Department of Health and Human Services
Part 1. Overview Information
Participating Organization(s)

Agency for Healthcare Research and Quality (AHRQ)

NOTE:  The policies, guidelines, terms, and conditions stated in this announcement may differ from those used by the NIH. 

 

Where this Notice of Funding Opportunity Announcement (NOFO) provides specific written guidance that may differ from the general guidance provided in the grant application form, please follow the instructions given in this NOFO.

Also note that AHRQ has different page limits than NIH for the application Research Strategy, which can be found within each individual NOFO.

Components of Participating Organizations

Agency for Healthcare Research and Quality (AHRQ)

Funding Opportunity Title

Consumer Assessment of Healthcare Providers and Systems (CAHPS) VI (U18)

Activity Code

U18 Research Demonstration – Cooperative Agreements

Announcement Type

New

Please note that AHRQ will only accept New applications. Renewal applications will not be accepted.

Notice of Funding Opportunity Announcement (NOFO) Number

RFA-HS-22-007

Companion Funding Opportunity

None

Assistance Listing Number(s)

93.226

Funding Opportunity Purpose

The purpose of this Notice of Funding Opportunity (NOFO) is to invite cooperative agreement applications to continue the work of the Consumer Assessment of Healthcare Providers and Systems (or CAHPS®) Cooperative Agreement program, initiated in 1995 by the Agency for Healthcare Research and Quality (AHRQ).

Key Dates
Posted Date

March 29, 2022

Open Date (Earliest Submission Date)

April 4, 2022

Letter of Intent Due Date(s)

30 days prior to the application due date

Application Due Date(s)

June 6, 2022

All applications are due by 5:00 PM local time of applicant organization.

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

Late applications will not be accepted.

AIDS Application Due Date(s)

Not applicable

Scientific Merit Review

Generally, four months after receipt date

Advisory Council Review

Not applicable

Earliest Start Date

Generally, four months after the peer review date

Expiration Date

June 7, 2022

Due Dates for E.O. 12372

Not Applicable

Required Application Instructions

It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed to do otherwise (in this NOFO or in a Notice from the NIH Guide for Grants and Contracts). Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced. Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV and follow the AHRQ Grants Policy and Guidance found on the AHRQ website at http://www.ahrq.gov/funding/policies/nofoguidance/index.html.

When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Applicants who propose the use of identifiable Centers for Medicare and Medicaid Services (CMS) data are advised to review NOT-HS-19-007 (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-19-007.html) for important changes to how applicants are to budget for the cost of this data.


Table of Contents

Part 1. Overview Information
Part 2. Full Text of the Announcement

Section I. Funding Opportunity Description
Section II. Award Information
Section III. Eligibility Information
Section IV. Application and Submission Information
Section V. Application Review Information
Section VI. Award Administration Information
Section VII. Agency Contacts
Section VIII. Other Information

Part 2. Full Text of Announcement
Section I. Funding Opportunity Description

Background: Overview of CAHPS

Since its inception in 1995, the CAHPS program has advanced the science of patient experience, particularly through the development of CAHPS surveys and related materials that allow consumers to assess their quality-related experiences with their health plans, from providers, and in health care facility settings (see https://www.ahrq.gov/cahps/about-cahps/cahps-program/index.html). CAHPS surveys ask consumers and patients to report on and evaluate their experiences with health care services. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The CAHPS Program also conducts research to increase knowledge of patient experience, and how patient experience should best be measured and improved. The CAHPS Program also includes, as well as develops, tools to assist in analyzing CAHPS data and improving patient experience.

The CAHPS Program has continuously funded cooperative agreements in 5-year increments called 'competitive segments' since 1995. In this new competitive segment, referred to as CAHPS VI, AHRQ intends to support two cooperative agreements. The AHRQ CAHPS Program also supports a CAHPS User Network contractor that provides support to the Program regarding materials development, communications, education programs, and other activities including program operations.

The acronym "CAHPS" is a registered trademark of the US Department of Health and Human Services and maintained by AHRQ.

 

History of AHRQ’s CAHPS Program:

AHRQ’s CAHPS Program was first funded in 1995 to address consumer needs for healthcare quality information. AHRQ (at that time named the Agency for Health Care Policy and Research (AHCPR)) was concerned about questions consumers should be asking about health plans, and available sources of information to address those questions (1). Preliminary work showed that the few existing surveys on this topic did not represent the consumer perspective, and were, instead, focused on presenting information for industry use.

The initial funding for the CAHPS program awarded three cooperative agreements and one support contract to develop surveys whose results could be compared across entities (health plans), and developed reports accessible and understandable to consumers. Given the high stakes use for reports, AHCPR envisioned a collaborative team that informed standard setting for reporting and consistency in methodology and product development. The grantees and AHCPR staff developed processes to endure that the needs for collaboration and consistency would be met, including the formulation of cross-grantee teams. The cross-grantee teams each established their requirements for producing collaborative work to ensure consistency in all product development activities. The grantees, along with AHCPR, also established principles guiding product development, including methods and standards that are necessary to produce valid and reliable surveys that allow for comparisons across settings, as well as other CAHPS Program guiding principles that have structured and still guide program activities and product development. The original program structure is currently in use, although additional teams have been added (e.g., Communications) to meet emerging needs. The methods and standards for survey development can be found in "Getting the CAHPS® Trademark: A Guide for Survey Developers" available upon request from Caren.Ginsberg@ahrq.hhs.gov. For more history on the AHRQ CAHPS Program and products, please see Medical Care, March 1999, 37, 3, Supplement and https://www.ahrq.gov/cahps/about-cahps/index.html.

The CAHPS surveys are now broadly used by governmental agencies such as the Centers for Medicare and Medicaid Services (CMS), and many private sector organizations, including other health care purchasers, and the National Committee for Quality Assurance for a variety of different purposes such as value-based purchasing, public reporting, and accreditation (see https://www.ahrq.gov/cahps/surveys-guidance/index.html).

Throughout the expansion of the CAHPS Program and its products, AHRQ has maintained its unique role as the agency sponsoring independent research to ensure that the surveys and related materials are current, responsive to the user community and changing health service delivery needs, enhance patient-centeredness, improve patient experience and use the best survey science in questionnaire development and survey administration. To promote those goals, the CAHPS team has developed surveys and supplemental item sets to be used with a CAHPS survey; survey administration guidelines; research addressing survey mode and length, guidance for reporting CAHPS data to consumers, providers and other audiences and focused research on quality improvement. The supplemental item sets include the development of patient narrative items that are used in conjunction with a CAHPS survey to strengthen their value. (Detailed information about CAHPS products and history can be found athttps://www.ahrq.gov/cahps/index.html.)

The CAHPS program is the lead innovator in consumer assessment of a patient’s experience in health care. Now entering its 27th year of funding from AHRQ, the understanding and importance of patient experience, and the methodological approaches and considerations in assessing and reporting what happens in a healthcare encounter have matured significantly from the original health plan CAHPS survey. The AHRQ CAHPS program is the lead in developing methodology for assessment, incorporating patients and stakeholders in a collaborative process to develop meaningful and relevant measurement tools and approaches, including the development of patient narratives, reporting patient experience, and data-driven quality improvement research from the perspective of what’s important to patients.

The CAHPS surveys have become the primary tool for measuring patient experience to enhance patient-centered medical care. CAHPS survey methods research has contributed significantly to the discussion of effective modes of administering CAHPS surveys based on the responsiveness and representativeness of specific patient populations. AHRQ intends for this funding opportunity to serve as a mechanism to further the knowledge of patient experience, CAHPS instrument development and refinement, survey methods research, and to further integrate patient experience measurement and perspectives into health service delivery.

 

CAHPS Team Organization:

The CAHPS Program decided to adopt a work process and organization to ensure consistency in establishing national standards for patient experience and facilitate communication and cooperative development of surveys and reporting of patient experience results for consumer choice. The resulting team structure was composed of representatives from each funded entity, the User Network Contractor, and AHRQ staff. The structure continues to exist and has proven successful to enhanced communication and joint decision-making about establishing measurement standards and other work of the teams. The team structure has remained largely intact since its inception but given the collaborative nature and communication needs surrounding the development of national standards, funded grant Project Directors/Principal Investigators (PDs/PIs) and AHRQ will need to determine whether the current structure of team collaboration is still optimal.

Currently, all teams include personnel from each grantee organization, either a PI, staff member, or both; a representative from the User Network contract, and AHRQ staff. The current working teams include the following, and are organized to conduct research, develop a particular survey, reporting resource, quality improvement guide, or other product.

CAHPS Consortium: The CAHPS Consortium provides technical oversight to the CAHPS Program and products.

  • CAHPS Survey Instrument Team: The CAHPS Instrument Team members collaborate on activities involving the development, ongoing maintenance, and stewardship of the CAHPS surveys and supplemental items, and the trademarking of surveys and item sets seeking to use the CAHPS trademark. The team uses a standard multi-step and evidence-based approach to reviewing and updating CAHPS survey instruments (see https://www.ahrq.gov/sites/default/files/wysiwyg/cahps/about-cahps/research/cahps-survey-instruments.pdf).
  • CAHPS Communication Team: The CAHPS Communications Team is responsible for internal (to the program and the Agency) and external communications and program messaging to the public. The CAHPS Program provides frequent communications, technical assistance, and learning programs to a variety of stakeholders and other audiences. These communications include program goals, new research, product launches, and product training in many ways as determined by audience analysis and user feedback. The CAHPS program, supported by the CAHPS Communication Team uses a variety of communication strategies to deliver this information including online methods, research publications, and presentations.
  • CAHPS Reports Team: Historically, this team worked to establish best practices in reporting quality information to consumers. Currently, this team focuses on the development of patient narrative questions that can be added as supplemental items to existing CAHPS surveys.
  • CAHPS Quality Improvement Team: The CAHPS Quality Improvement Team developed and continues to update the Ambulatory Care Quality Improvement Guide. Additionally, this team meets to discuss the quality improvement research.
  • CAHPS Analysis Team: This team meets intermittently as questions about data analysis arise or to update analytic software (the “CAHPS macro”).

Promoting equity is an important societal goal. AHRQ intends that research funded by the agency contribute to this goal by addressing equity. AHRQ encourages applicants responding to this NOFO to consider whether there are equity issues in their proposed projects and, where relevant, to address these issues in the proposed research plan.

Pursuant to its authorizing legislation, see 42 U.S.C. 299(c), AHRQ conducts and supports research for AHRQ priority populations (see Section IV.7 for a list of priority populations).  AHRQ is interested in research that includes a focus on priority populations such that meaningful subgroup analysis can be conducted and results stratified by priority population can be produced.

 

Research Objectives

This NOFO invites grant applications to conduct research within five broad areas:

  • (1) Survey and supplemental item set development, revision and trademarking;
  • (2) Survey methods research aimed at achieving equity;
  • (3) Analysis and reporting of patient experience data;
  • (4) Patient experience quality improvement studies based on CAHPS data; and
  • (5) Developing internal and external program communication strategies.

 

Each of these areas is described in detail below.

This NOFO lists areas for research in support of AHRQ’s goals, and approaches to this research as examples of work that could be performed in support of a particular effort. Applicants should not be constrained by these suggestions and can propose subject matter or topics for measurement that fulfill programmatic and agency goals, including the support of investigator-led research to better understand patient experience with health care and develop scientifically valid and feasible strategies and tools to assess patient experience and its measurement, and support the CAHPS patient experience measurement standards; and use patient experience data to improve the quality of care.

The successful adoption and implementation of CAHPS products is based on collaboration among potential users, stakeholders, health professional organizations, health advocacy groups and many other people and organizations. Also, development and promotion of maximally useful CAHPS products depends on cooperation, trust and open sharing of information and participation within the CAHPS team structure. In describing their ability to perform the research in response to this NOFO, applicants must highlight their experience with, and ability and willingness to work as, part of collaborative teams in addition to their technical skills and research-related experience. Applicants are encouraged to develop partnerships with organizations that could provide opportunities for field testing CAHPS surveys and other products.

Applicants must propose research to support each of the 5 areas below. Applicants must propose at least one research project in support of Research Areas 1A, 1B, 2, 3, 4, and describe their approach to participating in Area 5. Applicants can combine activities from these different topic areas to meet a specific research goal, but all topic areas must be addressed. For example, it would be acceptable if an applicant proposed developing a new CAHPS supplemental item set (Area 1A) in support of their quality improvement research (Area 4).  The budget allocation estimates for the following areas of work are to be used as general guidance in preparing an application.

Area 1. Survey and supplemental item set development, revision and trademarking

The CAHPS Program intends to continue its work to develop and revise patient experience surveys and supplemental item sets, as well as to administer the CAHPS trademark for surveys to ensure that they meet the qualifications for a national standard, described in "Getting the CAHPS® Trademark: A Guide for Survey Developers" (the CAHPS Survey Developers Guide). The CAHPS Survey Developers Guide was developed by the CAHPS Program to provide consistency and standards in survey development activities that ensure standardization in survey and measure development. Surveys that meet the standards in development and testing can use the CAHPS trademark on the survey instrument. (To request copies of "Getting the CAHPS® Trademark: A Guide for Survey Developers" contact Caren.Ginsberg@ahrq.hhs.gov).

While the CAHPS Survey Developers Guide identifies the steps and standards in CAHPS survey development, AHRQ is interested in applicants’ approach to and considerations about developing a survey, supplemental item set, or both to address patient experience for a particular topic area or setting; any research needed to inform this survey development activity; setting(s) of care and unit(s) of analysis; approach to working with stakeholders; approach and considerations towards identifying cognitive testing respondents and designing a pilot test for the survey; and a discussion of proposed survey administration methods. This discussion should emphasize the goal of achieving health equity. Applicants should address barriers to, and facilitators of, achieving the goal of a CAHPS survey. This will necessitate a thoughtful review of issues/challenges that are likely to be raised when the survey is considered for a CAHPS trademark, as well as any suggestions or strategies regarding how these issues/challenge(s) can be satisfied to expedite the awarding of the CAHPS trademark.

Area 1A. Survey and item set development

Applicants must identify at least one (1) area of survey or supplemental item set to develop over the course of this cooperative agreement. AHRQ is interested in applicants’ proposed foundational work that is necessary to develop standard patient experience measures in their selected area; the principles that would guide their survey or supplemental item development process and testing methods; how a survey or supplemental item set might be used; and considerations in developing survey administration recommendations.

In addition, applicants must describe how their choice of area for survey or supplemental item set development would contribute to knowledge of patient experience of care, and why measurement is needed in this area.

Survey and supplemental item set development must follow guidance detailed in the CAHPS Survey Developer's Guide. Applicants are encouraged to follow the principles specified within the Survey Developer’s Guide and CAHPS Design Principles when describing their methodological approaches and background research for survey or supplemental item set development.  Applicants interested in viewing "Getting the CAHPS® Trademark: A Guide for Survey Developers" can request the document directly from Caren.Ginsberg@ahrq.hhs.gov. The CAHPS Design Principles can be accessed here: https://www.ahrq.gov/cahps/bibliography/index.html?f%5B0%5D=facets_biblio_topics%3A14532 Any proposed narrative item set development must follow the patient narrative development processes described in the CAHPS website bibliographic references at https://www.ahrq.gov/cahps/bibliography/index.html?f%5B0%5D=facets_biblio_topics%3A14532.

AHRQ is open to topic areas but is interested in developing a CAHPS patient experience measurement instrument (core survey or a supplemental item set to be used with an existing CAHPS core survey) for the inpatient mental health setting. Other potential areas of interest could include patient experience with respectful care, perceived bias, trust, patient safety, understanding experience of care for the disabled, or in clinical trials as supplemental item sets that could be used with other existing core surveys such as the CAHPS Clinician and Group Survey, Hospital CAHPS survey, or Health Plan Survey. Applicants should feel free to suggest other settings and topics for CAHPS surveys and item sets, with an accompanying proposed approach and details about the anticipated prospective use.

Area 1B. Survey and item set revision

The applicants must describe a minimum of one (1) existing CAHPS survey or item set to revise over the course of this Cooperative Agreement. Applicants must propose an existing CAHPS survey or supplemental item set which appears on the CAHPS website that would need a substantial update to remain current with user needs or current arrangements in health care services. In their applications, applicants should consider the steps in the CAHPS Survey Developers Guide in their update and specify why those steps might or might not be necessary in the update process. AHRQ is interested in the applicant’s reasoning and approach to and need for this update, considerations in planning an update, the role of stakeholders and patients in this process, and the barriers and facilitators towards its completion. AHRQ is interested in seeing approaches to the revision of Health Plan 5.0/5.1 and the CAHPS Clinician and Group 3.0/3.1 surveys but is open to other topic areas. The Instrument Team will prioritize the survey and item set updates and will proposed a team structure in which grantees share in the responsibility for designing, developing, and completing the work of the update.

Applicants should propose considerations to updating surveys and/or supplemental item sets such as reasons for the proposed update, potential new domains, approaches to identifying stakeholder needs, and research needed to update surveys. Through their participation on the instrument team, they should plan for participation in and cooperative approaches to at least two (2) substantial survey updates over the 5 years of this cooperative agreement and take the lead in directing the update of their proposed area.

The CAHPS Instrument team works collaboratively to conduct work on jointly decided topics related to CAHPS instrumentation. During the course of the project period, grantees will decide the team structure that would allow them to work collaboratively. Currently, the Instrument Team meets weekly. The Instrument Team is composed of the Principal Investigators (full team) in addition to a designated instrument design specialist from each grantee organization (sub-team). The Full Instrument team activities include the work of the CAHPS Consortium regarding all survey development, and they jointly decide on the work on which the team collaborates. Examples of this work jointly undertaken by the Instrument Team include a thorough review of all CAHPS supplemental items, and the development of the Clinician and Group CAHPS Survey v4 (beta) (developed with additional AHRQ funding in response to the COVID-19 pandemic), as well as providing review to survey development and revision activities.

The CAHPS Instrument team also provides oversight to the process by which externally developed surveys seeking to use the CAHPS trademark. CAHPS Consortium members developed this Instrument team structure and function in order to fulfill their mission of ensuring consistency in the patient experience measure development process. This review process applies to all surveys under development or revision that aim to secure use or continue use of the CAHPS trademark. The grantees apply this review process to all survey development or revision projects. They, along with other members of the CAHPS Consortium (AHRQ CAHPS staff, and the CAHPS Survey User Network Contractor), meet regularly with survey developers, review plans and progress, and provide feedback that developers must follow to secure use of the CAHPS trademark. All of these steps are outlined in the CAHPS Survey Developers guide.

Area 2. Survey methods research aimed at achieving health

Another focus of this NOFO is on the pursuit of research about survey methodology topics to advance health equity. Potential topics are explored in the examples below, although applicants can propose other areas of research to achieve health equity aims. Applicants must propose at least one (1) study of survey methods research aimed at achieving health equity. This research can be conducted as part of the work to develop/revise a survey and/or supplemental item set or can be conducted independently of a survey development activity. For all proposed topic(s), applicants should articulate an approach that includes a literature review to further refine an area of survey methods research relevant to CAHPS surveys that can improve health equity. Further, applicants should develop a research plan that may include cognitive interviews, focus groups, instrument development, and field testing, among other survey development/refinement activities.

Example:    Research on survey administration methodology

An important emphasis of the CAHPS program is the achievement of health equity, including through the pursuit of research on survey administration methodologies appropriate for CAHPS surveys. In keeping with this CAHPS program goal, applicants are encouraged to submit proposals for research studies that evaluate the effectiveness of survey administration modes and methods that may facilitate CAHPS survey participation by underserved patients and/or those who may have limited means of participating in CAHPS surveys. Prospective topics under the rubric of survey administration research include non-response analysis, examining the characteristics and patterns associated with respondents who are eligible to participate in CAHPS surveys, but who do not participate, whether through their own volition or through challenges associated with completing CAHPS surveys. Non-response study results may glean valuable insights that can be used to advance health equity efforts.

The ongoing use of mail and phone methodologies to administer CAHPS surveys, including the increasing use of web-based administration options, provides another line of inquiry important to the successful administration of CAHPS survey users. While CAHPS V work explored the responsiveness and representativeness of CAHPS survey administration methodologies, generally finding that a multi-mode administration yields the highest response rates, web-only administration was found to yield the lowest response rates. Future research into differential non-response associated with data collection mode (e.g., interview; web; telephone; mail; etc.) or type of response (web or paper) can explore the response patterns associated with potential survey respondents. These research studies may yield substantive insights that could leave increased response rates, particularly among underserved patients.

Applicants could propose research studies that focus on identifying those survey administration modes that most successfully boost participation rates among multiple patient group(s), including historically under-represented patient groups. 

Example:    Measurement of sexual orientation and gender identity (SOGI)

Another potential topic that applicants could pursue is the development, administration, analysis and/or reporting of measures about sexual orientation (SO) and gender identity (GI). Currently, there is a need to collect CAHPS survey information from populations that are frequently under-represented in healthcare surveys to help promote and ensure health equity. The collection of accurate and reliable data measuring SOGI in CAHPS surveys can help achieve advances in healthcare access and health equity for under-represented patient groups who may experience limitations in access to quality healthcare and/or less than positive healthcare experiences.

To better understand the diverse needs of SOGI populations, more representative and better quality data are needed, particularly given the multitude of methodological challenges associated with collecting SOGI information from patients (and, as appropriate, their families). These challenges include conceptual complexities in accurate operationalization of SOGI questions; respondents’ conflation of sexual identity and gender identity; variations in how SOGI items perform in languages other than English and across cultures as well as within semantic translations; degree of comfort in asking SOGI questions of respondents; respondent concerns about privacy of their responses; respondent understanding of SOGI concepts and questions; and measurement challenges such as respondent misinterpretation, item nonresponse, and social desirability.

Because these multiple challenges can lead to item non-response, measurement error and/or the collection of inaccurate data, focused research studies are needed that can inform the future collection of SOGI information from patients with increased accuracy and sensitivity to the needs of patients and their families.

Area 3. Analysis and reporting of patient experience data

The CAHPS Program has a long historical emphasis on the analysis and reporting of CAHPS data. Past CAHPS grantees have developed and conducted research projects to advance the science of reporting healthcare quality information to consumers and other audiences. Applicants must propose research that examines the analysis and reporting of CAHPS patient narrative data. Applicants can also propose additional research about reporting CAHPS data to consumers and to providers and their organizations. Applicants must demonstrate their research experience in this area and propose an approach to further advance reporting of CAHPS data for the purpose(s) of consumer choice and/or quality improvement. Applicants can consider developing on-line tools or other systems for quality reporting purposes.

Research to support analysis, reporting, and use of CAHPS Narrative Elicitation data (CAHPS patient narratives) for consumer choice and quality improvement.

AHRQ is interested in research to advance the reporting and analysis of patient narrative information stemming from the CAHPS patient narrative supplemental item sets. AHRQ has invested a significant amount of support and commitment to the effective capture of patient experience in multiple healthcare settings and various health conditions through the use of patient narratives. These narratives have been collected through a structured series of open-ended questions added to the end of CAHPS and other patient experience surveys. CAHPS patient narrative items are open-ended questions that prompt survey respondents to tell a clear and detailed story about their healthcare experiences and are administered as CAHPS Supplemental Item Sets that accompany CAHPS core surveys (see, for example Schlesinger M,  2018; https://pubmed.ncbi.nlm.nih.gov/30293521/

 and Grob et al, 2019 https://pubmed.ncbi.nlm.nih.gov/30883954). 

Patient narratives provide considerable insight into the experience of patients and offer a valuable complement to standardized survey scores, helping clinicians to understand and improve the patient’s experience of care. CAHPS narrative items generate insights into the topics addressed by the survey’s measures in addition to other important aspects of patient experience that may not be captured by closed-ended questions.

The CAHPS narrative elicitation research program has four major components designed to advance the science and implementation of patient narratives:

  • Narrative Elicitation: The systematic prompting of patients to describe their experiences through a structured set of open-ended questions developed and tested with the same degree of scientific rigor used in the development of CAHPS closed-ended survey questions.
  • Narrative Analysis: The development of analysis methods for carefully extracting key insights revealed by narratives through both human coding and machine learning techniques.
  • Use of Narratives in Public Reporting: The development of methods for reporting narrative information to consumers in ways that complement rather than obscure other performance metrics.
  • Use of Narratives for Improvement: The development of methods for presenting narrative feedback for use by providers and health care organizations to improve patient experience.

Applicants must propose at least one (1) study of CAHPS patient narrative information to: further the analysis of patient narratives using Natural Language Processing (NLP); reporting of patient narratives; using patient narratives for consumer choice; or using patient narratives for quality improvement. This work could emphasize developing tools to analyze narrative text obtained from a variety of CAHPS data users, identify ways to report this information or examine how CAHPS patient narrative information can be used to improve care. Research could also include analyses of using CAHPS patient narrative information to improve health equity or dispel stereotypes about providers. Applications should propose research aimed at using these data in conjunction with CAHPS scores in a way that enhances CAHPS findings.

Area 4. Patient experience quality improvement studies based on CAHPS survey findings to advance the practice of patient experience

The CAHPS Program began with a primary goal of providing information to consumers and purchasers which they could use to guide their health plan selection decisions. As the CAHPS Program has evolved, there has been growing interest in exploring the usefulness of CAHPS data for identifying opportunities and designing strategies to improve the quality of health care from the consumer or patient perspective.

Each applicant must propose at least one (1) quality improvement (QI) study to conduct during the course of the project period. For purposes of this activity, QI is defined as consisting of systematic and continuous actions that lead to measurable improvements in patient experience of care.  Proposed quality improvement studies must be relevant to CAHPS surveys. Description of these study designs must demonstrate that the applicant’s team has the skills and expertise necessary for designing, conducting, implementing, and evaluating such quality improvement studies.

Applicants can propose any topic as the basis for their QI study. Studies can include using CAHPS surveys as pre- and post- measures of change or studies of how CAHPS surveys and data are used in healthcare organizations. Areas of interest for potential QI studies include demonstrating the clinical implications of improving patient experience, including implications for safer patient care; the business case for improving patient experience; and/or exploring the relationship between patient experience and health care worker job satisfaction, workforce burnout, and workplace safety.

In their response to this NOFO, applicants can propose research to support updates to the CAHPS Ambulatory Care Improvement Guide (https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/improvement-guide.html). Applicants could consider proposing studies that employ interventions and measurement strategies that can be used relatively easily and at low cost to other settings.  

As Area 4 focuses on quality improvement studies using CAHPS survey data, quality improvement studies using CAHPS patient narrative data should be addressed in Area 3.

 

Area 5. Developing internal and external program communication strategies

The CAHPS Communications Team is responsible for internal (to the program and the Agency) and external communications and meets weekly as necessary. The current structure of this team includes participation by one Principal Investigator or Co-Principal Investigator from each cooperative agreement and a senior member of the grantee organization project team to serve as representatives to the Communications Team. Representatives from the User Network Contract and AHRQ, including AHRQ's Office of Communications also serve as team members.

Some specific activities of the Communications Team are described below.

A. Annual CAHPS Research Meeting

AHRQ will host an annual one-day meeting to discuss a research topic of interest to CAHPS researchers and users.  Organizations who receive CAHPS VI awards, CAHPS User Network support contractor and AHRQ staff participate in the planning and conduct of an annual meeting. As determined by the team, grantees might present their CAHPS research findings at the meeting. Topics have included quality improvement using CAHPS surveys, CAHPS survey responsiveness and representativeness, and updates on the CAHPS narrative elicitation research.

Grantees' activities (in consultation with the AHRQ Project Officer) will include, but not be limited to: identification of topics, planning the theme of the meeting, developing an agenda, developing content for the sessions and proposing speakers; serving as speakers, moderators or facilitators at the meeting; developing a strategy for soliciting and reviewing proposed sessions for the meeting; and working with the CAHPS User Network support contractor on all other elements of meeting planning, presentation and evaluation. Grantees, the User Network Contractor, and the AHRQ Project Officer will decide whether the meeting will be in person, virtual, or a hybrid of both depending on environmental factors, meeting topic, support, and expected participants.

 

B. Annual CAHPS Planning Meeting

Grantees will attend a one-day annual CAHPS planning meeting held virtually to discuss any ongoing topics of concern, upcoming plans for collaborative efforts and emerging priorities Grantees will collaborate with the AHRQ CAHPS program and the User Network Contractor to develop the agenda and will be prepared to present information to speak to specific issues.

C. Supporting dissemination and promotion activities

Grantees collaborate with the CAHPS User Network contractor as necessary on the development and delivery of materials related to new patient experience of care research, product announcements, general program materials and training.

Such promotion and dissemination could consist, for example, of participating in a WebEx presentation on current research, developing content as necessary for the CAHPS website, or authoring blogs about current work. Topics for these communications will be determined in collaboration with AHRQ CAHPS staff and the CAHPS User Network Contractor. Applicants to this NOFO may wish to suggest successful strategies for reaching CAHPS users with new information about CAHPS research, products, and services. Additional promotional material can consist of authoring program briefs, FAQs about CAHPS surveys, or other educational materials about the CAHPS program.

Grantees are encouraged to present information about CAHPS research and products at professional meetings; publish articles (including monographs and special journal supplements, if appropriate) about CAHPS-related working professional journals; and meet with groups who play a critical role in the adoption of CAHPS products, such as the National Committee for Quality Assurance (NCQA) or the National Quality Forum (NQF).

Recipients of awards under this NOFO must provide annual and final reports of performance in achieving the NOFO objective to continue the work of the CAHPS program and represents the sixth phase of program funding (hereafter referred to as “CAHPS VI”). (see section VI.3. Reporting).

See Section VIII, Other Information - Required Federal Citations, for policies related to this announcement.

See Section VIII. Other Information for award authorities and regulations.

Section II. Award Information
Funding Instrument

Cooperative Agreement: A support mechanism used when there will be substantial Federal scientific or programmatic involvement. Substantial involvement means that, after award, AHRQ scientific or program staff will assist, guide, coordinate, or participate in project activities. See Section VI.2 for additional information about the substantial involvement for this NOFO.

Application Types Allowed

New

Please note that AHRQ will only accept New applications. Renewal applications will not be accepted

The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types. Only those application types listed here are allowed for this NOFO.

Clinical Trial?

Optional: Accepting applications that either propose or do not propose clinical trial(s)

Need help determining whether you are doing a clinical trial?

Funds Available and Anticipated Number of Awards

AHRQ will invest up to $3 million per year for five years to support up to two awards.

The number of awards is contingent upon the availability of funds and the submission of a sufficient number of meritorious applications. 

Future year funding is contingent upon the availability of funds for each year of support.

Award Budget

The total costs (direct and indirect) for a project awarded under this NOFO will not exceed $1.5 million in any given year and $7,500,000 for the entire project period.

Funds may be used only for those expenses that are directly related to and necessary to the project and must be expended in compliance with the applicable Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR Part 75) and the HHS Grants Policy Statement.

Award Project Period

The project period may not exceed 5 years.

These projects are being funded pursuant to 42 U.S.C. 299a, which provides that AHRQ shall conduct and support research, support demonstration projects, and disseminate information on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness, and value of health care services.

All applications submitted and AHRQ grants made in response to this NOFO are subject to 45 CFR Part 75 (Uniform Administrative Requirements, Cost Principles and Audit Requirements for HHS Awards; https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75), the HHS Grants Policy Statement (see https://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award.

Section III. Eligibility Information
1. Eligible Applicants
Eligible Organizations

Higher Education Institutions

  • Public/State Controlled Institutions of Higher Education
  • Private Institutions of Higher Education

The following types of Higher Education Institutions are always encouraged to apply for AHRQ support as Public or Private Institutions of Higher Education:

    • Hispanic-serving Institutions
    • Historically Black Colleges and Universities (HBCUs)
    • Tribally Controlled Colleges and Universities (TCCUs)
    • Alaska Native and Native Hawaiian Serving Institutions
    • Asian American Native American Pacific Islander Serving Institutions (AANAPISIs)

Nonprofits Other Than Institutions of Higher Education

  • Nonprofits with 501(c)(3) IRS Status (Other than Institutions of Higher Education)
  • Nonprofits without 501(c)(3) IRS Status (Other than Institutions of Higher Education)

For-Profit Organizations

  • Small Businesses
  • For-Profit Organizations (Other than Small Businesses)

Governments

  • State Governments
  • County Governments
  • City or Township Governments
  • Special District Governments
  • Indian/Native American Tribal Governments (Federally Recognized)
  • Indian/Native American Tribal Governments (Other than Federally Recognized)
  • Eligible Agencies of the Federal Government
  • U.S. Territory or Possession

Other

  • Independent School Districts
  • Public Housing Authorities/Indian Housing Authorities
  • Native American Tribal Organizations (other than Federally recognized tribal governments)
  • Faith-based or Community-based Organizations
  • Regional Organizations

HHS grants policy requires that the grant recipient perform a substantive role in the conduct of the planned project or program activity and not merely serve as a conduit of funds to another party or parties. If consortium/contractual activities represent a significant portion of the overall project, the applicant must justify why the applicant organization, rather than the party(s) performing this portion of the overall project, should be the grantee and what substantive role the applicant organization will play. Justification can be provided in the Specific Aims or Research Strategy section of the PHS398 Research Plan Component sections of the SF424 (R&R) application.  There is no budget allocation guideline for determining substantial involvement; determination of substantial involvement is based on a review of the primary project activities for which grant support is provided and the organization(s) that will be performing those activities.

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.
Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.
Foreign components, as defined in the HHS Grants Policy Statement via  https://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf may participate in projects as member of consortia or as subcontractors only.

Required Registrations

Applicant Organizations

Applicant organizations must complete and maintain the following registrations as described in the SF 424 (R&R) Application Guide to be eligible to apply for or receive an award. All registrations must be completed prior to the application being submitted. Registration can take 6 weeks or more, so applicants should begin the registration process as soon as possible. AHRQ Submission of Grant Applications states that failure to complete registrations in advance of a due date is not a valid reason for a late submission.

  • System for Award Management (SAM)– Applicants must complete and maintain an active registration, which requires renewal at least annually. The renewal process may require as much time as the initial registration. SAM registration includes the assignment of a Commercial and Government Entity (CAGE) Code for domestic organizations which have not already been assigned a CAGE Code.
  • NATO Commercial and Government Entity (NCAGE) Code – Foreign organizations must obtain an NCAGE code (in lieu of a CAGE code) in order to register in SAM. 
  • Unique Entity Identifier (UEI)- A UEI is issued as part of the SAM.gov registration process.  SAM registrations prior to fall 2021 were updated to include a UEI. For applications due on or after January 25, 2022, the UEI must be provided on the application forms (e.g., FORMS-G); the same UEI must be used for all registrations, as well as on the grant application.
  • Dun and Bradstreet Universal Numbering System (DUNS) – Organization registrations prior to April 2022 require applicants to obtain a DUNS prior to registering in SAM. By April 2022, the federal government will stop using the DUNS number as an entity identifier and will transition to the Unique Entity Identifier (UEI) issued by SAM. Prior to April 2022, after obtaining a DUNS number, applicants can begin both SAM and eRA Commons registrations. The same DUNS number must be used for all registrations, as well as on the grant application.
  • eRA Commons - Once the unique organization identifier (DUNS prior to April 2022; UEI after April 2022) is established, organizations can register with eRA Commons in tandem with completing their full SAM and Grants.gov registrations; all registrations must be in place by time of submission. eRA Commons requires organizations to identify at least one Signing Official (SO) and at least one Program Director/Principal Investigator (PD/PI) account in order to submit an application.
  • Grants.gov – Applicants must have an active SAM registration in order to complete the Grants.gov registration.

Program Directors/Principal Investigators (PD(s)/PI(s))

All PD(s)/PI(s) must have an eRA Commons account.  PD(s)/PI(s) should work with their organizational officials to either create a new account or to affiliate their existing account with the applicant organization in eRA Commons. If the PD/PI is also the organizational Signing Official, they must have two distinct eRA Commons accounts, one for each role. Obtaining an eRA Commons account can take up to 2 weeks.

Please note that for applications with due dates of January 25, 2022, and after, all individuals listed in the SF424 R&R Senior/Key Person Profile (Expanded) Form will be required to have an eRA Commons username (Commons ID). See NOT-OD-21-109 (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-21-109.html) for details.

The PD/PI must be registered with ORCID. The personal profile associated with the PD(s)/PI(s) eRA Commons account must be linked to a valid ORCID ID. For more information on linking an ORCID ID to an eRA Commons personal profile see the ORCID topic in our eRA Commons online help.

Eligible Individuals (Program Director/Principal Investigator)

Any individual(s) with the skills, knowledge, and resources necessary to carry out the proposed research as the Program Director(s)/Principal Investigator(s) (PD(s)/PI(s)) is invited to work with his/her organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for AHRQ support.

For institutions/organizations proposing multiple PDs/PIs, visit the Multiple Program Director/Principal Investigator Policy and submission details in the Senior/Key Person Profile (Expanded) Component of the SF424 (R&R) Application Guide.

2. Cost Sharing

 

This RFA does not require cost sharing.

While there is no cost sharing requirement included in this RFA, AHRQ welcomes applicant institutions, including any collaborating institutions, to devote resources to this effort.  An indication of institutional support from the applicant and its collaborators indicates a greater potential of success and sustainability of the project.  Examples of institutional support would include: donated equipment and space, institutional funded staff time and effort, or other resource investments.  Applicant institutions should indicate institutional support by outlining the specific contributions to the project and providing assurances that their organization and any collaborators are committed to providing these funds and resources to the project. This information can be included at the end of the budget justification section of the application, but institutional support dollars are not to be shown/included in the detailed budget request.

3. Additional Information on Eligibility
Number of Applications

Applicant organizations may submit more than one application, provided that each application is scientifically distinct.

AHRQ will not accept duplicate or highly overlapping applications under review at the same time.  This means that the AHRQ will not accept:

  • A new (A0) application that is submitted before issuance of the summary statement from the review of an overlapping new (A0) or resubmission (A1) application.
  • A resubmission (A1) application that is submitted before issuance of the summary statement from the review of the previous new (A0) application.
  • An application that has substantial overlap with another application pending appeal of initial peer review (see NOT-OD-18-197).

 

Section IV. Application and Submission Information
1. Requesting an Application Package

The application forms package specific to this opportunity must be accessed through ASSIST, Grants.gov Workspace or an institutional system-to-system solution. Links to apply using ASSIST or Grants.gov Workspace are available in Part 1 of this RFA. See your administrative office for instructions if you plan to use an institutional system-to-system solution.

2. Content and Form of Application Submission

It is critical that applicants follow the Research (R) Instructions in the SF424 (R&R) Application Guide, except where instructed in this Notice of funding opportunity announcement to do otherwise. Conformance to the requirements in the Application Guide is required and strictly enforced. Applications that are out of compliance with these instructions may be delayed or not accepted for review.

Letter of Intent

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.

By the date listed in Part 1. Overview Information, prospective applicants are asked to submit a letter of intent that includes the following information:

  • Descriptive title of proposed activity
  • Name(s), address(es), and telephone number(s) of the PD(s)/PI(s)
  • Names of other key personnel
  • Participating institution(s)
  • Number and title of this funding opportunity

The letter of intent should be sent to:


Caren Ginsberg, PhD
Telephone: 301-427-1894
Fax: 301-427-1341
Email: Caren.Ginsberg@ahrq.hhs.gov

 

Page Limitations
  • All page limitations described in the SF424 Application Guide and the Table of Page Limits must be followed.
  • Specific Aims is limited to 1 page.
  • Research Strategy, including tables, graphs, figures, diagrams, and charts, is limited to 30 pages.
Instructions for Application Submission

The following section supplements the instructions found in the SF424 (R&R) Application Guide and should be used for preparing an application to this RFA.

SF424(R&R) Cover

All instructions in the SF424 (R&R) Application Guide must be followed.  

SF424(R&R) Project/Performance Site Locations

All instructions in the SF424 (R&R) Application Guide must be followed.  

SF424(R&R) Other Project Information

All instructions in the SF424 (R&R) Application Guide must be followed.  

SF424(R&R) Senior/Key Person Profile

All instructions in the SF424 (R&R) Application Guide must be followed. 

R&R or Modular Budget

All instructions in the SF424 (R&R) Application Guide must be followed.

 

Budget Component: Special Instructions for AHRQ applications

AHRQ is not using the Modular Grant Application and Award Process. Applicants applying for funding from AHRQ are to ignore application instructions concerning the Modular Grant Application and Award Process, and prepare applications using instructions for the Research and Related Budget Components of the SF 424 (R&R). 

Applications submitted in the Modular format will not be reviewed.

R&R Subaward Budget

All instructions in the SF424 (R&R) Application Guide must be followed.

PHS 398 Cover Page Supplement

All instructions in the SF424 (R&R) Application Guide must be followed.  

PHS 398 Research Plan

All instructions in the SF424 (R&R) Application Guide must be followed, with the following additional instructions: 

Applicants must propose research or activities to support each of the 5 areas below. Applicants must propose at least one research project in support of Research Areas 1A, 1B, 2, 3, 4, and describe their approach to participating in Research Area 5. Applicants can combine activities from these different topic areas to meet a specific research goal, but all topic areas must be addressed.

Resource Sharing Plan: Individuals are required to comply with the instructions for the Resource Sharing Plans as provided in the SF424 (R&R) Application Guide, with the following modification:

Appendix:

Do not use the Appendix to circumvent page limits. Follow all instructions for the Appendix as described in the SF424 (R&R) Application Guide.  See NIH/NIOSH/AHRQ New Policy Appendix Guide located at NOT-OD-18-126.

PHS Human Subjects and Clinical Trials Information

When involving human subjects research, clinical research, clinical trials (and when applicable, clinical trials research experience) follow all instructions for the PHS Human Subjects and Clinical Trials Information form in the SF424 (R&R) Application Guide, with the following additional instructions:

If you answered “Yes” to the question “Are Human Subjects Involved?” on the R&R Other Project Information form, you must include at least one human subjects study record using the Study Record: PHS Human Subjects and Clinical Trials Information form or Delayed Onset Study record.

Study Record: PHS Human Subjects and Clinical Trials Information

All instructions in the SF424 (R&R) Application Guide must be followed.

Delayed Onset Study

Note: Delayed onset does NOT apply to a study that can be described but will not start immediately (i.e., delayed start).

All instructions in the SF424 (R&R) Application Guide must be followed.

PHS Assignment Request Form

All instructions in the SF424 (R&R) Application Guide must be followed. 

Foreign Institutions

Non-domestic (non-U.S.) Entities (Foreign Institutions) are not eligible to apply.

Non-domestic (non-U.S.) components of U.S. Organizations are not eligible to apply.

Foreign components, as defined in the HHS Grants Policy Statement (http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf )may participate in projects as member of consortia or as subcontractors only.

3. Unique Entity Identifier and System for Award Management (SAM)

See Part 1. Section III.1 required registrations for information regarding the requirement for obtaining a unique entity identifier and for completing and maintaining active registrations in System for Award Management (SAM), NATO Commercial and Government Entity (NCAGE) Code (if applicable), eRA Commons, and Grants.gov

4. Submission Dates and Times

Part I. Overview Information contains information about Key Dates and times. Applicants are encouraged to submit applications before the due date to ensure they have time to make any application corrections that might be necessary for successful submission. When a submission date falls on a weekend or Federal holiday, the application deadline is automatically extended to the next business day.

Organizations must submit applications to Grants.gov (the online portal to find and apply for grants across all Federal agencies). Applicants must then complete the submission process by tracking the status of the application in the eRA Commons, NIH’s electronic system for grants administration. AHRQ and Grants.gov systems check the application against many of the application instructions upon submission. Errors must be corrected and a changed/corrected application must be submitted to Grants.gov on or before the application due date and time.  If a Changed/Corrected application is submitted after the deadline, the application will be considered late. Applications that miss the due date and time are subjected to the NIH Policy on Late Application Submission.

Applicants are responsible for viewing their application before the due date in the eRA Commons to ensure accurate and successful submission.

Information on the submission process and a definition of on-time submission are provided in the SF424 (R&R) Application Guide.

5. Intergovernmental Review (E.O. 12372)

This initiative is not subject to intergovernmental review.

6. Funding Restrictions

For efficient grant administration, AHRQ grant administration procedures will be used and conducted in accordance with the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The HHS Grants Policy Statement can be found at http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf.

Grant funds may NOT be used for the purchase of food of any kind (refreshments, meals, etc.). AHRQ will not award funds to support the cost of food.

These awards will not be made under expanded authorities; therefore, pre-award costs are not allowable without prior approval from AHRQ.

7. Other Submission Requirements and Information

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide. Paper applications will not be accepted.

Applicants must complete all required registrations before the application due date. Section III. Eligibility Information contains information about registration.

For assistance with your electronic application or for more information on the electronic submission process, visit How to Apply – Application Guide. If you encounter a system issue beyond your control that threatens your ability to complete the submission process on-time, you must follow the Dealing with System Issues guidance. For assistance with application submission, contact the Application Submission Contacts in Section VII.

Important reminders:

All PD(s)/PI(s) must include their eRA Commons ID in the Credential field of the Senior/Key Person Profile application form. Failure to register in the eRA Commons and to include a valid PD/PI Commons ID in the credential field will prevent the successful submission of an electronic application to NIH. See Section III of this FOA for information on registration requirements.

 

The applicant organization must ensure that the unique entity identifier (DUNS number or UEI as required) provided on the application is the same number used in the organization’s profile in the eRA Commons and for the System for Award Management. Additional information may be found in the SF424 (R&R) Application Guide.

See more tips for avoiding common errors.

Applications must be submitted electronically following the instructions described in the SF424 (R&R) Application Guide.  Paper applications will not be accepted.

See more tips for avoiding common errors.

The applicant should pay particular attention to the SF424 (R&R) application guide instructions (https://grants.nih.gov/grants/how-to-apply-application-guide/forms-g/general-forms-g.pdf) concerning letters of support. Letters of support, recommendation, or affirmation from any entity or individual not directly participating in the project should not be included.

Upon receipt, applications will be evaluated for completeness and compliance with application instructions by the Center for Scientific Review, AHRQ. Applications that are incomplete or non-compliant will not be reviewed.

Institutional Review Board (IRB) approval of human subjects is not required prior to peer review of an application (see https://grants.nih.gov/grants/guide/notice-files/NOT-HS-00-003.html). However, initiation of IRB review, if necessary or applicable, is strongly encouraged to assure timely commencement of research.

Although there is no immediate acknowledgement of the receipt of an application, applicants are generally notified of the review and funding assignment within eight (8) weeks.  

Post Submission Materials

Applicants are required to follow the instructions for post-submission materials, as described in

Any instructions provided here are in addition to the instructions in the policy.

Priority Populations

AHRQ is committed to the inclusion of priority populations in health services research. The overall portfolio of health services research that AHRQ conducts and supports shall include the populations specifically named in AHRQ’s authorizing legislation: inner city; rural; low income; minority; women; children; elderly; and those with special health care needs, including those who have disabilities, need chronic care, or need end-of-life health care. 42 U.S.C. 299(c)(1). AHRQ also includes in its definition of priority populations those groups identified in Section 2(a) of Executive Order 13985 as members of underserved communities: Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.  AHRQ must ensure that these requirements are reflected in the overall portfolio of research conducted and supported by the Agency. 42 U.S.C. 299(c)(2).

AHRQ will broadly implement this inclusion policy across the research that AHRQ supports and conducts so that the portfolio of research is inclusive of all populations. AHRQ intends that these populations be included in studies such that the research design explicitly allows conduct of valid analyses. The policy applies to all grant applications. Investigators should review the document entitled, “AHRQ Policy on the Inclusion of Priority Populations,” which is available at https://grants.nih.gov/grants/guide/notice-files/NOT-HS-21-015.html. Applicants under this NOFO must consider and discuss including priority populations in research design as specified in this Notice.

Public Access to AHRQ-Funded Scientific Publications

Investigators should review the document titled ‘AHRQ Announces new Policy for Public Access to AHRQ-Funded Scientific Publications’, which is available at (http://grants.nih.gov/grants/guide/notice-files/NOT-HS-16-008.html). For all research arising from AHRQ support, this policy requires that AHRQ-funded authors submit an electronic version of the author’s final peer-reviewed accepted manuscript to the National Library of Medicine's PubMed Central (PMC) to be made publicly available within 12 months of the publisher’s date of publication.

Plan for Sharing Research Data

The precise content of the data-sharing plan will vary, depending on the data being collected and how the investigator is planning to share the data. Applicants who are planning to share data should describe briefly the expected schedule for data sharing; the format of the final dataset; the documentation to be provided; whether or not any analytic tools also will be provided; whether or not a data-sharing agreement will be required and, if so, a brief description of such an agreement (including the criteria for deciding who can receive the data and whether or not any conditions will be placed on their use); and the mode of data sharing (e.g., under its own auspices by mailing a disk or posting data on its institutional or personal website or through a data archive or enclave).

Investigators choosing to share under their own auspices may wish to enter into a data-sharing agreement. References to data sharing may also be appropriate in other sections of the application.

The reasonableness of the data sharing plan or the rationale for not sharing research data will be assessed by the reviewers. However, reviewers will not factor the proposed data sharing plan into the determination of scientific merit or the priority score.  Please see:  The Agency for Healthcare Research and Quality Data Management Plan Policy, Notice Number NOT-HS-20-011. 

AHRQ Data Management Plan Policy

Investigators should review the document titled AHRQ Data Management Plan (DMP) Policy, which is available at (https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-011.html). This policy requires applicants for AHRQ new/competing grants and research contracts to include a DMP for managing, storing and disseminating the primary data, samples, physical collections and other supporting materials created or gathered in the course of research funded by AHRQ, or state why data management is not possible, as a component of their grant application or research contract proposal. 

Data Confidentiality

The AHRQ confidentiality statute, 42 USC 299c-3(c), requires that information that is obtained in the course of AHRQ supported activities and that identifies individuals or establishments be used only for the purpose for which it was supplied.  Information that is obtained in the course of AHRQ-supported activities and that identifies an individual may be published or released only with the consent of the individual who supplied the information or is described in it. There are civil monetary penalties for violation of the confidentiality provision of the AHRQ statute. 42 USC 299c-3(d). In the Human Subjects section of the application, applicants must describe procedures for ensuring the confidentiality of the identifying information to be collected (see NOT-HS-18-012: Confidentiality in AHRQ-Supported Research).  The description of the procedures should include a discussion of who will be permitted access to this information, both raw data and machine-readable files, and how personal identifiers and other identifying or identifiable data will be restricted and safeguarded.  Identifiable patient health information collected by grantees under this RFA will also be obtained and managed in accordance with the HIPAA Privacy Rule, 45 CFR Parts 160 and 164. 

The grantee should ensure that computer systems containing confidential data have a level and scope of security that equals or exceeds that established by the HIPAA Security Rules if applicable (see HIPAA website in prior paragraph) and that established by the Office of Management and Budget (OMB) in OMB Circular No. A-130, Appendix III - Security of Federal Automated Information Systems. The applicability and intended means of applying these confidentiality and security standards to subcontractors and vendors, if any, should be addressed in the application.

Sharing Research Resources:  Rights in Data

Unless otherwise provided in grant awards, AHRQ grantees may copyright, or seek patents for, as appropriate, final and interim products and materials developed in whole or in part with AHRQ support, including, but not limited to, methodological tools, measures, software with documentation, literature searches, and analyses.  Such copyrights and patents are subject to a royalty-free, non-exclusive, and irrevocable AHRQ license to reproduce, publish, use or disseminate for any purpose consistent with AHRQ’s statutory responsibilities and to authorize others to do so for any purpose consistent with AHRQ’s statutory responsibilities. In accordance with its legislative dissemination mandate, AHRQ purposes may include, subject to statutory confidentiality protections, making project materials, databases, results, and algorithms available for verification or replication by other researchers.  In addition, 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 substantial or valuable 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.  AHRQ requests that grantees notify the Office of Communications (OC) when an AHRQ-funded research article has been accepted for publication in a peer-reviewed journal. Researchers should submit manuscripts that have been accepted for publication in a peer-reviewed journal to JournalPublishing@ahrq.hhs.gov at least four to six weeks in advance of the journal’s expected publication date. 

Regulations applicable to AHRQ grantees concerning intangible rights and copyright can be found at 45 CFR 75.322.

Other Special Requirements

Applicants should demonstrate specific experience in collaborating with other research and support organizations to realize larger programmatic goals.

Applicants should use the following percentages as guidelines, though not strict limits, for allocation of resources by project area:

Area 1- Survey and supplemental item development, revision, and trademarking: 35%

Area 2- Survey methods research aimed at achieving health equity: 20%

Area 3- Analysis and reporting of patient experience data: 20%

Area 4- Patient experience quality improvement studies based on CAHPS survey findings to advance the practice of patient experience: 20%

Area 5- Developing internal and external program communication strategies: 5%

PD/PIs and/or designated grantee team members will be required to attend the following meetings:

Weekly conference calls with PD/PIs and AHRQ Program Official throughout the project (other designated team members may attend depending on topic);

Scheduled conference calls of the instrument (weekly), reports (weekly), quality improvement (monthly) and communications teams (weekly) and others, throughout the project (at least one designated individual per cooperative agreement);

One virtual annual planning meeting to discuss project progress and planning;

One virtual annual research meeting to discuss work related to project research

Applicants should budget for

--At a minimum 1 new CAHPS survey or new supplemental item set during the life of the project in General Project Budget

--At a minimum 1 revision of an existing CAHPS survey or supplemental item set and Instrument Team activities including review of CAHPS trademark survey activities (collaborative with CAHPS Instrument team members)

--At a minimum one study of survey methods research aimed at health equity

--At a minimum one study of analysis and reporting of patient experience data

--At a minimum one quality improvement study

--Approaches to support Communications Team 

--Up to 10 virtual Technical Expert Panel meetings over the life of the cooperative agreement 

--Four public-facing webcasts annually for CAHPS users to discuss project research and findings.

Section V. Application Review Information
1. Criteria

The mission of AHRQ is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.

AHRQ's priority areas of focus are detailed here: https://www.ahrq.gov/funding/policies/foaguidance/index.html

.  As part of this mission, applications are submitted to AHRQ to support health services research which are evaluated for scientific and technical merit through the AHRQ peer review system.

Applications that are complete and responsive to the NOFO will be evaluated for scientific and technical merit by an appropriate objective group convened in accordance with standard AHRQ peer-review procedures that are described in 42 CFR Part 67, Subpart A.  Incomplete and/or non-responsive applications or applications not following instructions given in this NOFO will not be reviewed.  Only the review criteria described below will be considered in the review process.

Administrative Criteria: Upon receipt, applications will be evaluated for completeness by the Center for Scientific Review, National Institutes of Health, and for responsiveness by AHRQ.

Merit Review Criteria: Merit Review Criteria, as described below, will be considered in the review process.

Overall Impact

Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following review criteria and additional review criteria (as applicable for the project proposed).

Scored Review Criteria

Reviewers will consider each of the review criteria below in the determination of scientific merit and give a separate score for each. An application does not need to be strong in all categories to be judged likely to have major scientific impact. For example, a project that by its nature is not innovative may be essential to advance a field.

Significance

Does the project address an important problem or a critical barrier to progress in the field? Is the prior research that serves as the key support for the proposed project rigorous? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field? Does the applicant understand the use and importance of CAHPS surveys, their developmental principles, and patient experience measurement? Does the applicant understand the history of the CAHPS program, challenges it faces moving forward, and areas in which patient experience work can grow within healthcare delivery? Does the applicant understand the significance of survey methods research to health equity and patient experience of care assessment? 

Investigator(s)

Are the PD(s)/PI(s), collaborators, and other researchers well suited to the project?  Have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? If the project is collaborative or multi-PD/PI, do the investigators have complementary and integrated expertise; are their leadership approaches, governance and organizational structure appropriate for the project?  Are the PD(s)/PI(s), partners, team members, collaborators, and other affiliated researchers well suited to the project?  Have they demonstrated an ongoing record of accomplishments that have advanced their field(s)? Do the investigators have complementary and integrated expertise; are their leadership approaches, governance and organizational structures appropriate for the project?

Do the PI/PD and partners have experience in:

  • Designing patient-based experience of care surveys, field testing them, developing measures for public reporting using appropriate methodological and statistical techniques;  
  • Conducting ethnographic or other relevant qualitative research studies to identify cultural and sociologic factors leading to differences in care across populations and settings of care, as required by the applicant's proposed approach;
  • Identifying and working productively with stakeholders from different organizations (e.g., accreditation organizations, health plans, consumer advocacy organizations, purchasers of health care services, etc.) and different health care service delivery settings (i.e., hospitals, community- based clinics, patient centered medical homes (PCMH), nursing homes, assisted living facilities, Accountable Care Organizations);
  • Demonstrating an understanding of the needs and various audiences who use health care information (e.g., consumers, patients, purchasers, plans, providers, payers, State and local-level health care organizations, etc.) and the ways in which they might use this information (selection of plans and providers; rewarding performance; comparing plan/provider performance; comparing plan/provider performance identifying local or multi-site quality problems; etc.);
  • Identifying and recruiting appropriate sites, audiences for survey instrument testing, report template testing, QI studies and evaluation studies;
  • Recruiting members of populations (e.g., people with limited cognitive skills or limited English proficiency; for example; people with deficits in reading skills; people from diverse ethnic and cultural backgrounds; people with diminished visual capacity) to include in testing;
  • Conducting research in and studies of survey development methods; survey research design; sampling; and psychometric analysis;
  • Designing and implementing studies that examine mode of survey administration; development, testing, and analysis of patient narrative questions; and patient experience of care survey development and data analysis;
  • Collaborating with, providing technical assistance or training to, and/or monitoring the progress of test sites, community-based organizations, data supplying organizations and site representatives;
  • Designing and implementing methodologically sound quality improvement programs based on patient experience data;
  • Designing and implementing process and outcome evaluations, including: specification of evaluation questions and outcome measures; data analysis; development of data-based recommendations and use of the recommendations to improve products and procedures;
  • Developing measurement tools for use in QI and evaluation studies;
  • Developing narrative items to assess patient experience in multiple settings, and analysis using Natural Language Processing methodologies for these data, as required for the applicant's proposed approach?
Innovation

Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation, or interventions proposed?    Does the proposed team have experience in developing and testing new ways to deliver health quality information to a wide range of audiences (patients, consumers, providers, health plans, national, state, and local policy makers, government agencies, etc.)? Does the proposed team have experience developing and testing novel ways to administer national surveys of patient experience?

Approach 

Are the overall strategy, methodology, and analyses well-reasoned and appropriate to accomplish the specific aims of the project? Have the investigators included plans to address weaknesses in the rigor of prior research that serves as the key support for the proposed project? Have the investigators presented strategies to ensure a robust and unbiased approach, as appropriate for the work proposed? Are potential problems, alternative strategies, and benchmarks for success presented? If the project is in the early stages of development, will the strategy establish feasibility and will particularly risky aspects be managed? Have the investigators presented adequate plans to address relevant biological variables, such as sex, for studies in human subjects? 

If the project involves human subjects and/ clinical research, are the plans to address

1) the protection of human subjects from research risks, and

2) inclusion (or exclusion) of individuals on the basis of sex/gender, race, and ethnicity, as well as the inclusion or exclusion of individuals of all ages (including children and older adults), justified in terms of the scientific goals and research strategy proposed

Does the team have experience with all aspects of fielding a large scale, multi-site survey including but not limited to: formulation of a methodologically sound design; use of appropriate psychometric and other statistical and analytical techniques (e.g., imputation methods, case mix adjustment methods,) performance of validity and reliability studies on large-scale survey instruments; identification and resolution of methodological issues associated with sample selection and sample size; administration of surveys to the subpopulation of interest and within a variety of health care delivery settings; identification and resolution of methodological issues associated with mode of administration? Does the proposed team have experience in developing patient experience of care surveys and supplemental item sets using standardized CAHPS methodology (please see CAHPS survey developer guidelines)? Does the PD/PI have strong working knowledge of the methodology for developing patient experience of care surveys using the standardized survey development guidelines established by the CAHPS program?  Does the team have experience producing detailed guidelines for survey data submissions for the CAHPS databases or other similar databases? Does the applicant include a variety of methods to explore the cultural, ethnographic and other contextual facilitators and barriers to equitable patient experience of care as required for the proposed approach?  Does the proposed team have experience writing clear, concise reports, summaries, and other documents? Does the team have experience in testing and translating surveys and related materials into Spanish with an approved CAHPS methodology? Does the proposed team have experience managing and collaborating productively with geographically distant team members who represent different disciplines, fields of study, and points of view? Does the proposed team have knowledge of health care quality issues (especially those important to consumers and other purchasers) as they pertain to long-term services and support, hospital care, care for those with limited cognitive skills, visual skills or other disability, and care received in ambulatory settings?

Environment

Will the scientific environment in which the work will be done contribute to the probability of success? Are the institutional support, equipment and other physical resources available to the investigators adequate for the project proposed? Will the project benefit from unique features of the scientific environment, subject populations, or collaborative arrangements?   

Additional Review Criteria

As applicable for the project proposed, reviewers will evaluate the following additional items while determining scientific and technical merit, and in providing an overall impact score, but will not give separate scores for these items.

  •  How well does the proposed research plan align with AHRQ’s mission and research priorities? 
  • How well does the application address the purposes and objectives of this NOFO?
  • Is the application responsive to all areas of the NOFO?
  • Does the proposal reflect the Agency's interest in advancing methodologies and instruments for capturing the patient experience of people seeking healthcare for mental health conditions or another Agency priority?
  • How responsive is the application to special eligibility criteria including the project requirements noted in the NOFO?
Inclusion of Priority Populations

Peer reviewers must include their assessment of the proposed inclusion plan for priority populations in evaluating the overall scientific and technical merit of the application and assigning the impact score.

In conducting peer review for scientific and technical merit, the peer review groups will:

  • Evaluate the application for the presence or absence of the inclusion plan based on the proposed research objectives.
  • Evaluate the adequacy of the proposed plan for the inclusion of priority populations.
  • Evaluate the proposed justification for the exclusion of priority populations when a requirement for inclusion is described as inappropriate with respect to the purpose of the research.
  • Evaluate the plans for outreach and recruitment of study participants, including priority populations, where appropriate.
  • Evaluate the proposed plan for study design, execution and outcome assessments so that study results will be relevant to one or more priority populations, where appropriate.
  • Assess the plan as being “acceptable” or “unacceptable” with regard to the appropriateness of the inclusion or exclusion of priority populations in the proposed research.
Protections for Human Subjects

For research that involves human subjects but does not involve one of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate the justification for involvement of human subjects and the proposed protections from research risk relating to their participation according to the following five review criteria: 1) risk to subjects, 2) adequacy of protection against risks, 3) potential benefits to the subjects and others, 4) importance of the knowledge to be gained, and 5) data and safety monitoring for clinical trials.

For research that involves human subjects and meets the criteria for one or more of the categories of research that are exempt under 45 CFR Part 46, the committee will evaluate: 1) the justification for the exemption, 2) human subjects involvement and characteristics, and 3) sources of materials. For additional information on review of the Human Subjects section, please refer to the Guidelines for the Review of Human Subjects.

For details regarding IRB approval, applicants may refer to the "AHRQ Revised Policy for Institutional Review Board (IRB) Review of Human Subjects Protocols in Grant Applications" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html). Applicant should also be aware of the AHRQ policy for use of single IRB for cooperative research, 45 CFR 46.114 (b)” https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-005.html.

Degree of Responsiveness

Reviewers will assess how well the application addresses the purpose and objectives of this NOFO, including the advancement of health equity.

How responsive is the application to the special eligibility criteria, including the project requirements, noted in the NOFO?

Resubmissions

Not Applicable.

Renewals

Not Applicable.

Revisions

Not Applicable.

Additional Review Considerations

As applicable for the project proposed, reviewers will consider each of the following items, but will not give scores for these items, and should not consider them in providing an overall impact score.

How well does the proposed research plan align with AHRQ’s mission and research priorities?

Resource Sharing Plans

Reviewers will comment on whether the following Resource Sharing Plans, or the rationale for not sharing the following types of resources, are reasonable.

The reviewers will comment on whether the Data Management Plan is reasonable.

Budget and Period of Support

Reviewers will consider whether the budget and the requested period of support are fully justified and reasonable in relation to the proposed research.

2. Review and Selection Process

Applications will be evaluated for scientific and technical merit by (an) appropriate Scientific Review Group(s) convened by AHRQ, in accordance with AHRQ peer review procedures  that are described in 42 CFR Part 67, Subpart A.  Incomplete and/or non-responsive applications or applications not following instructions given in this NOFO will not be reviewed.

As part of the scientific peer review, all applications:

  • May undergo a selection process in which only those applications deemed to have the highest scientific and technical merit (generally the top half of applications under review) will be discussed and assigned an overall impact score.
  • Will receive a written critique.

Applications will compete for available funds with all other recommended applications submitted in response to this NOFO.

The following will be considered in making funding decisions:

  • Scientific and technical merit of the proposed project as determined by scientific peer review.
  • Availability of funds.
  • Responsiveness to goals and objectives of the NOFO.
  • Proposed plan to address health equity.
  • Relevance and fit within AHRQ research priorities, as well as overall programmatic and geographic balance of the proposed project to program priorities.
3. Anticipated Announcement and Award Dates

After the peer review of the application is completed, the PD/PI will be able to access his or her Summary Statement (written critique) via the eRA Commons. Refer to Part 1 for dates for peer review, advisory council review, and earliest start date.

Information regarding the disposition of applications is available in the HHS Grants Policy Statement (see https://www.ahrq.gov/funding/policies/hhspolicy/index.html).

Section VI. Award Administration Information
1. Award Notices

If the application is under consideration for funding, AHRQ will request "Just-In-Time" information from the applicant.  Just-In-Time information generally consists of information on other support, any additional information necessary to address administrative and budgetary issues, and certification of IRB approval of the project's proposed use of human subjects.  For details regarding IRB approval, applicants may refer to the "AHRQ Revised Policy for Institutional Review Board (IRB) Review of Human Subjects Protocols in Grant Applications" (https://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html) Applicant should also be aware of the AHRQ policy for use of single IRB for cooperative research, 45 CFR 46.114 (b)” https://grants.nih.gov/grants/guide/notice-files/NOT-HS-20-005.html.

If all administrative and programmatic issues are resolved, a formal notification in the form of a Notice of Award (NoA) will be provided to the applicant organization for successful applications. The NoA signed by the AHRQ grants management officer is the authorizing document and will be sent via email to the e-mail address designated by the recipient organization during the eRA Commons registration process.

Awardees must comply with any funding restrictions described in Section IV.6. Funding Restrictions.

Selection of an application for award is not an authorization to begin performance. Any costs incurred before receipt of the NoA are at the recipient's risk. These costs may be reimbursed only to the extent considered allowable pre-award costs.  

Any application awarded in response to this NOFO will be subject to the DUNS, SAM Registration, and Transparency Act requirements.

ClinicalTrials.gov: If an award provides for one or more clinical trials. By law (Title VIII, Section 801 of Public Law 110-85), the "responsible party" must register and submit results information for certain “applicable clinical trials” on the ClinicalTrials.gov Protocol Registration and Results System Information Website (https://register.clinicaltrials.gov). AHRQ expects registration and results reporting of all trials whether required under the law or not. For more information, see https://www.ahrq.gov/funding/policies/human-subjects/index.html

Institutional Review Board or Independent Ethics Committee Approval: Recipient institutions must ensure that all protocols are reviewed by their IRB or IEC. To help ensure the safety of participants enrolled in AHRQ-funded studies, the recipient must provide AHRQ copies of documents related to all major changes in the status of ongoing protocols. 

Data and Safety Monitoring Requirements: The AHRQ policy for data and safety monitoring requires oversight and monitoring of all AHRQ-conducted or -supported human biomedical and behavioral intervention studies (clinical trials) to ensure the safety of participants and the validity and integrity of the data. Further information concerning these requirements is found at https://www.ahrq.gov/funding/policies/human-subjects/index.html and in the application instructions (SF424 (R&R) and PHS 398).

Investigational New Drug or Investigational Device Exemption Requirements: Consistent with federal regulations, clinical research projects involving the use of investigational therapeutics, vaccines, or other medical interventions (including licensed products and devices for a purpose other than that for which they were licensed) in humans under a research protocol must be performed under a Food and Drug Administration (FDA) investigational new drug (IND) or investigational device exemption (IDE). 

2. Administrative and National Policy Requirements

All AHRQ grants awards are subject to HHS’s “Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards,” (http://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75), and the HHS Grants Policy Statement (see http://www.ahrq.gov/funding/policies/hhspolicy/index.html), and the terms and conditions set forth in the Notice of Award.

All applicants will be subject to a term and condition that applies the terms of 48 CFR section 3.908 to the award, and requires that grantees inform their employees in writing of employee whistleblower rights and protections under 41U.S.C. 4712 in the predominant native language of the workforce.

As necessary, additional Terms and Conditions will be incorporated into the NoA.

Should you successfully compete for an award, recipients of federal financial assistance (FFA) from HHS must administer their programs in compliance with federal civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age and, in some circumstances, religion, conscience, and sex (including gender identity, sexual orientation, and pregnancy). This includes ensuring programs are accessible to persons with limited English proficiency and persons with disabilities. The HHS Office for Civil Rights provides guidance on complying with civil rights laws enforced by HHS. See https://www.hhs.gov/civilrights/for-providers/provider-obligations/index.html

and https://www.hhs.gov/civil-rights/forindividuals/nondiscrimination/index.html.

Contact the HHS Office for Civil Rights for more information about obligations and prohibitions under federal civil rights laws at https://www.hhs.gov/ocr/about-us/contact-us/index.html or call 1-800-368-1019 or TDD 1-800-537-7697.

For additional guidance regarding how the provisions apply to AHRQ grant programs, please contact the Scientific/Research Contact that is identified in Section VII under Agency Contacts of this NOFO.

Health Literacy – Below are available HHS resources.

HHS Health.gov: Health Literate Care Model

AHRQ: Health Literacy Universal Precautions Toolkit

Pursuant to 2 CFR 200.216: there is a prohibition on certain telecommunications and video surveillance services or equipment that became effective on or after August 13, 2020.

AHRQ regulatory procedures that pertain to suspension and termination are specified in 45 CFR Parts 75.371 through 75.375

In accordance with the statutory provisions contained in Section 872 of the Duncan Hunter National Defense Authorization Act of Fiscal Year 2009 (Public Law 110-417), AHRQ awards will be subject to the Federal Awardee Performance and Integrity Information System (FAPIIS) requirements.  FAPIIS requires Federal award making officials to review and consider information about an applicant in the designated integrity and performance system (currently FAPIIS) prior to making an award.  An applicant, at its option, may review information in the designated integrity and performance systems accessible through FAPIIS and comment on any information about itself that a Federal agency previously entered and is currently in FAPIIS.  The Federal awarding agency will consider any comments by the applicant, in addition to other information in FAPIIS, in making a judgement about the applicant’s integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 45 CFR Part 75.205 “Federal awarding agency review of risk posed by applicants.” 

Cooperative Agreement Terms and Conditions of Award

The following Terms and Conditions will be incorporated into the award notice and will be provided to the grant recipient at the time of award.

 

Terms and Conditions of Cooperative Agreement Award

 

The following special terms of award are in addition to otherwise applicable OMB administrative guidelines, DHHS grant administration regulations at 45 CFR Parts 75, and other DHHS, PHS, and AHRQ grant administration policy statements.  AHRQ will use these procedures in evaluating and administering this cooperative agreement.

The administrative and funding instrument used for this program is the cooperative agreement. A cooperative agreement is an "assistance" mechanism (rather than an "acquisition” mechanism), in which substantial AHRQ programmatic involvement with the grantee is anticipated during the performance of the activities.  Under a cooperative agreement, the AHRQ purpose is to support and stimulate the recipients' activities by involvement in and otherwise working jointly with the award recipient in a partnership role; it is not to assume direction, prime responsibility, or a dominant role in the activities.  Consistent with this concept, the dominant role and prime responsibility resides with the grant recipient and the PD(s)/PI(s) for the project as a whole, although specific tasks and activities may be shared between the grantee and AHRQ as described in the NOFO. Cooperative activities are intended to strengthen the individual grantee activities through the facilitation of data sharing, data access and communications.

All cooperative activities that include significant government involvement will require prior approval by AHRQ.

Activities conducted under this award that involve the collection of information e.g., conducting surveys or requesting responses to uniform questions from nine or more persons, establishments or other entities, with certain exceptions, are currently required to be cleared by OMB under the Paperwork Reduction Act (PRA).  (44 USC 3501-3521).  PRA review and approval is required in cooperative agreements if AHRQ has significant input or control over the data collection activity. Submissions for clearance under the PRA are through AHRQ and HHS. Therefore, impacted awardees should include the time in their proposed timelines to develop materials and receive necessary clearances.  It typically takes at least 6 months from date of initial submission to AHRQ and sometimes much longer if submissions are incomplete or the justification for the proposed data collection plans are questioned during the clearance process. Information collection that requires PRA clearance may not begin until awardees receive written notification via e-mail from AHRQ that clearance has been obtained. Detailed information on the PRA can be found here https://www.hhs.gov/guidance/document/paperwork-reduction-act-pra-1995-0

 

Program Director/Principal Investigator (PD/PI) Rights and Responsibilities

 

The PD(s)/PI(s) will have the primary responsibility for conducting research in accordance with the terms and conditions of the Notice of Award, and cooperating with other key parties, including the AHRQ Program Official and other awardees.

The PD(s)/PI(s) will participate in weekly teleconferences with the program official and/or other AHRQ personnel as appropriate.

The PD(s)/PI(s) and designated project staff will attend one annual one-day planning meeting with AHRQ and the User Network Contractor, which will be held  virtually. At this meeting, PIs, their staff, and the Network Contractor discuss progress on the work to date, identify common challenges and engage in problem solving.  Each PD/PI and any key personnel for implementation and evaluation are expected to participate in the annual planning meeting.

AHRQ Responsibilities

AHRQ program staff will have substantial programmatic involvement that is above and beyond the normal stewardship role in awards, as described below.

Cooperative activities are intended to strengthen individual projects and at the same time generate collaboration across the projects.  Specific cooperative aims and activities in carrying out individual projects may be shared among the awardees and the AHRQ program officials.

AHRQ staff will provide advice and support to the awardee and will assist in the cooperative work of the project beyond the usual program stewardship for grants. AHRQ program officials may also provide expertise/technical assistance to the grantee and assist with project activities, or help coordinate activities with the CAHPS VI grantees.

The Program Official will maintain regular contact with the PD(s)/PI(s) to consult on key project decisions, help to trouble-shoot implementation barriers/challenges, and confirm that projects are proceeding according to project timelines and plans. The Program Official, in coordination with the grantee, will also disseminate project findings to research and policy audiences. Progress will be reviewed quarterly. 

AHRQ will:

  • Review the development of project timelines and project plans and assess progress.
  • Work closely with grantees and AHRQ contractors to ensure harmonization of cross-grantee metrics for evaluation.
  • Coordinate and facilitate collaboration and engagement with stakeholders.
  • Facilitate the development of common frameworks, tool kits, and other products for implementation and evaluation activities.
  • Facilitate conference calls with grantees and annual in-person (or virtual, if appropriate) meetings.
  • Work closely with grantees and other federal partners to ensure dissemination of products.

Additionally, AHRQ program staff will be responsible for the normal scientific and programmatic stewardship of the award and will be named in the award notice.

Collaborative Responsibilities

Awardees will be required to work collaboratively with each other as described above  and with AHRQ to share information and develop common resources as noted above. Awardees and AHRQ will also participate in periodic meetings including monthly teleconferences and annual in-person meetings.

3. Reporting

When multiple years are involved, awardees will be required to submit the Research Performance Progress Report (RPPR) annually unless specified otherwise in the terms of the award.  

For details regarding annual progress report submission, refer to https://www.ahrq.gov/funding/grant-mgmt/noncomp.html.  If instructions on the AHRQ website are different from the RPPR Instructions, follow the instructions on the AHRQ website. Annual progress reports are due 3 months before the start date of the next budget period of the award.

Program planning and performance reporting requirements:

Recipients of awards under this NOFO must provide annual and final reports of performance in achieving the NOFO objective to continue the work of the CAHPS program and represents the sixth phase of program funding (hereafter referred to as “CAHPS VI”). (see section VI.3. Reporting).

 

Reach:

  • Performance Measure: Which priority populations were the focus of the CAHPS survey development and research? Was this reach adequate for the purposes of improving patient experience?
  • Timeline: Midpoint of funding cycle and end of year 5

 

Performance Measure: What is the audience for CAHPS research and products? How does this audience overlap with stakeholders who were consulted during the project period? Was the outreach adequate for project needs?

  • Timeline: Midpoint of funding cycle and end of year 5

 

Process:

  • Performance Measure: How many projects had components focusing on equity? What areas of equity were assessed, and what were the findings?
  • Timeline: Midpoint of funding cycle and end of year 5

 

Performance Measure: How was information on CAHPS research and products disseminated? What was the nature of that dissemination (e.g., numbers of publications, webcasts, etc.)? 

  • Timeline: Midpoint of funding cycle and end of year 5

 

Impact:

  • Performance Measure: What advances were made in understanding patient experience? What was learned? In what ways can patient experience be improved as a result of this research? 
  • Timeline: Midpoint of funding cycle and end of year 5

Grantees are required to submit expenditure data on the Federal Financial Report (FFR; SF 425) annually.

Expenditure data is to be reported on the Federal Financial Report (FFR; SF 425). AHRQ requires annual financial expenditure reports for ALL grant programs as described in the HHS Grants Policy Statement (https://www.ahrq.gov/funding/policies/hhspolicy/index.html).  AHRQ implementation of the FFR retains a financial reporting period that coincides with the budget period of a particular project.  However, the due date for annual FFRs is 90 days after the end of the calendar quarter in which the budget period ends.  For example, if the budget period ends 4/30/2019, the annual FFR is due 9/30/2019 (90 days after the end of the calendar quarter of 6/30/2019).

A final Progress Report, final Federal Financial Report, and Final Invention Statement are required when an award ends. All final reports are due within 90 days of the project period end date.  For further details regarding grant closeout requirements, refer to https://www.ahrq.gov/funding/grant-mgmt/index.html#Closeout.

The Federal Funding Accountability and Transparency Act of 2006 (Transparency Act), includes a requirement for awardees of Federal grants to report information about first-tier subawards and executive compensation under Federal assistance awards issued in FY2011 or later.  All awardees of applicable AHRQ grants and cooperative agreements are required to report to the Federal Subaward Reporting System (FSRS) available at www.fsrs.gov on all subawards over $25,000.  See the HHS Grants Policy Statement (http://www.ahrq.gov/funding/policies/hhspolicy/index.html) for additional information on this reporting requirement.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts from all Federal awarding agencies with a cumulative total value greater than $10,000,000 for any period of time during the period of performance of a Federal award, must report and maintain the currency of information reported in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period.  The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently FAPIIS).  This is a statutory requirement under section 872 of Public Law 110-417, as amended (41 U.S.C. 2313).  As required by section 3010 of Public Law 111-212, all information posted in the designated integrity and performance system on or after April 15, 2011, except past performance reviews required for Federal procurement contracts, will be publicly available.  Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75 – Award Term and Conditions for Recipient Integrity and Performance Matters.

 

Section VII. Agency Contacts

We encourage inquiries concerning this funding opportunity and welcome the opportunity to answer questions from potential applicants.

Application Submission Contacts

eRA Service Desk (Questions regarding ASSIST, eRA Commons, application errors and warnings, documenting system problems that threaten submission by the due date, and post-submission issues)

 

Finding Help Online: https://grants.nih.gov/support/index.html(preferred method of contact)
Telephone: 301-402-7469 or 866-504-9552 (Toll Free)

 

General Grants Information (Questions regarding application instructions, application processes, and NIH grant resources)
Email: GrantsInfo@nih.gov (preferred method of contact)
Telephone: 301-637-3015

 

Grants.gov Customer Support (Questions regarding Grants.gov registration and Workspace)
Contact Center Telephone: 800-518-4726
Email: support@grants.gov

Scientific/Research Contact(s)

Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety (CQuIPS)
Agency for Healthcare Research and Quality (AHRQ)
Telephone: 301-427-1894
Fax: 301-427-1341
E-mail: caren.ginsberg@ahrq.hhs.gov

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Division of Scientific Review

Office of Extramural Research, Education, and Priority Populations

Agency for Healthcare Research and Quality

Email: DSR@ahrq.hhs.gov

Financial/Grants Management Contact(s)

Brian Campbell
Agency for Healthcare Research and Quality (AHRQ)
Office of Management Services
Division of Grants Management
Telephone: (301) 427-1457
E-mail: Brian.Campbell@ahrq.hhs.gov

Section VIII. Other Information

Recently issued trans-AHRQ policy notices may affect your application submission. A full list of policy notices published by AHRQ is provided in the NIH Guide for Grants and Contracts. Notices can also be found at AHRQ Grants Policy Notices.  All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement.  

 

Authority and Regulations

This program is described in the Assistance Listings (formerly called the Catalog of Federal Domestic Assistance) at https://sam.gov/content/assistance-listings/federal and is not subject to the intergovernmental review requirements of Executive Order 12372 or Health Systems Agency review.

Awards are made under the authority of 42 USC 299 et seq., and in accordance with 45 CFR Part 75 and other referenced applicable statutes and regulations.  All awards are subject to the terms and conditions, cost principles, and other considerations described in the HHS Grants Policy Statement. The HHS Grants Policy Statement can be found at  https://www.ahrq.gov/funding/policies/hhspolicy/index.html.

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