AHCPR HEALTH SERVICES RESEARCH - PROGRAM ANNOUNCEMENT

Release Date:  March 26, 1998

PA NUMBER:  PA-98-049

P.T.

Agency for Health Care Policy and Research

PURPOSE

The mission of the Agency for Health Care Policy and Research (AHCPR) is to
support and conduct research that improves the outcomes, quality, access to, and
cost and utilization of health care services.  AHCPR 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 policy makers with the ability
to assess the impact of system changes on outcomes, quality, access, cost, and
use of health care services.

The AHCPR research agenda is designed to be responsive to the needs of consumers,
patients, clinicians and other providers, institutions, plans, purchasers, and
Federal and state policy makers for evidence-based information which they need
in order to improve quality and outcomes, control costs, and assure access to
needed services.

This Program Announcement (PA) expresses AHCPR priority interests in research,
demonstration, dissemination, and evaluation projects to:

o  Support improvements in health outcomes -- drawing from the literature on
variations in clinical practice, the documented increase in occurrence of chronic
diseases, and growing interest in the impact of different delivery modalities and
financing arrangements on the outcomes of care, AHCPR seeks to support research
to better understand and improve the outcomes of health care and, in particular,
what works, for whom, when, and at what cost.

o  Strengthen quality measurement and improvement -- a broad array of research
topics is of interest here, ranging from studies to develop valid and reliable
measures of the process and outcomes of care, to strategies for incorporating
quality measures into programs of quality improvement, to the dissemination and
implementation of validated quality improvement mechanisms in a manner that tests
their generalizability and examines alternative ways to collect, compare, and
report the resulting information.

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 costs 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.

AHCPR has identified as a special focus of research across each of the major
program areas health issues related to priority populations, including minority
populations, women, and children.

AHCPR has also identified as Emerging Research Interests two additional areas
that are becoming increasingly important in today's market driven health care
delivery system.  These are research on methodologic advances in health services
research, especially cost-effectiveness analysis, and research on ethical issues
across the spectrum of health care delivery.

AHCPR encourages research using data from the Medical Expenditure Panel Survey
(MEPS), developed by AHCPR with collaboration by the National Center for Health
Statistics, and other AHCPR-supported data bases such as the Healthcare Cost and
Utilization Project (HCUP-3).

AHCPR 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
to 3 years; and results that can be integrated rapidly into practice or policy.

The program areas outlined in this PA are also applicable to AHCPR grants for
small projects, dissertation support, large and small conferences, and training. 
(See MECHANISM OF SUPPORT.)

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.  AHCPR encourages applicants to submit grant
applications with relevance to the specific objectives of this initiative. 
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 202/512-1800.

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, public and private non-
profit organizations including universities, clinics, units of state and local
governments, firms, and foundations.  AHCPR, by statute, can make grants only to
nonprofit organizations; however, for-profit organizations may participate as
members of consortia or subcontractors. Organizations described in section
501(c)4 of the Internal Revenue Code that engage in lobbying are not eligible.

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

MECHANISM OF SUPPORT

This PA mechanism of support 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 direct costs of $50,000 or less ("small
project grants" or R03s) should follow the application procedures in the "AHCPR
Small Project Grant Program" PA, published in the NIH Guide for Grants and
Contracts (NIH Guide), February 23, 1996.  AHCPR also supports conference and
dissertation grants (NIH Guide:  small conference grants, January 26, 1996; large
conference grants, May 31, 1991; dissertation research grants, January 26, 1996
and amended October 11, 1996), and training, primarily through National Research
Service Award grants and fellowships, as announced periodically.

For research applications over $500,000 in direct costs for any year,
investigators must have received written agreement from AHCPR that it will accept
the applications (NIH Guide, August 22, 1997).

Program Announcements and Grant Notices listed above are available through the
AHCPR Web site http://www.ahcpr.gov (Funding Opportunities) and from the AHCPR
contractor Equals Three Communications, Inc., see INQUIRIES.

RESEARCH OBJECTIVES

AHCPR seeks research on a wide range of topics under the  Priority Program Areas:
1) Support Improvements in Health Outcomes, 2) Strengthen Quality Measurement and
Improvement, and 3) Identify 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, and other decisionmakers to effect needed health care
changes; and to measure the impact of changes at all levels of health care
delivery.  AHCPR 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  SUPPORT 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 opportunities for
improvement have been demonstrated.  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.  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 used for multiple conditions,
or innovative approaches to health care delivery to improve outcomes.
2.  Impact of diagnostic and other health care technologies on cost and patient
outcomes.
3.  Development and testing of 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.
4.  Evaluation of strategies for the use of patient-reported outcome measures in
practice (e.g., shared decisionmaking), or development and validation of measures
that incorporate patient values and preferences.
5.  The relationship between processes and outcomes of care, including timing of
services.
6.  Evaluation of, and development of measures for, outcomes, effectiveness, and
cost effectiveness of clinical preventive services for all ages.
7.  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.
8.  Effects of information technology applications, such as computerized
decision-support systems, on improving outcomes.
9.  Observational studies using Medicare, Medicaid, or managed care data to
answer discrete questions related to the outcomes, effectiveness, cost, or
quality of medical care.
10.  Pharmaceutical outcomes, including:
  a. Relative effectiveness and cost effectiveness of available pharmaceuticals,
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  STRENGTHEN QUALITY MEASUREMENT AND IMPROVEMENT

Research is needed to improve the capacity of the health care system to deliver
quality care.  There is increasing emphasis on understanding how to assess and
measure quality across the full spectrum of care, in various settings and in
transition across settings, and for different population groups; and on
understanding the influence of organizational, as well as clinical, factors on
levels of quality.

A.  Quality Measurement and Improvement.  Interests include:

1.  Innovative approaches to measuring quality, including the perspectives of
providers, patients, and consumers.
2.  Adaptation of existing measures and development and validation of new
measures for use with diseases, conditions, and procedures where gaps in
knowledge exist, including the impact of comorbidities on the stability and
accuracy of quality measurement and measurement of the quality of end-of-life
care.
3.  General quality measurement methods, including risk and severity adjustment,
and methods for measuring functional status and quality of life.
4.  Evaluation of the kinds of quality improvement systems which promote changes,
systemic and sustainable, in clinical practice and improve the quality of care.
5.  The appropriateness of different data sources for quality measurement, and
development and evaluation of methods for using data to improve quality of care.
6.  Effects of computerized decision-support systems, integrated information
systems, electronic medical records, and other information technology
applications on improving quality of care.
7.  Methods for changing the behavior of clinicians, provider institutions,
plans, and patients to improve quality of care.
8.  Strategies for integrating quality measurement and improvement into office-
based and primary care settings, as well as acute and long-term care settings.
9.  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.
10.  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.
11.  Development and evaluation of typologies and measurement techniques that
allow study of the effects of organizational and communication strategies on
quality improvement.
12.  Patient and consumer issues, such as:
  a. Innovative ways to assess and measure quality dimensions important to
patients/consumers.
  b. Data collection, particularly from consumers with special needs, including
those cognitively impaired, institutionalized, and from differing cultural
backgrounds and literacy levels, to ascertain their perceptions about the care
received and their care needs.
  c. Development of information necessary to inform the complex care decisions
for people living with chronic illness or disability, including HIV/AIDS.

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.

o  IDENTIFY 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 assess the effects of these
interrelated factors on the delivery of health care, including preventive
services, that is accessible and equitable, and demonstrates high quality.

A.  Access, Costs, and Use of Health Services.  Interests include:

1.  Studies that use Medical Expenditure Panel Survey (MEPS) and other AHCPR data
sources to assess the cost and utilization of health resources.  (See "AHCPR
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.  Assessment of the determinants of access to care and strategies to improve
access, especially for underserved populations.
5.  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.  The nature, content, and efficiency of primary care practice by different
clinicians, and characteristics of those practices that lead to improvements in
access and quality of care.
2.  Access to primary care services, and socioeconomic factors that influence
access.
3.  Access to and availability of specialty services, and long-term and home
health care for persons with chronic and disabling conditions and the elderly.
4.  Access to and availability of clinical preventive services (CPS), including
research on barriers to delivery of CPS at both the clinical and organizational
levels and strategies for removing barriers.
5.  Clinical decisionmaking in primary care, including an emphasis on patient
involvement in the health care process.
6.  Communication, coordination of services, and partnerships among patients,
primary care clinicians, and other members of the health care team.
7.  Organization, financing, and management of primary care services.
8.  Issues related to geriatric care, including preventive services, outcomes
measurement, and the impact of health care organizational and process
alternatives.
9.  Impact of innovations by health plans on the cost and effectiveness of
primary care services.
10.  Effects of information technology applications in primary care practice,
such as computerized decision-support systems, on quality and costs of health
care.

To ensure generalizable results, primary care research may need to involve large
data bases and/or multiple practices or clinical sites.

PRIORITY POPULATIONS

Three population groups warrant a special focus for health services research: 
minority populations, women, and children.  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.  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.  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.

AHCPR 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:

1.  Minority Populations
a.  Evaluation of effective service delivery methods for eliminating disparities
in treatment between minority and majority populations.
b.  Effect of cultural competence on improving access to and outcomes of care for
minority patients.
c.  Enhancing meaningful community participation in health services research
projects.
2.  Women
a.  Assessment of the effectiveness of services and treatment approaches for
common, high-cost conditions in women in various age, racial/ethnic, and income
groups.
b.  Research on effective models of informed/shared decisionmaking about
treatment options and choices.
3.  Children
a.  Impact of changes in organizational and financial arrangements, including the
impact of expansions of insurance, such as Title XXI of the Social Security Act,
on children's health and health care.
b.  Development and evaluation of ways to measure and improve effectiveness,
outcomes, quality, and cost of care for children, including those with special
health care needs.

EMERGING RESEARCH INTERESTS

Two additional areas of health services research that are becoming 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 changing values regarding the provision of care, from the
provision of all possible care without cost considerations, to the provision of
less and less costly care.
3.  Studies to emphasize and clarify tradeoffs related to resource allocation and
the tension between individual and population or societal needs.

AHCPR Data

To the extent feasible, AHCPR applicants are encouraged to submit projects that
build on available data, will generate early results, and are modest in time,
scale, and cost.

AHCPR encourages research applications that will use data from the Medical
Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project
(HCUP-3), and other AHCPR 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 in March 1997.  The release schedule
for other data through calendar year 1998 is available from the MEPS section of
the AHCPR Web site (See below).

The HCUP-3 includes two data bases covering 1988-1994, with 1995 data available
early in 1998.  These all-payer databases were created through a Federal-state-
industry partnership to build a multistate health care data system.  Both data
bases contain patient-level information for inpatient hospital stays in a uniform
format with privacy protections.  The Nationwide Inpatient Sample (NIS) is a
national sample of about 900 hospitals.  The State Inpatient Database (SID),
available from the partner states, contains inpatient records for all community
hospitals in 17 states, and ambulatory surgery data from five states.  These data
bases 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-3 is available from the Data and Methods section of
the AHCPR Web site, and AHCPR staff (See INQUIRIES).

CONDITIONS OF AWARD

Data Privacy

Information obtained in the course of AHCPR supported projects that identifies
an individual or entity must be treated as confidential in accordance with
section 903(c) of the Public Health Service Act.

Rights in Data

AHCPR 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 AHCPR funds.  Such copyrights and
patents are subject to a Federal Government license to use and permit others to
use these products and materials for AHCPR purposes.  AHCPR purposes may include,
subject to statutory confidentiality protection, making research materials, data
bases, and algorithms available for verification or replication by other
researchers; and subject to budget constraints, final products may be made
available to the health care community and the public by AHCPR, or its agents,
if such distribution would significantly increase access to a product and thereby
produce public health benefits.  Ordinarily, to accomplish distribution, AHCPR
publishes research findings but relies on grantee efforts to market grant-
supported products.  In keeping with AHCPR's legislative mandates to make both
research results and data available, copies of all products and materials
developed under a grant supported in whole or in part by AHCPR funds are to be
made available to AHCPR promptly and without restriction, upon request by AHCPR.

INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS
INVOLVING HUMAN SUBJECTS

It is the policy of AHCPR that women and members of minority groups be included
in all AHCPR-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 was published in the Federal Register of March 28, 1994 (FR 59
14508-14513), and in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994. 
AHCPR follows the NIH Guidelines, as applicable.

Investigators may obtain copies from those sources or from the AHCPR contractor,
Equals Three Communications, Inc., listed under INQUIRIES.

AHCPR is also encouraging investigators to consider including children in study
populations, as appropriate.  AHCPR 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 AHCPR
Web site http://www.ahcpr.gov (Funding Opportunities) and InstantFAX (see
instructions under INQUIRIES).

AHCPR program staff may also provide information concerning these policies (See
INQUIRIES).

APPLICATION PROCEDURES

Applicants should use the research grant application form PHS 398 (rev. 5/95) in
applying for these grants, and submit applications in accordance with the
standard receipt dates outlined in the application materials. (state and local
government applicants may use form PHS-5161-1, Application for Federal Assistance
(rev. 5/96), and follow those requirements for copy submission.)

Application kits are available at most institutional offices of sponsored
research and may be obtained from the Division of Extramural Outreach and
Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC
7910, Bethesda, MD  20892-7910, telephone 301/710-0267, Email: asknih@od.nih.gov

AHCPR applicants should obtain application materials from the AHCPR contractor:
Equals Three Communications, Inc., 7910 Woodmont Avenue, Suite 200, Bethesda, MD 
20814-3015; telephone 301/656-3100 or FAX 301/652-5264.

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.

Submit a signed, typewritten original of the application, including the
Checklist, and five signed photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  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, AHCPR 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.

REVIEW CONSIDERATIONS

Applications that are complete will be evaluated for scientific and technical
merit by an appropriate peer review group convened in accordance with AHCPR 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 the highest scientific merit will be discussed and
assigned a priority score.

AWARD CRITERIA

Applications will compete for available funds with other investigator-initiated
applications requesting AHCPR support.  The following will be considered in
making funding decisions:  quality of the proposed project as determined by peer
review, program balance, and availability of funds.

General Review Criteria

Review criteria for grant applications are:  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.

INQUIRIES

Applicants are encouraged to use AHCPR's Web site (http://www.ahcpr.gov) to learn
about AHCPR major initiatives, such as Q-Span (Expansion of Quality of Care
Measures) and CAHPS (Consumer Assessment of Health Plans).  This will help assure
that new applications build on existing research, as appropriate, and are not
unnecessarily redundant with currently supported research.

Copies of this PA are available from:

Equals Three Communications, Inc.
7910 Woodmont Avenue, Suite 200
Bethesda, MD  20814-3015
Telephone:  (301) 656-3100
FAX:  (301) 652-5264

The PA is available on AHCPR's Web site, http://www.ahcpr.gov (Funding
Opportunities) and through AHCPR 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 InstantFAX 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.  AHCPR InstantFAX operates 24 hours a day,
7 days a week.  For questions about this service, call Judy Wilcox, Office of
Health Care Information, at 301/594-1364, ext. 1389.

AHCPR welcomes the opportunity to clarify any issues or questions from potential
applicants.  Written and telephone inquiries 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, ext. 1199; email: cclancy@ahcpr.gov

Quality of Care
Sandra K. Robinson, M.S.P.H.
Acting Director
Center for Quality Measurement and Improvement
Telephone: 301/594-1349, ext. 1314; email: srobinso@ahcpr.gov

Evidence-based Practice
Douglas B. Kamerow, M.D.
Director
Center for Practice and Technology Assessment
Telephone: 301/594-4015, ext. 1773; e-mail: dkamerow@ahcpr.gov

Primary Care
Carolyn Clancy, M.D.
Acting Director
Center for Primary Care Research
Telephone: 301/594-1357, ext. 1338; e-mail: cclancy@ahcpr.gov

Cost and Financing
Ross H. Arnett, III
Director
Center for Cost and Financing Studies
Telephone: 301/594-1406, ext. 1452; e-mail: rarnett@ahcpr.gov

Organization, Delivery, and Markets
Irene Fraser, Ph.D.
Director
Center for Organization and Delivery Studies
Telephone: 301/594-1410, ext. 1475; e-mail: ifraser@ahcpr.gov

Priority Populations:  Morgan N. Jackson, M.D., Director, Minority Health
Program, Telephone, 301/594-1406, ext. 1477, e-mail, mjackson@ahcpr.gov; Marcy
Gross, Director, Women's Health, Telephone, 301/594-1455, ext. 1028, e-mail,
mgross@ahcpr.gov; and Denise Dougherty, Ph.D., Child Health Coordinator,
Telephone, 301/594-1321, ext. 1019, e-mail, ddougher@ahcpr.gov

Clinical Preventive Services
David Atkins, M.D.
Medical Officer
Center for Practice and Technology Assessment
Telephone: 301/594-4015, ext. 1776; e-mail: datkins@ahcpr.gov

Cost-effectiveness Analysis and Other Methodological Advances
Carolyn Clancy, M.D.
Director, Center for Outcomes and Effectiveness Research
Telephone: 301/594-1485, ext. 1199
E-mail: cclancy@ahcpr.gov

AHCPR Data Sources:

MEPS Household Component
Nancy Krauss
Center for Cost and Financing Studies
Telephone: 301/594-1406, ext. 1489; e-mail: nkrauss@ahcpr.gov

MEPS Nursing Home Component
Jeffrey Rhoades
Center for Cost and Financing Studies
Telephone: 301/594-1406, ext. 1473; e-mail: jrhoades@ahcpr.gov

HCUP-3
Kelly Carper
Telephone: 301/594-1406, ext. 1520; e-mail: kcarper@ahcpr.gov or
hcupnis@ahcpr.gov or hcupsid@ahcpr.gov

For other program referral assistance, contact:

Kelly Morgan
Telephone: 301/594-1357, ext. 1335; e-mail: kmorgan@ahcpr.gov

Direct inquiries regarding fiscal matters to:

Mable L. Lam
Chief, Grants Management Staff
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852-4908
Telephone: 301/594-1447, ext. 1165
FAX 301/594-3210
E-mail: mlam@ahcpr.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance Numbers
93.180 and 93.226.  Awards are made under authorization of Title IX of the Public
Health Service Act (42 U.S.C. 299-299c-6) and Section 1142 of the Social Security
Act (42 U.S.C. 1320b-12) as applicable.  Awards are administered under the PHS
Grants Policy Statement and Federal regulations 42 CFR 67, Subpart A, and 45 CFR
Parts 74 and 92.  This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a
smoke-free workplace and promote the non-use of all tobacco products.  In
addition, Public Law 103-227, The Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which regular
or routine education, library, day care, health care, or early childhood
development services are provided to children.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the American
people.

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	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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