Full Text HS-96-004
NIH GUIDE, Volume 25, Number 8, March 15, 1996
RFA:  HS-96-004
P.T. 34

  Health Services Delivery 

Agency for Health Care Policy and Research
Letter of Intent Receipt Date:  April 26, 1996
Application Receipt Date:  June 12, 1996
The Agency for Health Care Policy and Research (AHCPR) announces the
availability of cooperative agreements to develop and test quality of
care measures.  The projects undertaken as a result of this Request
for Applications (RFA) will (1) expand the conceptual and
methodological basis for developing quality measures, and (2) produce
relevant, feasible, reliable, valid, and rigorously tested sets of
new quality measures for comparison across different sites.  The
fundamental long term goal of this effort is to strengthen the
science base underlying the evolution of performance measures while
expanding the range of available, ready-to-use measures which address
the continuum of care.  To complement current efforts underway in the
field, development of measures for clinical conditions and
populations where measures are lacking will have a high priority.
Applicants are encouraged to form consortia that provide (1) the
technical capabilities to develop quality of care measures, and (2)
access to delivery settings in which to test the utility of these
measures.  Potential consortia participants include:  health care
plans, purchasers, State health agencies (particularly those involved
with Medicaid managed care), Peer Review Organizations (PROs),
horizontally and vertically integrated delivery systems, and academic
health science centers.  Consortia participants should include
appropriate multidisciplinary expertise in clinical, scientific,
information systems, and administrative areas.  Both consortia
members and project staff should include individuals from academic
and delivery settings with expertise in research and evaluation.
The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  AHCPR urges
applicants to submit applications with relevance to the specific
objectives of this initiative.  Potential applicants may obtain a
copy of "Healthy People 2000" (Full Report:  Stock No. 017-001-
00474-0 or Summary Report:  Stock No. 017-001-00473-1) through the
Superintendent of Documents, Government Printing Office, Washington,
DC 20402-9325 (telephone: 202/512-1800).
Applications may be submitted by domestic non-profit organizations,
associations, public or private, including universities, units of
State and local governments, non- profit firms, and non-profit
foundations; or a consortium of organizations.  If the application is
submitted by a domestic, non-profit, public or private organization,
a consortium may include other types of organizations, such as
for-profits.  Racial/ethnic minorities, women, and persons with
disabilities are encouraged to apply as Principal Investigators.
The administrative and funding instrument will be the cooperative
agreement (U18), in which substantial AHCPR scientific and
programmatic involvement with the awardee(s) is anticipated during
the performance of the project.  The total project period for each
application submitted in response to the RFA may not exceed five
years.  This is a one-time solicitation.  The anticipated award date
is September 1, 1996.
The AHCPR expects to award up to $3 million in Fiscal Year 1996 for
several short and long term projects, dependent upon the overall
availability of funds.  Funded projects will reflect a balance
between short time projects (one to three years), which can rapidly
produce performance measures using existing knowledge and
instruments, and projects that require a longer developmental period
(three to five years).
The number of awards is dependent on the number of high quality
applications and their individual budget requirements; it is not the
intent of AHCPR that the awards be equal in size.  Funding beyond the
initial budget period will depend upon annual progress reviews by
AHCPR and the availability of funds.
The AHCPR is charged with enhancing the quality, appropriateness, and
effectiveness of health care services; and access to such services.
The AHCPR accomplishes this through a broad program of scientific
research and promotion of improvements in clinical practice and in
the organization, financing, and delivery of health care services.
As efforts are made to increase the efficiency with which health care
is provided and to curtail unnecessary expenditures, accountability
demands the ability to assess clinical performance and maximize
health care value (AHCPR, 1995).
In March 1992, AHCPR convened a conference to examine research
priorities in quality improvement and quality assurance.  The
conference provided a forum for discussion among health care
providers, researchers, policymakers, and quality management
professionals, working in both the public and private sectors (AHCPR,
1993).  Based on that conference, AHCPR issued a Program Announcement
in May 1993 entitled, "Health Care Quality Improvement and Quality
Assurance Research," which delineated the general parameters of
AHCPR's support for investigator-initiated research in this area.
AHCPR also supports more applied activities intended to assist
providers, payers, and quality management professionals in using the
results of research.
A recently completed effort supported by AHCPR developed a typology
for classifying and assessing existing clinical performance measures
(Center for Health Policy Studies/Center for Quality of Care Research
and Education, 1995).  The project has collected clinical quality
measures developed by public and private organizations and created a
summary description of each measure.  Information on the measures is
recorded in linked data bases.  The data bases can be searched to
identify and compare measures; for example, measures related to
ambulatory care or a particular clinical condition.
AHCPR is building on the valuable work currently underway in the area
of performance measurement through private and public sponsorship.
These efforts include:
o  Continued evolution of the Health Plan Employer Data and
Information Set by the National Committee for Quality Assurance
directed at purchasers for evaluating health maintenance
organizations and identifying gaps in measurement by the Committee on
Performance Measurement;
o  The Foundation for Accountability's effort to develop performance
measures which can be used by purchasers to evaluate the broad range
of health insurance products;
o  Performance measurement development and an initiative to develop a
framework for the selection of performance measurement systems by the
Joint Commission on Accreditation of Healthcare Organizations, which
addresses several delivery settings;
o  The Practice Assessment Quality Improvement Program by the
American Medical Association directed to physicians' offices;
o  Development of a Nursing Care Report Card for hospital services by
the American Nurses Association;
o  Development of result statements and related performance measures
for selected public health concerns by the Department of Health and
Human Services with State and local health departments and a range of
public and private partners; and
o  Numerous purchasing coalitions and related "report card" projects
(e.g., the Pacific Business Group on Health).
This solicitation for the Expansion of Quality Measures (Q-SPAN)
supports current public and private sector initiatives by focusing on
complementary content areas and issues related to developing and
testing new measures of the technical quality of care.  (Note:  the
terms "quality of care measures," "technical quality of care
measures," "quality measures," "clinical quality measures," and
"performance measures" are used interchangeably in this document,
while recognizing that some terms are more broadly used to encompass
measures related to consumer satisfaction surveys).  Applications are
invited for a wide variety of measurement development and testing
efforts.  Examples of the types of projects to be funded through this
RFA include:
1.  Development of quality measures for specific clinical conditions
and health delivery settings or services in which there has been
limited performance measurement development and use to date (e.g.,
care for chronic illnesses, emergency and urgent care services, child
and adolescent health, behavioral health, home health care, and
rehabilitation services).
2.  Development of measures or sets ("families") of measures
appropriate for different levels of analysis, perhaps targeted for
specific preventive care and clinical conditions, and uses.  Levels
of analysis could focus on provider, practice site (hospital, home
care agency, etc.) and/or financing/delivery system.  (Note:  While
the community level is also an important emerging area for quality
measures, it is excluded from the scope of this solicitation,
although conceptual attention to the level of analysis may be
appropriate in developing the application.) Examples of questions
which could be addressed include:
o  Within a specific clinical area, what measure is most valid and
reliable when the health care plan is the level of analysis?  Is that
measure also appropriate at the individual practitioner/practice site
level of analysis, or is there a related measure better suited to
that level?  As one example, a measure of the rate of mammography
screening might be appropriate at the practitioner/practice site
level.  On the other hand, a measure of the stage of breast cancer
when found might be inappropriate at the practitioner and/or practice
site level due to the small numbers problem, but reasonable at the
level of the plan.  A response to this solicitation could include
creation of a systematic method for approaching the level of analysis
and the development of one or more families of measures.  (Note:
Clearly, the patient or the practitioner is the usual unit of
analysis for gathering data about such measures.  In the above
example for mammography screening, the status of each patient is
obtained with respect to having or not having a mammogram in a given
period of time so that the unit of analysis is each individual woman.
Whether the data should then be aggregated to the population of the
practitioner/practice site, the insuring entity, or even, perhaps,
the employer, is the level of analysis which needs explication.)
o  Are there measures that can be applied across payment systems
(e.g., fee for service, point-of-service plans, health maintenance
organizations)?  Much of the current measurement effort focuses on
managed care because of the relative ease of identifying the
population for which the health care plan is responsible.  An
important contribution to the field would be made by the development
of measures which can be applied regardless of the financing/delivery
o  What determines whether a measure can be applied across a spectrum
of uses, ranging from internal quality improvement within an
organization, to externally reported information to purchasers (who
may eventually link performance with varying levels of compensation),
to publicly reported information in the media?
3.  Development of "families" of measures which cross service sites
(e.g., hospital, home care, rehabilitation, ambulatory care, and long
term care), allowing for longitudinal analyses of processes of care,
outcomes, and functional capacities across total enrolled populations
or specific clinical/diagnostic cohorts.
4.  Creation and implementation of outcomes measures appropriate to
assess quality of care can present several challenges.  Iezzoni
(1994) notes that the meaningful assessment of patients' outcomes
requires two basic methodologies:  (1) a measure of the outcome
itself, and (2) a way to adjust for patients' risks for various
outcomes.  Further, development of risk adjustment strategies is
critical to more widespread use of appropriate outcomes measures for
comparisons.  Additionally, measurement of outcomes is further
complicated by the length of time that may need to elapse between the
provision of care and the evaluation of specific outcomes.  Little
systematic information is available about the optimal time that
should elapse for linking various outcomes with their antecedent care
events.  Do the methods for evaluating and validating measurements of
outcomes differ from those for other types of measures?  What level
of risk adjustment and calibration is needed for a measure to be
useful for the various purposes of, for example, internal quality
improvement vs. public reporting?
In addition, are there measures that might be classified as process
measures for one provider/practice setting level, but are outcomes
measures for another provider/practice setting or for the organized
delivery system level?  For example, is readmission to the hospital
for a particular condition within a specified time frame an outcome
measure for the hospital but a process measure for the ambulatory
care?  While the absolute assignment of a measure to the traditional
categories of structure, process, and outcome (Donabedian, 1966) is
not the focus of this solicitation, current discussions of "outcomes"
would benefit from further consideration of these categories along
with the development of linked or nested measures among and between
the various levels of analysis.
Performance measures have been evolving without accompanying
conceptual frameworks.  Therefore, a requirement for every
application in response to this RFA will be the inclusion of the
conceptual framework(s) that will be used to guide the development
and testing of the quality measures.  For example, how does one
determine the "best" indicator?  The conceptual frameworks are
expected to figure prominently in work-in-progress and final reports.
Thus, it is expected that the field will be the beneficiary of rich
and diverse conceptualizations concerning the measurement of quality,
as well as rigorously tested measures.
Objectives and Scope
The objectives of this RFA are to:  (1) develop technical measures of
quality of care for selected conditions, diagnoses, or enrolled
populations (which may also address the continuum of care across
delivery settings); (2) test and evaluate the measures in multiple
evaluation sites.  The fundamental long term goal of this effort is
to strengthen the science base underlying the evolution of
performance measures while expanding the range of available,
ready-to-use measures that address the continuum of care.
To complement current efforts underway in the field, development of
measures for clinical conditions and populations where measures are
lacking will have a high priority.  Also of great importance are
measures that include the care provided to Medicaid and Medicare
Measures developed under this solicitation are intended for the
comparative assessment or evaluation of clinical care provided to
groups of patients in various settings or delivery systems.  Measures
may be designed for application within a specific type of setting
(e.g., measures addressing the quality of care provided in nursing
homes) or may address the assessment of clinical quality within a
continuum of care and across different types of settings (e.g.,
diagnosis and treatment of conditions that are seen by both
internists and specialists; assessment of care that is provided in
both ambulatory and inpatient settings).
While technical quality of care measures developed under this RFA may
be derived from information obtained from consumers, consumer
satisfaction measures (e.g., overall satisfaction with care) are
excluded from this announcement.  Development of diagnostic tools,
instrumentation, or health status measures per se are excluded;
however, applications focusing on use of existing diagnostic tools,
instrumentation, and health status measures for comparative quality
assessment are encouraged.
Applicants may propose a narrow or broad project in responding to
this RFA.  For example, a relatively narrow project may focus on the
development of measures for a specific clinical condition or
diagnosis in one type of practice setting (e.g., hospital, home
care).  A broader project may develop a longitudinal set of measures
for a specific clinical condition and may specify the level of
analysis for each measure in the set.  Another broad project may
address the longitudinal assessment of the well population or a
specific age cohort within it (e.g., adolescents).  A rationale and
conceptual framework for the selected focus must be presented.
It is anticipated that the resulting quality measures will be rates
or ratios with rigorously specified numerators and denominators,
sampling parameters, data collection procedures, and data analysis
procedures.  Because of the latitude for awardees to select the focus
and scope, there is not a requirement for the data to come
exclusively from a specific type of data source.  Projects that
explore how best to use existing State, Peer Review Organization
(PRO), and employer sources of data for comparable quality measures
are of interest.
For measures to be applied in settings other than those in which they
were developed, and in order for the field to develop in an additive
and logical manner, there needs to be a commonly shared template for
writing the specifications for performance measures.  Therefore, it
is anticipated that there may be some linkage between other AHCPR
projects and the Q-SPAN projects in order to develop and apply such a
specifications template.  If available by the time of their final
reports, awardees will be asked to employ the developed
specifications template in documenting their measures.
Study Design
Awardees will need to accomplish a number of objectives in two major
phases:  1) development of the measures, and 2) testing/evaluation of
the measures.  Throughout these phases, awardees will collaborate
with AHCPR staff.  Awardees are expected to prepare interim reports
for each of the phases identified below and a final report that
summarizes all activities.  Elements of these reports will be
determined jointly by the awardees and AHCPR.  Applicants may propose
the length of time to be spent in each phase.  Although each of the
phases is discrete, their specific time frames may overlap.  If
appropriate to the scope of the project, applicants may propose a
rolling schedule where some measures have moved into the testing
phase while others are still under development.
Phase I:  Development of Measures
The major goal of Phase I is to produce measures which have a sound
conceptual framework and strong scientific basis while being relevant
and feasible in terms of standardized data collection across plans,
employers, States, etc. and which provide comparable information to
guide quality improvement efforts.
For this phase, the application needs to clearly 1) identify the
focus or scope of the work which will be undertaken; 2) provide the
conceptual framework for how measurement development will be
approached; 3) describe the organizations participating in the
application; 4) submit background information on proposed steering
committee members' and their roles and responsibilities; 5) detail
the project management mechanisms which will be employed; 6) describe
a pilot-test phase establishing the relevance, feasibility,
reliability, validity, and appropriate calibration of the measures;
and 7) develop an initial management plan for Phase I which addresses
the preceding items.
Applicants should provide information in the application which
demonstrates their ability to:
o  Use existing research, clinical practice guidelines, literature
summaries, etc., to provide a basis for developing the quality
o  Specify elements needed for the quality measures from existing or
proposed sources of data.
o  Specify alternative approaches for gathering the data for the
quality measures (e.g., administrative data bases, medical records,
patient reports).
o  Related to 3. above, explore innovative data collection strategies
(e.g., linking with employer data to obtain time- off-from-work
o  Work with the sources of data (e.g., health care plans, States) to
ascertain feasibility, costs, and related data as the measures are
being developed.
o  Develop the specifications for calculating the quality measures in
both narrative and flowchart forms.
o  Identify the pilot test sites at which preliminary assessments of
the reliability and validity of measures will occur.
o  Conduct preliminary assessments of the relevance, feasibility,
reliability, validity, and appropriate calibration of the measures.
o  Update as necessary the measures under development to incorporate
emerging scientific findings.
Phase II:  Testing and Evaluation
The major goal of Phase II is to test, evaluate, and refine the
measures so that at the end of the project the measures are ready to
be used by the health care field at large.
For this phase, the application needs to clearly (1) identify a
preliminary set of  evaluation sites in which to implement and
evaluate the developed measures; (2) describe the mechanisms to be
used to assess the integrity of the data obtained at the evaluation
sites; (3) propose the formative and summative evaluations to be
conducted of the feasibility, costs, and utility of the measures; (4)
identify mechanisms to revise the measures as needed; (5) detail the
project management mechanisms which will be employed; and (6) develop
an initial management plan for Phase II which addresses the preceding
Applicants should provide information in the application that
demonstrates their ability to:
o  Develop an initial evaluation plan for this phase which includes
appropriate quantitative and qualitative methods.
o  Develop an initial evaluation site management plan.  The
evaluation site management plan should clearly specify both awardee
and site personnel roles and responsibilities and should include a
time table listing key decisions/activities related to and dates for
all demonstration components.
o  Assist evaluation sites' staffs in all phases of the evaluation
o  Collect and process evaluation data at pre-specified times.
o  Utilize the specifications template developed in conjunction with
other AHCPR projects as available and provide specifications for the
developed measures consistent with that template.
o  Update as necessary the measures under development to incorporate
new scientific findings along with the results of this comprehensive
evaluation phase.
Applicants should respond to the following requirements of the RFA:
Conceptual Framework
As discussed above, a conceptual framework(s) is expected to guide
the development and testing of the quality measures.
Steering Committee
Creation of a steering committee is necessary for the purpose of
coordination and communication among project participants.  The
committee should include appropriate clinical expertise.
Project Organization
If a consortium of institutions responds to this RFA, the application
should describe a practical structure for consortium decisionmaking
and governance, and the mechanisms designed to ensure that effective
collaboration will occur among sites.  Unanticipated disagreements
about methods, resource allocations, standardization, authorship,
etc., may arise during the course of any project.  A consortium must
be able to make unified decisions on the merits of these issues,
without dissolving or routinely relying upon outside arbitration.
Consortium arrangements typically take the form of a formal agreement
between an applicant and other organization(s). In the grant
application, a separate budget page and budget justification must be
included for each organization involved in the proposed consortium
Applicants should develop a timeline for project activities,
including percentage of effort for key staff for all years.
Confidentiality of Data
Information obtained in the course of this study that identifies an
individual or entity must be treated as confidential in accordance
with section 903(c) of the Public Health Service Act.  Applicants
must describe in the Human Subjects section of the application form
procedures for ensuring the confidentiality of identifying
information. This should include a discussion of who will be
permitted access to the information, both the raw data and machine
readable files, and how personal identifiers will be safeguarded.
Terms and Conditions of Award
This cooperative agreement anticipates substantial AHCPR scientific
and programmatic involvement with the awardees throughout the
initiation, implementation, and close-out phases.
Awardee Responsibilities
The awardee(s) will have primary responsibilities for all activities
o  Formation of a project steering committee, including the convening
of meetings and documenting of activities.
o  Design of organizational and communication mechanisms for the
development and evaluation of the measures congruent with the
activities and budget.
o  Measurement development processes.
o  Identification of pilot test sites and evaluation sites.
o  Provision of training and technical assistance to pilot test sites
and evaluation sites.
o  Identification of methods for the formative and summative
evaluations of the measures.
o  Submission to AHCPR of interim and final reports, including
discussion of difficulties encountered in planning, implementing, and
evaluating the products of this project.
o  Provision to AHCPR of the precise specifications for all the
measures on disk and other formats, using, if available, the template
devised in conjunction with other AHCPR projects.
o  Provision to AHCPR, upon request, of copies of all data generated
under the award.
o  Cooperation with other key parties in the Q-SPAN and complementary
AHCPR initiatives.
o  In cooperation with the AHCPR Project Officer, dissemination of
the quality measures and other research findings as they become
AHCPR Responsibilities
The AHCPR Project Officer and other AHCPR staff will have substantial
scientific and programmatic involvement during the conduct of this
activity.  Specifically, AHCPR's role in the cooperative agreement is
to provide technical assistance, advice, and support to the Principal
Investigator and to ensure that related AHCPR supported projects
complement one another.  AHCPR will participate in all key project
decisions, including but not limited to:
o  Provide guidance on the selection of aspects of the conditions or
other foci on which measures will be developed.
o  Approve the management plans and evaluation plan.
o  Work with the awardee to finalize pilot test sites and evaluation
o  Review and approve interim and final reports.
o  Provide collaboration with and information from other relevant
Federal agencies and programs.
o  Disseminate the quality measures and other research findings as
they become available.
o  Participate in or coordinate periodic strategy sessions to review
Prior written approval from AHCPR will be required for the addition
or deletion of a participating or collaborating institution, site, or
other organizational component.
The AHCPR reserves the right to terminate or curtail the study in the
event of:
o  Insufficient progress toward completion of study goals within an
agreed-upon timeframe.
o  Inability to work in a collaborative manner with pilot test sites,
evaluation sites, the steering committee, or other necessary
organizations and projects.
o  Inability to successfully address key methodological issues.
Rights in Data
AHCPR awardees may copyright or seek patents, as appropriate, for
final and interim products and materials including, but not limited
to, methodological tools and measures, software with documentation,
literature searches, and analyses, which are developed in whole or in
part with AHCPR funds.  Such copyrights and patents will be subject
to a Federal Government license to use these products and materials
for AHCPR purposes.  AHCPR purposes may include, subject to statutory
confidentiality protections, making research materials including data
bases and algorithms available for verification or replication by
other researchers; and subject to AHCPR budget constraints, final
products may be made available to the health care community and the
public by AHCPR, or its agents, if such distribution would
significantly increase access to a product and thereby produce public
health benefits.  Ordinarily, to accomplish distribution, AHCPR
publishes research findings but relies on awardee efforts to market
grant or cooperative agreement supported products.  In keeping with
AHCPR's legislative mandates to make both research results and data
available, copies of all products and materials developed under a
cooperative agreement supported in whole or in part by AHCPR funds
are to be made available to AHCPR promptly and without restriction,
upon request by AHCPR.
These special terms of award are in addition to and not in lieu of
otherwise applicable PHS grants policies and Federal regulations.
It is the policy of AHCPR that women and members of minority groups
be included in all AHCPR supported research projects involving human
subjects, unless a clear and compelling rationale and justification
are provided that inclusion is inappropriate with respect to the
health of the subjects or the purpose of the research.
The 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 provisions that are
substantially different from the 1990 policies.  All investigators
proposing research involving human subjects should read the "NIH
Guidelines on the Inclusion of Women and Minorities as Subjects in
Clinical Research," which was published in the FEDERAL REGISTER of
March 28, 1994 (FR 59 14508-14513), and printed in the NIH GUIDE FOR
GRANTS AND CONTRACTS of March 18, 1994, Volume 23, Number 11.  AHCPR
follows the revised NIH Guidelines, as applicable.
Investigators may obtain copies from those sources or from the AHCPR
contractor, Global Exchange, listed under INQUIRIES.  AHCPR program
staff may also provide information concerning this policy (See
Prospective applicants are asked to submit, by April 26, 1996, a
letter of intent that includes the names, addresses, and telephone
numbers of the proposed Principal Investigator and other key
personnel; the identities of proposed consortia members, including
any other participating organizations or institutions; a descriptive
title of the proposed project; and the number and title of this RFA.
Although a letter of intent is not required, is not binding, and does
not enter into the consideration of any subsequent application, the
information allows AHCPR to estimate the potential review workload
and avoid conflicts of interest in the review.  AHCPR will not
provide responses to letters of intent.
The letter of intent is to be sent to the Q-SPAN Project Officer at
the address listed under INQUIRIES.
The research grant application form PHS 398 (rev. 5/95) is to be used
in applying for these grants.  State and local government applicants
may use form PHS-5161-1, Application for Federal Assistance (rev.
9/92), and follow those requirements for copy submission.  These
forms are available at most institutional offices of sponsored
research and may be obtained from the Office of Extramural Outreach
and Information Resources, Office of Extramural Research, National
Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD
20892-7910, telephone 301/710-0267 or email:  girg@drgpo.drg.nih.gov.
AHCPR applicants are encouraged to obtain application materials from
the AHCPR contractor:  Global Exchange, Inc. (SEE INQUIRIES).
The RFA label available in the PHS 398 (rev. 5/95) application form
must be affixed to the bottom of the face page of the original
application.  Failure to use this label could result in delayed
processing of the application such that it may not reach the review
committee in time for review.  In addition, the RFA title and number
must be typed on line 2 on the face page of the application form and
the YES box must be marked.
Submit a signed, typewritten original of the application, including
the Checklist, and three signed, legible photocopies in one package
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier services)
At the time of submission, two additional copies of the application
must be sent to the Q-SPAN Project Officer at the address under
Applications submitted under this RFA must be received in the
Division of Research Grants, NIH, by June 12, 1996.  If an
application is received after that date, it will be returned to the
applicant without review.
Applications that are complete and responsive to this RFA will be
evaluated for scientific and technical merit by an appropriate peer
review group convened in accordance with AHCPR peer review
procedures.  As part of the merit review, all applications will
receive a written critique, and also may undergo a process in which
only those applications deemed to have the highest scientific merit
will be discussed and assigned a priority score.  Recommendations of
the peer review committee may be reviewed subsequently by AHCPR's
National Advisory Council.
General Review Criteria
Review criteria for all AHCPR grant applications are: significance
and originality from a scientific and technical viewpoint; adequacy
of the method(s); availability of data or proposed plan to collect
data required for the project; qualifications and experience of the
Principal Investigator and proposed staff; adequacy of the plan for
organizing and carrying out the project; reasonableness of the
proposed budget; and adequacy of the facilities and resources
available to the applicant (See also Special Review Criteria).
Special Review Criteria
In addition to the general review criteria above, the reviewers will
assess to the extent to which the application addresses the
Requirements of the RFA, including SPECIAL REQUIREMENTS and the
o  Understanding of issues related to completing the activities
o  Demonstrated ability to collaborate and cooperate with, provide
technical assistance and training to, and/or monitor the progress of
potential collaborating organizations, pilot test sites and
evaluation sites; and particularly to develop productive and
collegial interactions with other groups such as consortium members,
subcontractors, consultants, data supplying organizations, site
representatives, and AHCPR staff.
o  Understanding of all the issues related to the development of
scientifically-based valid and reliable quality measures.
o  Demonstrated ability to apply appropriate methods required for
testing, evaluating, and refining the quality measures including
specification of evaluation questions as well as use of quantitative
and qualitative data collection and analysis methods.
Applications will compete for available funds with all other
applications under this RFA.  The following will be considered in
making funding decisions:  quality of the proposed project as
determined by peer review; program balance, including the
complementarity of topics for which measures will be developed and
the likelihood of successful collaboration among projects based upon
sufficient compatibility of features; and availability of funds.
Written and telephone inquires concerning this RFA are encouraged.
Copies of this RFA are available from:
Global Exchange Inc.
7910 Woodmont Avenue, Suite 400
Bethesda, MD  20814-3015
Telephone 301/656-3100
FAX 301/652-5264
Copies of the RFA and AHCPR Pub. No. 96-0036 can also be requested by
e-mail at qspanrfa@po3.ahcpr.gov, and AHCPR InstantFAX at
301/594-2800.  To use InstantFAX, you must call from a fax machine
with a telephone handset.  Use the key pad on the receiver when
responding to prompts from InstantFAX.  The RFA will be sent at the
end of the ordering process.  AHCPR InstantFAX operates 24 hours a
day, 7 days a week.  For questions about this service, call AHCPR's
Division of Communications at 301/594-1364 ext. 159.
Direct inquires regarding programmatic issues, including information
on the policy of inclusion of women and minorities in study
populations, to:
Joann Genovich-Richards, RN, Ph.D.
Q-SPAN Project Officer
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 502
Rockville, MD  20852-4908
Telephone:  (301) 594-1352 ext. 114
FAX:  (301) 594-2155
Email:  jrichard@po3.ahcpr.gov
Direct inquires regarding fiscal matters to:
Carol Roache
Grants Management Staff
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 601
Rockville, MD  20852-4908
Telephone:  (301) 594-1447
FAX:  (301) 594-3210
Email:  croache@po7.ahcpr.gov
This program is described in the Catalog of Federal Domestic
Assistance No. 93.226.  Awards are made under authorization of Title
IX of the Public Health Service Act (42 U.S.C. 299- 299c-6), and
administered under the PHS Grants Policy Statement and Federal
Regulations 42 CFR 67, Subpart A, and 45 CFR Parts 74 and 92.  This
program is not subject to the intergovernmental review requirements
of Executive Order 12372 or Health Systems Agency review.
The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
projects.  In addition, Public Law 103-227, The Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routine education,
library, day care, health care, or early childhood development
services are provided to children.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.
AHCPR. (1995).  For a discussion of AHCPR's focus on quality, see
"Promoting Quality and Accountability Through Public-Private
Partnerships," an address to The Health Care Quality Alliance on
February 14, 1995 by Clifton R. Gaus, Sc.D., Administrator, AHCPR.
AHCPR. (1993).  Summary Report:  Putting Research to Work in Quality
Improvement and Quality Assurance.  Rockville: MD. AHCPR Publication
NO. 93-0001.
Center for Health Policy Studies/Center for Quality of Care Research
and Education. (1995).  Understanding and Choosing Clinical
Performance Measures for Quality Improvement: Development of a
Typology.  Rockville, MD: Agency for Health Care Policy and Research.
Contract No. 282-92-0038.  AHCPR Reports #95-N001 and #95-N002.
Donabedian, A. (1966).  Evaluating the Quality of Medical Care.
"Milbank Memorial Fund Quarterly." 44:166-203, (July, part 2).
Iezzoni, L.I. editor (1994). "Risk Adjustment for Measuring Health
Care Outcomes." Ann Arbor, MI: Health Administration Press, 3.2.

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