Full Text HS-95-001


NIH GUIDE, Volume 23, Number 44, December 16, 1994

RFA:  HS-95-001

P.T. 34, AA

  Health Care Economics 
  Child/Maternal Health 

Agency for Health Care Policy and Research
Health Resources and Services Administration

Application Receipt Date:  March 16, 1995


This announcement solicits applications to conduct research on (1)
Severity and Acuity Measures for Illness and Injury for Children; (2)
Child and Adolescent Patient Outcomes and Outcome Measures; (3) Costs
of Emergency Medical Services for Children; and (4) Emergency Medical
Services for Children (EMSC) System Organization, Configuration, and
Operation.  This solicitation represents a collaboration between the
Maternal and Child Health Bureau, Health Resources and Services
Administration (HRSA), and the Agency for Health Care Policy and
Research (AHCPR).


The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  The AHCPR
urges applicants to submit grant applications with relevance to the
specific objectives of this initiative.  Potential applicants may
obtain a copy of "Healthy People 2000" (Full Report:  Stock No.
017-001-00474-0 or Summary Report:  Stock No. 017-001-004374-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone 202-783-3238).


Applications may be submitted by non-profit organizations, public and
private, including universities, clinics, units of State and local
governments, non-profit firms, and non-profit foundations.  The
AHCPR, by statute, can support only non-profit organizations.
Racial/ethnic minority individuals, women, and persons with
disabilities are encouraged to apply as Principal Investigators.


This RFA will use the research project grant (R01) mechanism.
Responsibility for the planning, direction, and execution of the
proposed project will be solely that of the applicant.  Grant funds
are additive, not substitutive; they are not to be used to replace
existing resources.  Also, they may not be used for delivery of
services.  This RFA is a one-time solicitation.  The total requested
project period for applications submitted in response to this RFA may
not exceed three years.  Applications may request a maximum total of
$250,000 direct and indirect costs per year.  The earliest possible
award date will be September 1, 1995.  Annual progress reviews by
AHCPR and HRSA, and the availability of funds especially designated
for this research, will determine the continuation of grants up to
the three year limit.


The AHCPR and HRSA expect that up to $500,000 will be available in
Fiscal Year 1995 for first year support of two to three awards.



The Maternal and Child Health Bureau (MCHB), HRSA, and the AHCPR have
joined in a partnership to address research needs of pediatric
emergency medicine.  The EMSC program, authorized by the Congress in
1984, is an activity of MCHB that addresses the emergency-care needs
of sick and injured children that are different from those of adults.
The need for such special attention to children is supported by the
report of the Institute of Medicine (IOM) Committee on Pediatric
Emergency Medical Services issued in 1993 (Institute of Medicine,
Emergency Medical Services for Children, Washington, DC:  National
Academy Press 1993).  In this report, the Committee cited relative
neglect of research on pediatric emergencies, and outlined a research
agenda for EMSC.  From that agenda, MCHB and AHCPR have selected for
this RFA, four topics that fall most clearly within the area of
interest common to both agencies.

Research Issues

Listed below are the four broad topics selected to advance knowledge
about the provision of emergency medical services (EMS) to children.
Examples of specific issues are provided under each broad topic.

1.  Severity and Acuity Measures for Illness and Injury

o  Development and validation of generic scales or indexes for
children, with special attention to use (1) for triage in the
prehospital or emergency department (ED) setting; and (2) to adjust
case mix for purposes of research or performance evaluation.

o  Development and validation of specific severity scales, such as
measures of abdominal and chest trauma.

o  Development and evaluation of methods to triage patients more
accurately in the field and in EDs, with particular attention to
young children with possible serious illness.

2.  Patient Outcomes and Outcome Measures

o  Development and validation of outcome measures based on functional
status/disability, suitable for use in planning and evaluating
rehabilitation care.

o  Development and validation of outcome measures suitable for
research and performance evaluation.

o  Employing innovative approaches to longitudinal study of outcomes
with a follow-up to post-hospital care.

3.  Costs

o  Assessment of the marginal incremental cost of different
approaches to improving EMSC.

o  Evaluation of the cost-effectiveness of different EMSC program
configurations, with attention to impacts on emergency systems and
the health care system, and considering a broad set of program
benefits and outcomes.  Examples of such configurations would be
different approaches to medical control, categorization, and

o  Determination of the economic consequence of pediatric trauma or
severe illness to families and to taxpayers, taking into account
direct and indirect costs and all types and settings of EMSC.

4.  System Organization, Configuration, and Operation

o  Evaluation of effectiveness of interventions to upgrade EMS system
components to improve care of children.  Examples of such components
would be equipment, protocols, and telephone advice capabilities.

o  Study of effectiveness and efficiency of variations in EMSC care,
highlighting special population subgroups or groups in special
circumstances (homeless, migrant, military, rural/urban/suburban,
minority, managed care, uninsured, Medicaid, inner city).

o  Formulation of methods for developing population-based estimates
of need for ED and pediatric intensive care unit (PICU) beds for
local and regional areas, for purposes of planning and resource

Applicants are encouraged to take full advantage of opportunities for
efficient enhancements of available expertise, data, and other
research resources.  This might include collaboration with
researchers and practitioners outside their own institutions,
creative use of existing data, or "piggybacking" on other data
collection activities.  Another possibility for leveraging research
resources is to conduct comparisons of outcomes where existing
practice patterns or structures are known to differ (e.g., across
care settings, geographical areas, insurers, or providers).


It is the policy of AHCPR/HRSA that women and members of minority
groups must be included in all AHCPR/HRSA supported health services
research projects involving human subjects, unless a clear and
compelling rationale and justification are provided that inclusion is
inappropriate with respect to the health of the subjects or the
purpose of the research.

A new NIH policy resulting from the NIH Revitalization Act of 1993
(Section 492B of Public Law 103-43) supersedes and strengthens NIH's
previous policies (Concerning the Inclusion of Women in Study
Populations, and Concerning the Inclusion of Minorities in Study
Populations), which were in effect since 1990 and which AHCPR had
adopted.  The new NIH policy contains some provisions that are
substantially different from the 1990 policies.  AHCPR plans to
publish guidelines specific to AHCPR.  In the interim, AHCPR will
follow the NIH guidelines, as applicable.

All investigators proposing research involving human subjects should
read the "NIH Guidelines for Inclusion of Women and Minorities as
Subjects in Clinical Research," published in the Federal Register of
March 28, 1994 (FR 59 14508-14513), and reprinted in the NIH Guide
for Grants and Contracts, Volume 23, Number 11, March 18, 1994.

Investigators also may obtain copies of the NIH policy from the AHCPR
program staff listed under INQUIRIES.  AHCPR program staff may also
provide additional relevant information concerning this policy.


The application receipt date is March 16, 1995.  Applications are to
be submitted on the grant application form PHS 398 (rev. 9/91).
State and local government agencies may use form PHS 5161 and follow
those requirements for copy submission.  Application kits are
available at most institutional offices of sponsored research; from
the Office of Grants Information, Division of Research Grants,
National Institutes of Health, Westwood Building, Room 449, Bethesda,
MD 20892, telephone 301-710-0267; and for AHCPR applications from
Global Exchange Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD
20814-3015, telephone 301-656-3100 (FAX 301-652-5264).

The RFA title and number must be typed on line 2a of the face page of
the application form and the YES box must be marked.  In addition,
the RFA label available in the PHS 398 application form must be
affixed to the bottom of the face page of the application.  Failure
to use this label could result in delayed processing such that it may
not reach the review committee in time for review.

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

Division of Research Grants
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**

At the time of submission, two additional copies of the application
must be sent to:

Ms. Elinor Walker
Center for General Health Services Extramural Research
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 502
Rockville, MD  20852-4908

Completed applications must be received by the Division of Research
Grants by March 16, 1995.  If an application is received after that
date, it will be returned to the applicant without review.

Conference for Prospective Applicants

A conference of one to two days is planned for prospective
applicants, if there is sufficient interest from prospective
applicants.  This conference would provide programmatic and
administrative information and respond to questions concerning this
RFA.  If convened, the conference is planned for January 13, 1995 in
the Washington, DC area.

Attendance is not a prerequisite to applying.  Attendees must pay for
their own travel and accommodation costs.  Individuals with questions
concerning this conference may contact Ms. Elinor Walker at telephone
(301) 594-1352, ext. 108.

Those interested in attending the conference should, no later than
December 30, 1994, mail or FAX their names, addresses, and telephone
numbers to:

Outreach Department
National Center for Education in Maternal and Child Health
2000 15th Street, North
Arlington, VA  22201-2617
Telephone:  (703) 524-7802
FAX:  (703) 524-9335


Upon receipt, applications will be reviewed by the Referral Office,
Division of Research Grants, NIH, for completeness, and by AHCPR/HRSA
staff for responsiveness to the RFA.  Incomplete or nonresponsive
applications will be returned to the applicant without further
consideration.  Applications may undergo triage by an appropriate
peer review group on the basis of relative competitiveness.  The
AHCPR/HRSA will withdraw from further consideration those
applications judged to be non-competitive for award and notify the
applicant Principal Investigator and institutional official.  Those
applications judged to be competitive will undergo further peer
review for scientific merit by a review committee of experts convened
by the AHCPR.  When an application is reviewed, the peer review
committee may recommend further consideration for funding or no
further consideration.  The committee also assigns priority scores to
the applications for which further consideration is recommended.
Recommendations of the peer review committee may be reviewed
subsequently by AHCPR's National Advisory Council for Health Care
Policy, Research, and Evaluation.

Review Criteria

The general review criteria for these AHCPR/HRSA grant applications

o  significance and originality from a scientific and technical

o  adequacy of the proposed method(s);

o  availability of data or proposed plan to collect data required for
the project;

o  adequacy of the plan for organizing and carrying out the project;

o  qualifications and experience of the Principal Investigator and
proposed staff;

o  reasonableness of the proposed budget;

o  adequacy of the facilities and resources available to the
applicant; and

o  adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be

The initial review group will also examine the provisions for the
protection of experimental subjects, and the safety of the research

Special Review Criteria

In addition to the review criteria noted above, special scientific
and technical review criteria also apply.  A major review criterion
for evaluating applications under this solicitation is the likelihood
of obtaining convincing, new information that has the potential for
use to improve the delivery of emergency medical services to
children.  It is the task of the applicant to justify the need for
the research and the potential impact of the findings on emergency
medical services to children.  To the extent that the proposed
research is descriptive rather than analytic, investigators must
justify the importance of the expected results to understanding and
improving EMS services for children.  Investigators are encouraged to
consider the validity and implications of the major assumption
underlying this RFA:  that aspects of the emergency care system and
products of emergency care research pertaining to adults are
inadequate to the needs of children.  Applications to explore or test
this assumption are not ruled out, and applications based on this
assumption will be strengthened by incorporating evidence in its


Applications will compete for available funds with all other
applications for this RFA.  The following will be considered in
making funding decisions:  quality of the proposed project as
determined by peer review, and availability of funds.  The earliest
anticipated date of award for applications will be September 1, 1995.


Inquiries concerning this RFA are encouraged.  AHCPR and HRSA staff
welcome the opportunity to clarify any issues or questions from
potential applicants.  Direct programmatic inquiries to:

Elinor Walker
Center for General Health Services Extramural Research
Agency for Health Care Policy and Research
2101 East Jefferson Street
Rockville, MD  20852
Telephone:  (301) 594-1352, ext. 108
FAX:  (301) 594-2155
Email:  ewalker@PO3.AHCPR.GOV

Jean Athey, Ph.D.
Division of Maternal, Infant, Child, and Adolescent Health
Maternal and Child Health Bureau, HRSA
5600 Fishers Lane, Room 18-A-39
Rockville, MD  20857
Telephone:  (301) 443-4026
FAX:  (301) 443-1296

Direct inquiries regarding fiscal matters to:

Ralph L. Sloat, Grants Management Officer
Agency for Health Care Policy and Research
2101 East Jefferson Street
Rockville, MD  20852
Telephone:  (301) 594-1447
FAX:  (301) 594-3210
Email:  rsloat@PO7.AHCPR.GOV


This program is described in the Catalog of Federal Domestic
Assistance, Nos. 93.180, 93.226, and 93.127.  Awards are made under
authorization of the Public Health Service Act, Title IX (42 U.S.C.
299-299c-6) and Title XIX, Section 1910, as amended (42 U.S.C.
300w-9); and Section 1142 of the Social Security Act (42 U.S.C.
1320b-12).  Awards are administered under the PHS Grants Policy
Statement and Federal Regulations 42 CFR Part 67, Subpart A, and 45
CFR Parts 74 and 92.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372.

The Public Health Service strongly encourages all grant recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  This is consistent with the PHS mission to protect and
advance the physical and mental health of the American people.


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