clinical Services Research section of "Caring for People with Severe Mental Disorders: A National Plan of Research to Improve Services" and in earlier National Institute of Mental Health (NIMH) initiatives about specific populations and disorders, including children and adolescents, the elderly, rural populations, and schizophrenia. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This PA, Research on Quality of Care for Mental Disorders, is related to the priority area of mental health and mental disorders. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by foreign and domestic, for-profit and non-profit organizations, public and private, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Foreign institutions are not eligible for First Independent Research Support and Transition (FIRST) (R29) awards. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT Research support may be requested through applications for research project grants (R01), small grants (R03), and FIRST awards (R29). Because the R03 and R29 mechanisms have special requirements regarding eligibility, application format, and review criteria, applicants are strongly encouraged to consult with program staff (listed under INQUIRIES) and obtain specialized announcements. RESEARCH OBJECTIVES Background. Quality of care research attempts to determine reasons for differences between clinically or scientifically derived standards of care and the actual care provided in everyday practice. In addition, it is concerned with how well the performance of providers increases the probability of desired patient outcomes. Studies of quality of care often separate the context of care into three components: structure, process, and outcome. Structure refers to characteristics of the community, service system, and client that might affect process and outcome (e.g., system configuration, demographics, staffing ratios, ownership). Process refers to interventions that are intended to influence the course of a disorder (e.g., assessment, treatment approaches). Outcome refers to the impact of interventions on the disorders and client (e.g., clinical status, quality of life, expenditures, satisfaction). The quality of care provided to people with mental disorders varies across the Nation and among different service sectors. Recent changes in the organization and management of mental health services have heightened concern that quality of care may become compromised. Delineation of the components of good care and improved understanding of the factors that contribute to variation in the quality of care can help to ensure that the best treatment is provided. Research Issues. Listed below are examples of research topic areas that focus on quality of care in mental health. The list of examples is illustrative, not exhaustive; it is expected that additional important research topics will be identified by researchers who respond to this program announcement. o Studies that validate measures of the various domains of outcome in mental health treatment (e.g., symptoms, functional status, satisfaction) o Studies that determine the factors contributing to variations in quality of care across communities and service settings o Studies focusing on process factors that contribute to appropriate and effective care (e.g., what contributes to technical excellence) o Studies assessing contributions of structural characteristics to quality (e.g., system, community, provider characteristics) o Studies that link process with outcomes (e.g., management of psychotropic medications and clinical outcome) o Studies involving development, testing, and refinement of methods to establish quality of care standards (i.e., meta-analysis, consensus development conferences, decision analysis) o Studies of whether quality monitoring programs or treatment guidelines improve process and outcomes INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This new policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) and supersedes and strengthens the previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations), which have been in effect since 1990. The new policy contains some provisions that are substantially different from the 1990 policies. All investigators proposing research involving human subjects should read the "NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 (FR 59 14508-14513) and reprinted in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators also may obtain copies of the policy from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 9/91) and will be accepted at the standard application deadlines as indicated in the application kit. Application kits are available at most institutional offices of sponsored research and may be obtained from the Office of Grants Information, Division of Research Grants, National Institutes of Health, 6701 Rockledge Drive, Room 3032, MSC 7762, Bethesda, MD 20892-7762, telephone 301/435-0715. The title and number of the program announcement must be typed in Section 2a on the face page of the application. Applications for the FIRST award (R29) must include at least three sealed letters of reference attached to the face page of the original application. FIRST award (R29) applications submitted without the required number reference letters will be considered incomplete and will be returned without review. The completed original application and five legible copies must be sent or delivered to: Division of Research Grants National Institutes of Health 6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817 (for courier/overnight service) REVIEW CONSIDERATIONS Applications that are complete and responsive to the program announcement will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with the standard NIH peer review procedures. As part of the initial merit review, all applications will receive a written critique and undergo a process in which only those applications deemed to have the highest scientific merit, generally the top half of applications under review, will be discussed, assigned a priority score, and receive a second level review by the appropriate national advisory council or board, when applicable. Review Criteria o scientific, technical, or medical significance and originality of proposed research; o appropriateness and adequacy of the experimental approach and methodology proposed to carry out the research; o qualifications and research experience of the Principal Investigator and staff, particularly, but not exclusively, in the area of the proposed research; o availability of the resources necessary to perform the research; o appropriateness of the proposed budget and duration in relation to the proposed research; o adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. Plans for the recruitment and retention of subjects will also be evaluated. The initial review group will also examine the provisions for the protection of human subjects and the safety of the research environment. AWARD CRITERIA Applications will compete for available funds with all other approved applications. The following will be considered in making funding decisions: quality of the proposed project as determined by peer review, availability of funds, and program priority. As part of the NIMH Public-Academic Liaison (PAL) initiative, among applications assigned to the NIMH, preference may be given to those that involve active collaborations between academic researchers and public sector agencies in planning, undertaking, analyzing, and publishing research pertaining to persons with severe mental disorders. The PAL initiative is based on the premise that important new advances in understanding and treatment of severe mental disorders can result from improved linkages between the Nation's scientific resources and the public sector agencies and programs in which many persons with severe mental disorders receive their care. INQUIRIES Inquiries are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding programmatic issues to: Ann A. Hohmann, Ph.D., M.P.H. Division of Epidemiology and Services Research National Institute of Mental Health Parklawn Building, Room 10C-06 Bethesda, MD 20857 Telephone: (301) 443-3364 Email: AHOHMANN@AOAMH2.SSW.DHHS.GOV Direct inquiries regarding fiscal matters to: Diana S. Trunnell Grants Management Branch National Institute of Mental Health Parklawn Building, Room 7C-08 Bethesda, MD 20857 Telephone: (301) 443-3065 FAX: (301) 443-6885 Email: Diana_Trunnell@nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.242. Awards are made under authorization of the Public Health Service Act, Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and 285) and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review. Awards will be administered under PHS grants policies stated in the Public Health Service Grants Policy Statement, April 1, 1994. The Public Health Service (PHS) strongly encourages all grant and contract recipients to provide a smoke-free workplace and to 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. .
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