EVALUATION OF DEMONSTRATIONS: "REWARDING RESULTS"
RELEASE DATE: April 3, 2002
RFA: HS-02-006
Agency for Healthcare Research and Quality (AHRQ)
(http://www.ahrq.gov)
APPLICATION RECEIPT DATE: 05/20/2002
THIS RFA CONTAINS THE FOLLOWING INFORMATION:
o Purpose of this RFA
o Research Objectives
o Mechanism(s) of Support
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations
PURPOSE OF THIS RFA
This Request for Application (RFA) expresses the interest of the Agency
for Healthcare Research and Quality (AHRQ) in applications for grant
support for a comprehensive evaluation and analysis of a major national
initiative to demonstrate the impact of financial and nonfinancial
incentives on the quality of health care.
"Rewarding Results: Aligning Incentives with High-Quality Health Care"
is a national initiative of The Robert Wood Johnson Foundation (RWJF)
and other funding and technical assistance partners. Funding partners
include AHRQ and The California Health Care Foundation (CHCF).
Technical assistance partners include The National Health Care
Purchasing Institute (NHCPI) and The Center for Health Care Strategies
(CHCS).
The "Rewarding Results" initiative is intended to develop, evaluate,
and diffuse innovations in systems of provider payments and non-
financial incentives that encourage and reward high-quality care. Each
of several demonstration projects will include strong measurable goals
for high quality care that (1) address the major needs of the
applicant"s members, enrollees, beneficiaries, recipients, or
employees, (2) align payment systems and non-financial incentives with
the applicant"s quality goals, and (3) include a self-evaluation
approach that will help the grantee and initiative partners continually
improve their financial and non-financial incentives. The overall
demonstration program includes substantial collaborative technical
assistance to help grantees, applicants, and others to plan, implement,
and continually improve their efforts to align payment and incentives
with quality goals. Eligible applicants for the demonstration projects
include employers, health plans, purchasing coalitions, Medicaid
agencies, and Veterans Administration. The Call-for-Proposals (CFP)
for demonstration projects is available at www.nhcpi.net.
A major component of this initiative will be a comprehensive evaluation
across all the demonstration projects, designed to draw critical
findings and potential lessons from the combined experience of the
projects, so that public and private payers can apply these lessons to
the design of future incentive programs. This RFA expresses AHRQ"s
interest in funding such an overarching evaluation project that would
provide rigorous, objective, timely, and essential evidence about
demonstrated innovations in systems of provider payments and non-
financial incentives for improving the quality of care and about the
consequences of such innovations. In conducting the overarching
evaluation, the AHRQ awardee will work with funding and technical
assistance partners and all the demonstration projects. The AHRQ-
supported overarching evaluation will interact with and complement the
self-evaluation activities done by each demonstration project.
Examples of important questions to be addressed in the overarching
primary evaluation include: In what ways does provider performance
change in response to incentives, and how do responses vary among
different performance measures and over time? Do providers respond
primarily to financial or nonfinancial incentives, and what are the
interactive effects among those incentives? Does the incentive system
produce any measurable positive or negative economic consequences for
providers? Do those consequences track provider performance
appropriately, rewarding high quality providers relative to others?
Does the burden of reporting increase or decrease for providers, and
how does any change affect their satisfaction and the business case for
improving quality? How do changes in provider behavior affect consumer
satisfaction? What are the impacts on the costs of health plans and
other payers? How do the nature of the health care market, the type of
health plan or payer organization, and the underlying reimbursement
system affect these outcomes?
RESEARCH OBJECTIVES
1. Background
The mission of AHRQ is to support and conduct research that improves
the outcomes, quality, access to, and cost and utilization of health
care services. 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 payment and organizational changes on
outcomes, quality, access, cost, and use of health care services.
AHRQ"s research agenda is designed to be responsive to the needs of
consumers, patients, clinicians and other providers, institutions,
plans, purchasers, and Federal and State policymakers. AHRQ seeks to
provide all of these decision makers with the evidence-based
information that they need to improve quality and outcomes, control
costs, and assure access to needed services.
A 1999 report from the Institute of Medicine (IOM), "To Err is Human:
Building a Safer Health System," provided documentation and analysis of
the scope of patient safety issues in the American health care system.
In a related 2001 report, "Crossing the Quality Chasm", the IOM noted
that patient safety problems reflect "only a small part of the
unfolding story of quality in American health care." According to this
second report, there is a "chasm" between the health care we have and
the health care we could have, and this gap to a large extent springs
from two overarching system features: the way we pay for care, and the
way we structure the organizations that provide it. The report calls
for "action to improve the American health care delivery system as a
whole, in all of its quality dimensions, for all Americans." These
reports and similar calls for action have raised questions about what
particular public and private sector changes in the health care system
would most likely yield desired improvement. Changes under
consideration include new methods of payment for providers, practical
and effective risk adjustment methods, alternative approaches to
address capital requirements for improving the delivery of health care,
and changes in healthcare organizations and in the healthcare system
that would result in more efficiently designed care processes,
effective use of information technologies, the development of effective
teams, and improved coordination of care across patient conditions,
services, and settings.
In the context of the IOM"s call for action, the initiative "Rewarding
Results" will develop, evaluate, and diffuse innovations in systems of
provider payments and non-financial incentives that encourage and
reward high-quality care. A major component of this initiative will be
the AHRQ-supported overarching evaluation of the demonstration
projects, as discussed in this RFA.
This RFA complements many other current AHRQ initiatives to improve the
quality of health care. Particularly relevant to this RFA is a
recently published Program Announcement (The Impact of Payment and
Organization on Cost, Quality, and Equity, PA-01-125, NIH Guide, July
31, 2001) which expresses AHRQ"s highest priority interests in research
that would provide rigorous, objective, and essential evidence required
by public and private decision makers seeking to understand and improve
the health care system, to make changes in health care delivery,
insurance, and financing, and to manage the system in a manner that
would induce efficient, effective, timely, equitable and accessible
health care. Relevant issues under that initiative include (1) how
different payment methodologies and financial incentives within the
system affect health care quality, costs, and access and (2) the impact
of purchaser and public sector initiatives on quality, costs, and
access to health care and health insurance. Of particular interest is
the impact of such financial factors on the quality of health care for
vulnerable populations.
Although past and current AHRQ initiatives have provided an expanded
knowledge base about best practices in health care and about quality
measurement and quality improvement, there is still considerable
uncertainty about the most effective mechanisms especially payment
mechanisms-- for improving quality. In practice, attempts by
organizations to align incentives have often been linked with issues of
efficiency, productivity, revenue, and profits rather than with health
care quality. The "Rewarding Results" initiative is intended to
provide large, sustained, innovative, and pragmatic demonstrations of
how to make the link between incentives and quality a strong one.
Consistent with the AHRQ mission, the AHRQ-supported primary evaluation
project will provide rigorous, objective, timely, and essential
evidence about such demonstrated innovations and their consequences.
NHCPI, which serves as the National Program Office (NPO) for the
"Rewarding Results" initiative, will offer substantial technical
assistance for demonstration project applicants during their
application process. NHCPI is making available technical assistance
documents that provide information on case studies of existing efforts
to align payment systems and nonfinancial incentives with quality
goals, models for redesigning payment systems and nonfinancial
incentives, approaches for estimating potential return on investment
for changing provider rewards, and options for determining the impact
of the rewards innovations on quality and cost. These documents and
RWJF"s CFP are available at www.nhcpi.net. AHRQ applicants may
contact NHCPI if assistance is needed in understanding these documents.
These documents provide technical background for the potential nature,
extent, and scope of the demonstration projects. Thus, these documents
also serve as essential background for the objectives and methods of
the overarching evaluation discussed below. AHRQ applicants are urged
to make use of these documents in developing their applications.
A single Primary Evaluation Team will be funded by AHRQ under a
cooperative agreement, a core element of which is an Evaluation
Advisory Committee (EAC), comprised of representatives from the funding
and technical assistance partners, participating in the "Rewarding
Results" initiative. The EAC will hold up to four meetings a year both
to identify the questions, common measures, and methods which cut
across all the demonstration projects and to focus on questions,
measures, methods, and activities central to the overarching
evaluation. The EAC will provide advice to the Primary Evaluation Team
on the overarching evaluation and, in turn, provide coordination across
the demonstration projects in all their evaluation activities.
For budget purposes, applicants should assume that the EAC will meet in
the Washington, D.C. area. Facilities will be arranged by the AHRQ
project officer in consultation with the EAC.
Evaluation activity in the "Rewarding Results" initiative will be
conducted at two levels. First, each of the demonstration project
grantees will conduct self-evaluation activities. Second, the Primary
Evaluation Team will conduct an overarching primary evaluation across
all demonstration projects. These two levels of evaluation are,
however, interactive. On the one hand, each of the demonstration
projects will (1) engage in its own self-evaluation activities, (2)
provide information relevant to the overarching primary evaluation to
the Primary Evaluation Team, and (3) be provided evaluation-related
advice and assistance by the Primary Evaluation Team. Note that
considerable non-evaluation-related technical assistance will be also
be available to each demonstration project from NHCPI and CHCS. On the
other hand, the Primary Evaluation Team will conduct the overarching
primary evaluation and provide assistance and advice to funding and
technical assistance partners on the demonstration projects" evaluation
activities. Given the interactive nature of evaluation activities,
AHRQ applicants should include information in their application
demonstrating their ability to work collaboratively, and their
agreement to do so.
In particular, in the development of their applications, AHRQ
applicants may consider the following:
o As a condition of accepting RWJF funds, all demonstration project
grantees will be required to participate in the AHRQ evaluation.
Demonstration projects will be expected to meet RWJF requirements for
the submission of narrative and financial reports and also will be
required by RWJF to submit periodic information needed for overall
project performance monitoring and management. Demonstration project
directors may be asked to attend periodic meetings and give progress
reports on their grants. At the close of each grant, each demonstration
project grantee is expected to provide a written report on the project
and its findings suitable for wide dissemination.
o Successful RWJF applicants will have demonstrated that they
currently possess the systems and procedures to provide the healthcare
utilization and financial data that are necessary both for monitoring
and evaluating the demonstration programs they have proposed and for
the AHRQ-supported overarching evaluation of the entire "Rewarding
Results" initiative. These data will be sufficient to compare the costs
and results of the incentive demonstration with other payment
approaches each successful applicant is using within a selected market
and product line. RWJF applicants will have committed, in their
proposals, to make such information available in a timely manner.
For more on the relationship among participants, please see
Cooperative Agreement Terms and Conditions of Award below under SPECIAL
REQUIREMENTS.
Applicants under this AHRQ initiative are cordially invited to a
conference of applicants for RWJF demonstration projects. One purpose
of the conference is to give background information to RWJF applicants
and respond to their questions about the preparation of applications
for demonstration projects under the "Rewarding Results" initiative.
The conference will be held in Chicago, April 17-19, 2002. Attendance
is not a prerequisite for potential applicants under the AHRQ-supported
evaluation initiative. No technical assistance from AHRQ program staff
will be provided at the conference. Attendees must pay for their own
travel and accommodation costs. The conference will be open to any
individual or organization intending to apply. For further
information on the conference, see the NHCPI Website or contact Michael
Hagan at the address listed below.
2. Objectives
The main objective of the primary evaluation is to address a set of key
issues which fall into three broad categories: formative and
developmental issues, reporting standards, and outcomes. Some overlap
necessarily exists among these categories.
A. Formative and developmental issues:
o Can the payers patients establish process and outcome goals for
clinical practice, with the concurrence of their network of providers?
Can they establish performance measures that address those goals, and
validate the relationship between the measures and their goals?
o Can the payers determine appropriate financial and non-financial
incentives for providers to meet performance standards selected for
study? Which incentive systems do they consider, and which do they
actually select? What factors drive those decisions? What is the
source, extent and role of technical assistance in those decisions?
Can they develop the actuarial and information infrastructure to
provide incentives and feedback to providers in a timely manner? In
particular, can they collect the data necessary to support provider-
level measurement?
o Can the projects develop and implement a research design that
enables them to explore the effects of alternative incentive
structures? Can they provide feedback to allow for ongoing
improvements to the incentive systems, while maintaining the integrity
of the research design? If innovations in incentive systems are
implemented over time or across multiple sites, how are such
innovations diffused? Are they changed and shaped by the process of
implementation itself? Can the projects establish baselines against
which subsequent performance will be measured?
o Do claims and encounter data meet all the data requirements for
measuring performance, or are new reporting systems or codes needed?
If so, can the projects develop and implement those new systems?
B. Reporting standards issues:
o Do the data provided by the projects meet audit standards, and
support their claims for the outcomes of the initiative?
o How reliable are the data received from individual providers, and do
the projects have effective systems to monitor those data?
C. Outcomes
o In what ways does provider performance change in response to
incentives, and how does that vary among different performance measures
and over time? Do providers respond primarily to financial or
nonfinancial incentives, or are the effects interactive? If the effects
are interactive, how does that interaction work?
o Does the incentive system produce any measurable positive or
negative economic consequences for providers? Do those consequences
track provider performance appropriately, rewarding high quality
providers relative to others? Possible consequences include changes in
unit prices for providers, or changes in caseload and casemix (both
profitable and unprofitable).
o Do spillover effects positive or negative occur in other areas of
clinical practice that are not directly subject to incentives?
o How does the incentive system affect provider satisfaction, through
both tangible outcomes and changes in intangible professional and peer
rewards?
o Does the burden of reporting increase or decrease for providers, and
how does any change affect their satisfaction, participation, and the
business case for quality.
o How do changes in provider behavior affect consumer satisfaction?
o What are the impacts on the costs of health plans and other payers?
o How do the nature of the health care market, the type of health plan
or payer organization, and the underlying reimbursement system affect
these outcomes?
o Do assessments of outcomes vary with type of care provided, (e.g.,
primary care, speciality care), with settings of care (e.g., inpatient,
ambulatory, rehabilitative, long term care), or by populations served
(e.g., publicly or privately insured, the elderly or children)?
3. Demonstration projects" evaluations
Each demonstration project"s evaluation team will conduct a qualitative
and quantitative self-evaluation of the implementation and outcomes of
the "Rewarding Results" demonstration for their particular
organization"s project. The demonstration project"s evaluation team
will also be responsible for working with the AHRQ-supported Primary
Evaluation Team to develop and implement standard concepts and measures
among the demonstration projects, and for reporting data, qualitative
information, and self-evaluation findings back to the Primary
Evaluation Team. In addressing formative, planning, and demonstration
project development issues, each demonstration project"s self-
evaluation staff will do the following:
o Work with the project managers to develop a plan to design and
implement a performance incentive system, with clear milestones,
o Document the process that the organization uses to establish goals
for clinical practice, and for obtaining input from its providers,
document how the organization establishes performance measures for
those goals, and obtains buy-in from providers.
o Document any research or analyses that the organization undertakes
to validate the relationship between goals and performance measures.
o Work with the Primary Evaluation Team and evaluators from other
projects to obtain standard measures for shared performance goals, and
work with their own organization to revise their internal measures
where necessary to meet the standard.
o Document the process that the organization uses to determine
financial and nonfinancial incentives, and the extent of provider
involvement in those decisions.
o Assess the readiness of the actuarial and information system (IS)
infrastructure to support a performance incentive system and monitor
any changes that are necessary.
o Assess the ability of providers to meet the minimum reporting
requirements, and the variation in the quality of the data received
from different providers.
o Identify the key leaders on all of these issues both within the
organization and among the provider community, and the role that they
play in changing the culture of the organization, document how lessons
learned are incorporated into the incentive systems.
o Provide regular feedback on the project development process to the
primary evaluators, through a simple, web-based reporting system. This
reporting system should give monthly feedback on progress toward the
milestones, and factors contributing to success or failure in meeting
those milestones.
The demonstration projects will also conduct self-evaluations of
program outcomes. In the context of those self-evaluations,
demonstration projects will do the following:
o Work with the primary evaluators to develop a research design that
is appropriate for the specific project, and work with the project
managers to implement that design, document the technical, practical,
and political difficulties that conducting a reimbursement and feedback
experiment entails.
o Establish qualitative and quantitative baselines against which both
implementation and outcomes can be measured. Those baselines might
include: current reimbursement systems and their incentives or
disincentives for clinical performance, current IS technology and the
ability to collect and analyze provider-level data, current costs of
care for specified chronic conditions, the extent of performance
measurement and feedback to providers on their performance, comparisons
of current provider performance with standards for appropriate care,
and the extent of variation in performance among providers, and
assessments of provider and consumer satisfaction, providers" views of
the current reimbursement system, and their ability to perform high-
quality, cost-effective care.
o Work with the Primary Evaluation Team to develop strategies to
assess the perspectives of both providers and consumers on the
effectiveness of the reward system: those strategies might include
focus groups, site visits, or surveys, and address such issues as
satisfaction, the business case for rewarding performance, and changes
in the administrative burdens that providers face.
o Determine how provider performance changes in response to
incentives, track trends in performance and in the variation of
performance among providers, determine to the extent that the
experimental design permits the provider response to different types of
incentives, and the interactive effects of incentives.
o Identify possible spillover effects in other areas of clinical
practice that are not directly affected by incentives.
o Determine the changes in administrative costs of the organization
resulting from the implementation of the new systems, if possible,
determine changes in the organization"s overall costs for the
management of key chronic conditions.
o Assess changes in the satisfaction of both providers and consumers,
and in providers" perceptions of their ability to perform high-quality,
cost-effective care.
4. Primary Evaluation Team
The Primary Evaluation Team will work to produce overarching
conclusions from the demonstration projects. The Primary Evaluation
Team may:
o Provide extensive technical assistance to each project"s self-
evaluation activities as the project develops its performance plans.
Topics for technical assistance include goal setting, performance
measurement, experimental design, and developing baselines.
o Organize group technical assistance meetings bringing all of the
demonstration projects" evaluation teams together. Initially, those
meetings will focus on the development of standard measures and survey
instruments, and strategies that all of the projects will use.
Subsequent meetings will allow the evaluators to participate in peer-
to-peer technical assistance, and will give the Primary Evaluation Team
the opportunity to discuss problems that the evaluators are facing.
o Develop a simple web-based reporting system for the projects to
report monthly activities and progress toward milestones, assess the
quality of the data and information systems for each project, and the
validity of the findings that they report.
o Depending on the likelihood of successfully implementing well-
designed experiments for each project, assess the feasibility and cost
of using unfunded applicants or other demonstration projects as
"controls."
o Conduct a qualitative evaluation of how successful the projects are
in developing and implementing new reimbursement and incentive systems,
and changing the culture of both payers and provider organizations,
the factors that contribute to successful implementation, and the
factors that impede it. That evaluation will use information from the
monthly reports from the projects, the group meetings with the
demonstration projects" evaluation teams, structured site visits, and
focus groups with providers.
o To the extent possible, conduct an analysis of the effects of
financial and nonfinancial incentives on provider performance and
satisfaction, consumer satisfaction, costs to health plans, and the
business case for providers. If the demonstration projects are able to
design and implement successful experiments, the Primary Evaluation
Team might conduct a meta-analysis of their findings. Otherwise, it
might be necessary to try and obtain comparison data from unfunded
demonstration project applicants.
o For both the qualitative and the quantitative findings, assess the
extent to which the nature of the health care marketplace, the type of
health plan or payer, and the underlying reimbursement system may
affect the observed outcomes.
o Develop a series of formative and summative evaluation products for
AHRQ, NHCPI, and RWJF that provide ongoing insights into both program
development and the factors contributing to program successes and
failures, to include an assessment of IS "best practices" to support
quality initiatives.
5. Methods
It is anticipated that the methods used in the project funded under
this RFA will be both qualitative and quantitative. Applicants are
expected to present a clear, cohesive and compelling evaluation design
addressing both quantitative and qualitative methodological issues.
These issues may include, for example: confounding factors that
obscure or bias observation of the effects of the demonstrations,
measurement issues (e.g., reliability and the extent to which measures
reflect concepts they are intended to measure), potentially adverse
effects of the proposed evaluation design and solutions to such
problems, approaches to systematically aggregate multi-project, multi-
level, multi-period data, strategies for analysis of data and
presentation of results, potential quasi-experimental designs (e.g.,
the use of applicants not funded as demonstration projects as
"controls"), generalizability (i.e., the extent to which assessments
of demonstration activities and effects can be extrapolated to similar
environments), potential existing sources of data, and the use of
existing interview protocols. Applicants may address above-listed
issues to the extent there is relevance to their research design. This
list is for illustrative purposes and not to be taken as collectively
exhaustive of all issues relevant to the evaluation.
Applicants are expected to draw on their own experience, additional
technical expertise, and relevant background literature in
conceptualizing and presenting an evaluation design that addresses the
objectives of the "Rewarding Results" initiative. [See, e.g., Rossi
and Freeman, 1993, for a systematic approach to evaluation, and
"Qualitative Methods in Health Services Research", 1998, for
potentially relevant methodological discussions.] Proposed designs must
be flexible enough to take into consideration the variety of approaches
that demonstration projects might include in aligning their systems of
payments and non-financial incentives with quality goals. [See CFP for
a list of potential demonstration project approaches.]
Note that the Paperwork Reduction Act requires that grantees
participating in cooperative agreements generally need approval from
the Office of Management and Budget (OMB) to collect certain data such
as surveys from more than nine respondents. Accordingly, applicants
should (1) provide a justified budget for appropriate expertise, (2)
develop time lines reflecting the efforts necessary to gain approval,
and (3) delineate contingency plans should the request be disallowed.
Details of the Act and procedures to gain approval are available at:
http://www.hhs.gov/oirm/infocollect/
MECHANISM OF SUPPORT
This RFA will use the cooperative agreement (U01) award mechanism under
which the Principal Investigator retains the primary responsibility and
dominant role for planning, directing, and executing the proposed
project, with AHRQ staff being substantially involved as a partner with
the Principal Investigator, as described under the section "Cooperative
Agreement Terms and Conditions of Award." This RFA is a one-time
solicitation. Any future unsolicited, competing continuation
application based on this project will compete with all investigator-
initiated applications and will be reviewed according to the customary
peer review procedures. The anticipated award date is 9/01/2002.
AHRQ is not using the Modular Grant Application and Award Process.
FUNDS AVAILABLE
AHRQ intends to commit approximately $250,000 in total costs in FY 2002
to fund one grant in response to this RFA. Commensurate with the time
line of the "Rewarding Results" initiative, it is anticipated that AHRQ
applicants will request project periods of four years. Total costs
over the life of the project should not exceed $1,500,000. Although
the financial plans of AHRQ provide support for this program, awards
pursuant to this RFA are contingent upon the availability of funds and
the receipt of a sufficient number of meritorious applications.
Funding beyond the first year is contingent on the availability of
funds and satisfactory progress.
ELIGIBLE INSTITUTIONS
You may submit (an) application (s) if your institution has any of the
following characteristics:
o For-profit or non-profit organizations
o Domestic and foreign
o Public and private non-profit institutions, such as universities,
clinics, colleges, and hospitals
o Units of State and local governments
o Faith-based organizations
o Eligible Agency of the Federal Government
Under recently enacted reauthorization legislation, AHRQ is authorized
to enter into cooperative agreements with for-profit organizations as
well as with public and not-for-profit entities. Thus, for-profit
organizations may respond to this notice with research applications for
cooperative agreements. Such applications will be administered in
accordance with Subpart E of 45 CFR Part 74 and 42 CFR Part 67 Subpart
A (except we note that the latter regulation has not yet been amended
to reflect changes in Agency authority and Agency name.) (See December
6, 1999, AHRQ reauthorization at http://www.ahrq.gov/hrqa99a.htm).
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS
Any individual with the skills, knowledge, and resources necessary to
carry out the proposed research is invited to work with their
institution to develop an application for support. Individuals from
under represented racial and ethnic groups as well as individuals with
disabilities are always encouraged to apply for AHRQ programs.
SPECIAL REQUIREMENTS
Cooperative Agreement Terms and Conditions of Award
The following special Terms of Award are in addition to and not in lieu
of otherwise applicable OMB administrative guidelines, HHS grant
administration regulations at 45 CFR Parts 74 and 92, 42 CFR Part 67
Subpart A, and other HHS, PHS grants administration policy statements.
Applicants should be familiar with the Agency"s grant regulations, 42
CFR Part 67 Subpart A, and particularly sections 67.18-67.22.
The cooperative agreement (U01) is an "assistance" mechanism (rather
than an "acquisition" mechanism) in which substantial AHRQ scientific
and/or programmatic involvement with the awardee is anticipated during
performance of the activity. Under the cooperative agreement, the AHRQ
purpose is to support and/or stimulate the recipient"s activity by
involvement in and otherwise working jointly with the award recipient
in a partner role, but it is not to assume direction, prime
responsibility, or a dominant role in the activity. In the context of
this initiative, cooperative activities are intended to strengthen
individual demonstration evaluation activities and at the same time,
generate generalizable results across sites and tasks in the overall
evaluation project.
Consistent with the concept of cooperative agreements, also described
under MECHANISM OF SUPPORT, the dominant role and prime responsibility
for project activity resides with the awardee for the project as a
whole, although specific tasks and activities in carrying out the study
will be shared among the awardee, the AHRQ project officer, and others.
1. Cooperative Activities
The Agency for Healthcare Research and Quality, the Robert Wood Johnson
Foundation, the California Health Care Foundation, the National Health
Care Purchasing Institute, and the Center for Health Care Strategies
will all have substantial scientific and programmatic involvement
during the conduct of the demonstrations and their evaluation. These
entities will provide technical assistance, advice, and support to all
awardees, including the evaluation team, and guide the cooperative work
of the projects.
2. Awardee Rights and Responsibilities
The awardee will conduct evaluation and research in accordance with the
terms and conditions of the Notice of Grant Award, and cooperate with
other key parties named above. The Principal Investigator will
participate with the AHRQ Project Officer, NHCPI, RWJF Program
Officers, representatives of the RWJF "Rewarding Results" National
Advisory Committee, other funders, and other technical assistance
partners in the EAC, which will serve as the core mechanism for
cooperative planning and coordination of the evaluation. The Principal
Investigator will participate in EAC meetings. He or she will refine
and revise, when necessary, aspects of the evaluation design and
methodological procedures in accord with plans developed
collaboratively in the context of the EAC.
3. AHRQ Staff Responsibilities
The AHRQ Project Officer is responsible for coordination of the work of
the evaluation awardee to ensure that the evaluation will complement
the demonstration efforts and maximizes the generalizability of
findings. The AHRQ Project Officer will arrange and coordinate EAC
meetings. Facilities will be arranged by the AHRQ Project Officer in
consultation with EAC. The AHRQ Project Officer will maintain contact
with the Principal Investigator between EAC meetings to consult on key
project decisions to trouble-shoot problems and confirm that the
project is proceeding according to plan. The progress of work of the
AHRQ awardee will be reviewed annually in the context of applications
for continued funding of the project.
4. Advisory Committee
The Evaluation Advisory Committee will meet four times a year in the
Washington, D.C. area.
5. Arbitration
Awards may be terminated in cases where the awardee has been given
adequate notification about performance and fails to take corrective
actions, including cases of documented under-performance, cases where
there is a lack of participation in collaborative activities, and in
cases involving human subject ethical issues. Any disagreement that
may arise on scientific/programmatic matters (within the scope of the
award), between the award recipient and AHRQ may be brought to
arbitration. An arbitration panel will be composed of three members --
one selected by the individual awardee, a second member selected by
AHRQ, and the third member selected by the two prior selected members.
This special arbitration procedure in no way affects the awardee"s
right to appeal an adverse action that is otherwise appealable in
accordance with the PHS regulations at 42 CFR Part 50, Subpart D and
HHS regulation at 45 CFR Part 16.
Publication Transmittal: General AHRQ Requirements
In keeping with the Agency"s efforts to translate the results of AHRQ-
funded research into practice and policy, grantees and/or contractors
are to inform the AHRQ Office of Health Care Information (OHCI) when
articles from their studies are accepted for publication in the
professional literature. Grantees and contractors should also discuss
any ideas about other dissemination and marketing efforts with OHCI
staff. The goal is to ensure that efforts to disseminate research
findings are coordinated with other Agency activities to maximize
awareness and application of the research by potential users, including
clinicians, patients, health care systems and purchasers and
policymakers. This is critical when outreach to the general and trade
press is involved. Contact with the media will take place in close
coordination with OHCI and the press offices of the awardee"s
institution. In cases when products are created (such as annual or
final reports, Web-based tools, CD-ROMs), grantees and contractors will
be asked to submit to OHCI a brief plan describing how the product will
be publicized. An OHCI staff person will be assigned to each product
and will coordinate the implementation of the plan, especially issues
related to printing and electronic dissemination, and outreach to the
media.
WHERE TO SEND INQUIRIES
We encourage your inquiries concerning this RFA and welcome the
opportunity to answer questions from potential applicants. Inquiries
may fall into three areas: scientific/research, peer review, and
financial or grants management issues:
o Direct your questions regarding programmatic issues, including
information on the inclusion of women, minorities, and children in
study populations to:
Michael Hagan
Center for Organization and Delivery Studies
Agency for Healthcare Research and Quality
2101 East Jefferson Street, 6W37
Rockville, MD 20852
Telephone: (301) 594-6818
FAX: (301) 594-2314
Email: Mhagan@AHRQ.gov
o Direct your questions about peer review issues to:
Pat Thompson, Ph.D.
Director, Division of Scientific Review
Office of Research Review, Education and Policy
Agency for Healthcare Research and Quality
2101 E. Jefferson Ave., Suite 401
Rockville, MD 20852
Telephone: (301) 594-1404
FAX: (301) 594-0154
Email: pthompso@AHRQ.gov
o Direct your questions about financial or grant management matters
to:
George (Skip) Moyer
Grants Management Specialist
Division of Grants and Contracts Management
Agency for Healthcare Research and Quality
2101 East Jefferson Street, 6W23
Rockville, MD 20852
Telephone: (301) 594-1842
FAX: (301) 594-3210
Email: SMoyer@AHRQ.gov
LETTER OF INTENT
Prospective applicants may submit a letter of intent that includes the
following information:
o Descriptive title of the proposed research
o Name, address, and telephone number of the Principal Investigator
o Names of other key personnel
o Participating institutions
o Number and title of this RFA
Although a letter of intent is not required, is not binding, and does
not enter into the review of a subsequent application, the information
that it contains allows AHRQ staff to estimate the potential review
workload and plan the review. The letter of intent may to be sent at
any time prior to submission of the application. The letter of intent
should be sent to:
Michael Hagan
Center for Organization and Delivery Studies
Agency for Healthcare Research and Quality
2101 East Jefferson Street, 6W37
Rockville, MD 20852
Telephone: (301) 594-6818
FAX: (301) 594-2314
Email: MHagan@AHRQ.gov
AHRQ Data
If applicable, AHRQ encourages research applications that will use data
from the Medical Expenditure Panel Survey, or MEPS
http://www.ahrq.gov/data/mepsix.htm
the Healthcare Cost and Utilization Project, or HCUP-3
http://www.ahrq.gov/data/hcup/ and other AHRQ sources.
MEPS is a rich data source for healthcare utilization, expenditure and
insurance information. MEPS directly links data about persons and their
families with information obtained from their employers, insurers and
healthcare providers. It is the third in a series of nationally
representative surveys of medical care use and expenditures in the
U.S.. Unlike its predecessors, MEPS is an ongoing survey. MEPS collects
data on the specific health services that American 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. Current information on the availability of MEPS data is on
the MEPS section of the AHRQ Web site (http://www.ahrq.gov).
The HCUP includes databases covering 1988 -1999, with 2000 data
available in 2002. These all-payer databases were created through a
Federal- State-industry partnership to build a multistate healthcare
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 29 states. Other HCUP databases contain ambulatory surgery
data from 15 states. These databases can be directly linked to county-
level data form the Health Resources and Services Administration"s Area
Resource File and to hospital-level data from the Annual Survey of the
American Hospital Association.
SUBMITTING AN APPLICATION
Applications must be prepared using the PHS 398 research grant
application instructions and form (rev. 5/2001). The PHS 398 is
available at http://grants.nih.gov/grants/funding/phs398/phs398.html in
an interactive format. For further assistance contact GrantsInfo,
Telephone 301-710-0267, Email: GrantsInfo@nih.gov.
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 .
Applications submitted in the Modular format will be returned without
review.
USING THE RFA LABEL: The RFA label available in the PHS 398 (rev.
5/2001) application form must be affixed to the bottom of the face page
of the application. Type the RFA number on the label. Failure to use
this label could result in delayed processing of the application such
that it may not reach the review committee in time for review. In
addition, the RFA title and number must be typed on line 2 of the face
page of the application form and the YES box must be marked. The RFA
label is also available at:
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
SENDING AN APPLICATION TO NIH and AHRQ: Submit a signed, typewritten
original of the application, including the checklist, and three 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 (20817 for express/courier service)
At the time of submission, two additional copies of the application,
labeled "Advanced Copy (s)" must also be sent to:
Michael Hagan
Center for Organization and Delivery Studies
Agency for Healthcare Research and Quality
2101 East Jefferson Street, 6W37
Rockville, MD 20852
Telephone: (301) 594-6818
FAX: (301) 594-2314
APPLICATION PROCESSING: Applications must be received by the receipt
date listed in the heading of this RFA. If an application is received
after that date, it will be returned to the applicant without review.
The CSR and AHRQ will not accept any application in response to this
RFA that is essentially the same as one currently pending initial
review unless the applicant withdraws the pending application. The CSR
and AHRQ will not accept any application that is essentially the same
as one already reviewed. This does not preclude the submission of
substantial revisions of applications already reviewed, but such
applications must include an Introduction addressing the previous
critique.
Applicants are encourage to read all PHS Forms 398 instructions prior
to preparing an application in response to this RFA. The PHS 398 type
size requirements (p.6) will be enforced rigorously and non-compliant
applications will be returned. State and local government applicants
may use PHS 5161-1, Application for Federal Assistance (rev. 5/96), and
follow those requirements for copy submission.
Prior to IRB Approval
Beginning with applications for AHRQ submitted for the February 1, 2001
receipt date, Institutional Review Board (IRB) approval of human
subjects is not required prior to peer review of an application unless
otherwise indicated by the Agency
(http://grants.nih.gov/grants/guide/notice-files/NOT-HS-00-003.html.)
All investigators/applicants proposing research involving human
subjects should pay particular attention to the instructions in the
form PHS 398 regarding human subject involvement.
AHRQ program staff listed under INQUIRIES should be notified of
approvals as soon as possible, if approvals occur after grant
submission. The "AHRQ Revised Policy for IRB Review of Human Subjects
Protocols in Grant Applications" was published in the NIH Guide on
September 27, 2000. (http://grants.nih.gov/grants/guide/notice-
files/not-hs-00-003.html).
The RFA is also available on AHRQ"s Web site, http://www.ahrq.gov,
(under Funding Opportunities) 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 RFA number). The RFA 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 expects grant recipients to keep the Agency informed of
publications as well as the known uses and impact of their Agency-
sponsored research. Applicants (or grant recipients) are to agree to
notify AHRQ immediately when a manuscript based on research supported
by the grant is accepted for publication, and to provide the expected
date of publication as soon as it is known, regardless of whether or
not the grant award is still active. Additionally, in carrying out its
stewardship of research 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 AHRQ-sponsored research.
To receive an award, applicants must agree to submit an original and 2
copies of an abstract, executive summary, and full report of the
research results in the format prescribed by AHRQ no later than 90 days
after the end of the project period. The executive summary should be
sent at the same time on a computer disk which specifies on the label
the format used (WP5.1 or WP6.0 is preferable).
Application Preparation (for Using Center for Medicare and Medicaid
Services (CMS) Data)
For applications that propose to use Medicare and Medicaid data that
are individually identifiable, applicants should state explicitly in
the Research Design and Methods section of the Research Plan (form 398)
the specific files, time periods, and cohorts proposed for the
research. In consultation with the Center for Medicare and Medicaid
Services (CMS), formerly Health Care Financing Administration (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. To avoid double
counting, applicants should not include the cost of the data in the
budget.
Applicants should be aware that for individually identifiable Medicare
and Medicaid data, the Principal Investigator and his or her grantee
institutions will be required to enter into a Data Use Agreement (DUA)
with CMS to protect the confidentiality of data in accordance with
standards set out in 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
CMS or certify that the data have been destroyed. For the sole purpose
of assuring that data confidentiality is maintained, included in the
DUA is the requirement that the User agrees to submit to CMS, a copy of
all findings within 30 days of making such findings. The user agrees
not to submit these findings to any third party (including but not
limited to any manuscript to be submitted for publication) until
receiving CMSs approval to do so. Grantees must also comply with the
confidentiality requirements of Section 924(c) of the PHS Act. See the
Data Confidentiality section below for details on these requirements as
well as references to Circular A-130 and its implementation guides from
the National Institute of Standards and Technology.
In developing research plans, applicants should allow time for
refining, approving and processing their data requests. Requests may
take six months from the time they are submitted to complete.
Applications proposing to contact beneficiaries or their providers
require the approval of the CMS administrator and may require
meeting(s) with CMS staff. CMS data are provided on IBM mainframe tapes
using the record and data formats commonly employed on these computers.
Applicants should either have the capability to process these tapes and
formats or plan to make arrangements to securely convert them to other
media and formats. Questions regarding CMS data should be directed to
the AHRQ program official listed under INQUIRIES.
PEER REVIEW PROCESS
Upon receipt, applications will be reviewed for completeness and
responsiveness to the RFA. Incomplete and/or non-responsive
applications will be returned to the applicant without further
consideration. Applications that are complete and responsive to the
RFA will be evaluated for scientific and technical merit by an
appropriate peer review group convened in accordance with standard AHRQ
peer review procedures (codified at 42 CFR Part 67).
As part of the merit review, all applications will:
o Receive a written critique
o Undergo a process in which only those applications deemed to have
the highest scientific merit will be discussed and assigned a priority
score.
REVIEW CRITERIA
The goal of this AHRQ-supported project is the evaluation of
demonstration projects supported under the RWJF "Rewarding Results"
initiative in order to provide important, accurate, and timely
information to decision makers about how pragmatic changes in the
nature of payment and non-financial incentives may be linked to
desirable changes in the quality of health care.
In their written comments, reviewers will be asked to discuss the
following aspects of your application in order to judge the likelihood
that the proposed evaluation and research project will have substantial
impact on pursuit of this goal:
o Significance
o Approach
o Innovation
o Investigator
o Environment
The scientific review group will address and consider each of these
criteria in assigning your application"s overall score, weighting them
as appropriate for each application. It is not necessary that your
application be especially strong in all categories to be judged likely
to have a major scientific impact and thus deserve a high priority
score. In particular, you may propose to carry out your project in a
straightforward and standard manner that, while not innovative, very
appropriately addresses the most significant aspects of the evaluation
and research issues involved under this particular initiative.
(1) SIGNIFICANCE: Does the proposed evaluation and research address
the most significant aspects of relationships among payment, non-
financial incentives, and health care quality improvement? If the
articulated aims of the evaluation and research are achieved, will
scientific and practical knowledge about the relationships among
payment, non-financial incentives, and health care quality be advanced
in an important way?
(2) APPROACH: Are the conceptual framework, design, methods, and
analyses adequately developed, well integrated, and appropriate to the
aims of the project? Have all aspects of data collection and
management for the project been considered, with appropriate attention
to the quality and timeliness of data collection? Will data management
and analysis ensure that conclusions are valid? Do you acknowledge
potential problem areas and consider alternative tactics? Is the
proposed evaluation approach flexible enough to account for variance
across demonstration projects in their specific changes in payment and
in non-financial incentives, in their quality goals and performance
measures, etc.?
(3) INNOVATION: Does your project employ novel concepts, approaches or
methods? Are the aims original and innovative? Does your project
challenge existing paradigms or develop new methodologies or
technologies?
(4) INVESTIGATOR: Are you appropriately trained and well suited to
carry out this work? Is the work proposed appropriate to your
experience level as the Principal Investigator and to that of other
researchers (if any)? Are the numbers and roles of staff for the study
defined and justified? Do the investigators have experience with
identifying and applying appropriate evaluation methodologies and
research designs, especially in the context of health care payment,
non-financial incentive systems, and health care quality improvement?
Do the investigators have experience working with governmental agencies
in the performance of evaluation and research studies? Do the
investigators have appropriate experience in the design and
implementation of qualitative methods?
(5) ENVIRONMENT: Does the study environment in which your work will be
done contribute to the probability of success? Do the proposed
analyses take advantage of unique features of the environment or employ
useful collaborative arrangements? Is there evidence of institutional
support and capacity to undertake the proposed project?
ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your
application will also be reviewed with respect to the following:
o PROTECTIONS: The adequacy of the proposed protection for humans or
the environment, to the extent they may be adversely affected by the
project proposed in the application.
o INCLUSION: The adequacy of plans to include subjects from both
genders, all racial and ethnic groups (and subgroups), and children as
appropriate for the scientific goals of the research. Plans for the
recruitment and retention of subjects will also be evaluated. (See
Inclusion Criteria included in the section on Federal Citations, below)
o BUDGET: The reasonableness of the proposed project budget and the
requested period of support in relation to the proposed research.
DATA SHARING
Data Confidentiality
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 disclosures of such data. In the Human Subjects section of
the application, applicants must describe procedures for ensuring the
confidentiality of the identifying information to be collected. 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 awardee 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/. The application of
these confidentiality and security standards to subcontractors and
vendors, if any, should be addressed.
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).
RECEIPT AND REVIEW SCHEDULE
Letter of Intent Receipt Date: April 20, 2002
Application Receipt Date: May 20, 2002
Peer Review Date: July/August 2002
Earliest Anticipated Start Date: September 1, 2002
AWARD CRITERIA
Award criteria that will be used to make award decisions include:
o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
REQUIRED FEDERAL CITATIONS
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 UPDATED "NIH Guidelines on the Inclusion of Women and
Minorities as Subjects in Clinical Research," published in the NIH
Guide for Grants and Contracts on August 2, 2000
(http://grants.nih.gov/grants/guide/notice-files/not-od-00-048.html).
A complete copy of the updated Guidelines is available at
http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm.
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
Program staff may also provide additional information concerning these
policies (see INQUIRIES).
AHRQ also encourages investigators to consider including children in
study populations, as appropriate.
PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT:
The Office of Management and Budget (OMB) Circular A-110 has been
revised to provide public access to research data through the Freedom
of Information Act (FOIA) under some circumstances. Data that are (1)
first produced in a project that is supported in whole or in part with
Federal funds and (2) cited publicly and officially by a Federal agency
in support of an action that has the force and effect of law (i.e., a
regulation) may be accessed through FOIA. It is important for
applicants to understand the applicability of the amendment. NIH has
provided guidance at
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. It
is not likely that data gathered under projects supported through this
initiative will be used as a basis for federal regulation or action
having the force and effect of law, but it is possible. Were that the
case, the OMB Circular would then require disclosure of data underlying
the evidence upon which Federal policy decisions were made, if someone
requested this data under the Freedom of Information Act. However, the
above-cited AHRQ confidentiality statute protects individually
identifiable data and limits disclosures to those consented to by the
subjects or suppliers of consent, underlying data gathered for this
evaluation may only be made available in nonidentifiable form,
aggregated to prevent identification of subjects or with all
identifying information concealed.
Should applicants wish to place data collected under this RFA in a
public archive, which can provide protections for the data (e.g., as
required by the confidentiality statute applicable to AHRQ supported
projects, 42 U.S.C. 299c-3c) and manage the distribution of non-
identifiable data for an indefinite period of time, they may. The
application should include a description of any archiving plan in the
study design and include information about this in the budget
justification section of the application. In addition, applicants
should think about how to structure informed consent statements and
other human subjects procedures given the potential for wider use of
data collected under this award.
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.
AUTHORITY AND REGULATIONS: This program is described in the Catalog of
Federal Domestic Assistance, Number 93.226. Awards are made under
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.
REFERENCES
Crossing the Quality Chasm: A New Health System for the 21st Century,
Committee on Quality of Health Care in America, Institute of Medicine,
Washington, D.C., National Academy Press, 2001.
Rossi, Peter H. and Freeman, Howard E., Evaluation: A Systematic
Approach--5, Newbury Park, California, Sage Publications, 1993.
Qualitative Methods in Health Services Research (A Special Supplement),
Kelly Devers, Shoshanna Sofaer, and Thomas Rundall, editors, Health
Services Research, December 4, 1998.
Weekly TOC for this Announcement
NIH Funding Opportunities and Notices
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