PRIMARY CARE PRACTICE-BASED RESEARCH NETWORKS (PBRNs)
Release Date: January 21, 2000
RFA: HS-00-004
Agency for Healthcare Research and Quality (formerly AHCPR)
Letter of Intent Receipt Date: March 10, 2000
Application Receipt Date: April 27, 2000
PURPOSE
The Agency for Healthcare Research and Quality (AHRQ), formerly known as the
Agency for Health Care Policy and Research (AHCPR), announces the availability
of one-year exploratory grants to assist new or established practice-based
research networks (PBRNs) in planning for activities that will enhance their
capacity to conduct research in primary care settings and translate research
findings into practice. Each grant will support the development of a PBRN-
specific plan to: (1) establish or augment electronic collection and
aggregation of practice-derived data, (2) increase network capacity to study
the health care of racial and ethnic minority and/or underserved populations,
(3) create systems to facilitate the implementation of research findings by
network clinicians and practices, and, (4) identify potential sources of
ongoing network support. It is anticipated that after completion of these
exploratory grants, recipient organizations will be in a position to compete
for subsequent funds AHRQ expects to award in 2001 (contingent upon funding
availability) to assist PBRNs in carrying out individually developed plans.
The long-term goal of the overall initiative is to improve the capacity of
PBRNs to expand the primary care knowledge base and to establish mechanisms to
assure that new knowledge is incorporated into actual practice and that its
impact is assessed.
For the purposes of this RFA, a PBRN is defined as a group of ambulatory
practices devoted principally to the primary care of patients, affiliated with
each other (and often with an academic or professional organization) in order
to investigate questions related to community-based practice. This definition
includes a sense of ongoing commitment to the research endeavor, and an
organizational structure that transcends a single study (see further details
Qualifications under SPECIAL REQUIREMENTS).
HEALTHY PEOPLE 2010
The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of Healthy People 2010, a PHS-led national
activity for setting health improvement priorities for the United States.
AHRQ encourages applicants to submit grant applications with relevance to the
specific objectives of this initiative. Potential applicants may obtain a
copy of Healthy People 2010" at http://odphp.osophs.dhhs.gov/pubs/hp2000.
ELIGIBILITY REQUIREMENTS
Applications may be submitted by new or existing primary care practice-based
research networks located in the U.S. or by institutions affiliated with a
PBRN, which can be public or private non-profit organizations including
universities, clinics, firms, or units of State and local governments. For
the purpose of this RFA, AHRQ, by statute, can make grants only to non-profit
organizations, however, for-profit organizations may participate in grant
projects as members of a non-profit consortium or as subcontractors to a non-
profit entity. Organizations described in section 501(c)4 of the Internal
Revenue Code that engage in lobbying are not eligible.
AHRQ encourages women, members of minority groups, and persons with
disabilities to apply as Principal Investigators.
MECHANISM OF SUPPORT
This RFA will use the Exploratory Grant (P20) mechanism. Responsibility for
the planning, direction, and execution of the proposed project will be solely
that of the applicant. The Center for Primary Care Research (CPCR) within
AHRQ will serve as a Coordinating Center to facilitate the sharing of ideas
and encourage collaborations among recipient PBRNs. Representatives of
recipient PBRNs will be expected to attend group meetings convened by CPCR
during the funding period.
This RFA is a one-time solicitation. The total project period for an
application submitted in response to this RFA may not exceed one year. The
anticipated award date is September 29, 2000. It is anticipated that after
successful completion of these exploratory grants, recipient PBRNs will be in
a position to compete for subsequent multi-year funds which AHRQ will offer,
contingent upon funding availability, through a separate solicitation to be
released in Fiscal Year 2001.
FUNDS AVAILABLE
AHRQ expects to award up to $1.5 million total costs in Fiscal Year 2000 to
support up to 14 PBRNs under this RFA.
The actual number of applications funded is dependent on the number of high
quality applications received. Budget requests for applications submitted
under this RFA should not exceed $75,000 in direct costs. Representatives of
recipient PBRNs will meet with CPCR staff in Washington, D.C., as many as 3
times during the planning year. Budget requests should therefore include
travel expenses for this purpose.
Although the financial plan of AHRQ provides for this program, awards pursuant
to this RFA are contingent upon the availability of funds for this purpose.
RESEARCH OBJECTIVES
Background
Legislation passed by the one hundred sixth U.S. Congress and signed by the
President in December, 1999, amended Title IX of the Public Health Service Act
(42 U.S.C.299 et seq.) to mandate the establishment within the new AHRQ of a
Center for Primary Care Research to serve as the principal source of funding
for primary care practice research in the Department of Health and Human
Services. In addition, the AHRQ was directed to: (1) support research and
evaluations on the health care of priority populations, including low-income
and minority groups, (2) develop and evaluate strategies for reducing medical
errors and supporting clinical preventive services, (3) foster a range of
innovative approaches to the management and communication of health
information, (4) support efforts to speed the dissemination of research
findings to community practice settings, and, (5) employ research strategies
and mechanisms that link research directly with clinical practice in
geographically diverse locations throughout the U.S., including provider-
based research networks... especially (in) primary care. This RFA,
supporting the development of primary care PBRNs, is part of AHRQ’s response
to these Congressional mandates.
Practice-Based Research Networks and Primary Care
Building collaborative networks of office-based practices for the purpose of
research is a promising approach to the study of almost any type of ambulatory
health care, since findings from such research may be significantly influenced
by the practice setting(s). This approach appears to be even more important,
however, for the study of problems encountered in primary care, where the
characteristics of the particular practice setting are often so influential
that they become a constellation of factors that themselves must be
considered in the research design (Starfield, 1992). Whereas studies
conducted in inpatient settings or hospital outpatient departments may have
limited applicability to community-based primary care, research conducted
within primary care PBRNs can readily consider such factors as practice
organization and finances, and the community within which the practice is
located. These factors may be critical in the interpretation and
generalizability of findings.
The applicability of research findings to primary care practice is also
significantly influenced by the nature of the study population. Primary care
tends to deal with the management of unselected patients, many of whom present
with undifferentiated clinical problems and/or have multiple problems at once.
Findings from research that focuses on single diseases among highly selected
or referred patients may therefore have little, if any, relevance to problems
encountered in primary care. Moreover, such studies typically measure disease
or condition-specific physiological outcomes while primary care clinicians are
equally concerned about broader and more person-focused outcomes (AHCPR Task
Force on Building Capacity in Primary Care Research, 1993). Research
conducted within primary care PBRNs can potentially overcome these limitations
since the PBRN study population is very likely to be representative of the
general public, and primary care clinicians are typically involved as
investigators or consultants in defining the research design and the outcomes
to be measured.
The first primary care PBRNs were initiated in the U.S. in the late 1970s, and
a recent report indicates a total of 28 active primary care research networks
in North America (Nutting, 1996). Although a few PBRNs are national in scope,
the majority are local or regional in nature. Most exist within the
organizational structure of professional associations, although a few exist
within academic departments, and others are independent organizations. The
number of PBRN practices participating in any study (ranging from 15 to more
than 500) is usually sufficient to assure generalizability to average patient
populations, providers, and practice settings. Much of the early work of
PBRNs provided descriptions of the content and practice patterns of primary
care, while more recent research from a few networks has included
effectiveness studies and randomized clinical trials. The emerging body of
research by PBRNs demonstrates the ability of networks to link relevant
clinical questions with rigorous research methods in community settings to
produce important scientific information that not only is externally valid
but, in theory, is more easily assimilated into everyday practice (Nutting,
1999).
Challenges to Primary Care PBRNs
Whereas PBRNs have advantages for studying the common phenomena of primary
care in primary care settings, they also face a number of challenges.
Collecting, transferring and managing data generated from multiple sites is
often problematic, but is particularly challenging in the setting of diverse
primary care practices. Unlike the collection of data in most hospital
settings, few if any standards currently exist for the coding of
administrative/billing information routinely collected in primary care.
Therefore, such data are often not compatible and cannot be easily aggregated
for the purpose of analysis. Moreover, few existing primary care PBRNs have
managed to develop electronic data systems dedicated to collecting primary
research data, and the collection, transfer and aggregation of large volumes
of hand-written information from network practices that often are widely
dispersed geographically can be a major challenge. Of greater concern,
however, is the integrity of such information, which is typically recorded by
primary care clinicians or their staff in busy office settings. More
efficient and reliable data systems are needed to address the issue of
accuracy, reliability and validity of data generated within PBRNs (Wasson,
1997).
Since most PBRNs are composed of practices that are located predominantly in
suburban or rural sites, their ability to study the delivery of primary care
services to urban minority and underserved patient populations is often
limited. Very few published PBRN studies have specifically addressed the
persistent, and often increasing, health disparities that have been correlated
with race, ethnicity, poverty and insurance status, and the number of
minority/underserved patients included in most PBRN research has been
inadequate for meaningful subgroup analyses.
One of the early promises of the organizers of primary care PBRNs was that
research conceived and conducted in practice settings could follow a short
feedback loop back into practice and thus shorten the usually laborious
translation process of applying the research results to the practice of
primary care (Green, 1990). In the absence of methods to measure baseline and
subsequent rates of compliance with recommended evidence-based practices,
however, it is difficult to know whether this promise has in fact been
fulfilled. Information systems are needed to assist with prompt and
appropriate dissemination of new research evidence and to measure subsequent
changes in the processes of primary care practice. Such systems can inform
future research needs and enhance collective understanding of strategies to
accelerate continuous quality improvement in routine practice. In particular,
improved computer-based information systems can contribute significantly to
efforts aimed at reducing medical error rates and implementing clinical
preventive recommendations in primary care settings.
Finally, most if not all primary care PBRNs share the serious challenge of
sustaining an infrastructure capable of recruiting and retaining participating
practices, supporting the network, and generating fundable research projects.
Although there is considerable variation in the status of current PBRN
infrastructural support, few have significant, ongoing funding from any
academic institution or other organization. All appear to rely heavily on
volunteerism for central staff support and the cooperation of participating
practices and investigators. Primary care PBRNs must begin to seek new
avenues of funding from a variety of sources to provide support for PBRN
infrastructural needs, especially in those periods between major funded
research efforts.
SPECIAL REQUIREMENTS
Applications are encouraged from newly formed PBRNs as well as existing
networks, including those that have received funds from AHRQ, other
Governmental agencies, or private sources. Each PBRN funded by AHRQ will be
expected to develop, within twelve months, a detailed plan for network growth
specific to its current state of development as well as its size, patient
population served, and the practice styles of the group’s clinicians. At the
same time, AHRQ recognizes that the power of individual networks to study
health care events of primary care can be multiplied through regular
communication and research collaborations among PBRNs. To encourage such
collaborations and to assure the sharing of ideas across PBRNs during this
planning phase, CPCR intends to serve as a Coordinating Center for PBRN
planning activities. In addition to hosting conference calls and list-serve
discussions, CPCR will convene up to 3 meetings of representatives of
recipient PBRNs during the year of funding. The meetings will include initial
discussions of standard data elements, standard coding of primary care
processes, and the feasibility of aggregating certain data elements collected
from numerous PBRNs into a primary care database.
Required Elements of Planning and Development Effort
During the funding period, each PBRN will be required to develop a plan for
network growth in four key areas: (a) computerized data management and
practice evaluation, (b) research of special relevance to minority and/or
underserved populations, (c) translation of research into practice, and (d)
predictable network funding. The responsibility for directing the planning
and development effort should be assigned to a senior level person familiar
with PBRN research and competent in administration. This person should devote
a significant proportion (30% or more) of his/her time to this endeavor. The
PBRN may also choose to have an internal planning committee to assist the
planning director. The director/planning committee should evaluate the
current strengths and weaknesses of the network in the key identified areas
and consider all available resources in the planning process. Appropriate
consultants may be called upon to assist.
Specific required planning activities to be accomplished with funding through
the present RFA are listed below, by Area of Focus.
I. Data Management
o Evaluation of existing data collection capacities within all network-
affiliated practices, including the ability to use current informatic systems
to identify and follow eligible patients according to symptomatic or
diagnostic criteria.
o Development of options and specific methods to collect and aggregate
electronically from affiliated practices both standard core clinical data and
project-specific data. PBRN plans should consider all viable computer-based
options, including Internet-based data collection and the use of electronic
medical records. The final plan should include the projected cost of
implementing each option.
o Development of options and specific methods for ensuring data integrity
and the confidentiality of identifiable personal health information. The plan
should include a discussion of who will be permitted access to the
information, both raw data and machine readable files, and how personal
identifiers and other identifying or identifiable data will be safeguarded.
The final plan should include the projected cost of each option.
o Discussion of methods to coordinate appropriate review by institutional
review boards of future network studies, especially those in which clinical
data will be collected from multiple independent practices.
II. Minority And/Or Underserved Population Research
o Documentation that practices currently affiliated with the network serve
sufficient numbers of minority and/or underserved patients to permit studies
that have the statistical power to generate significant findings related to
ethnic minority subgroups (Blacks/African-Americans, Hispanic Americans,
American Indians, Alaskan Natives, Asian Americans and Pacific Islanders), OR
o Development of formal network linkages with additional primary care
practices that serve sufficient numbers of minority and/or underserved
patients to permit such studies.
III. Translation of Research Into Practice
o Development of methods to use new or existing computer-based information
systems to assess changes in clinical practice resulting from the
dissemination of new research evidence into practices affiliated with the PBRN
and to measure the impact of these changes on outcomes, cost and/or use of
services. The plan should specifically consider methods of using computer-
based information systems to assess strategies for reducing preventable health
care errors.
o Testing and implementation of appropriate tools developed by AHRQ and
others (e.g., evidence reports, quality measures, etc.) for the purpose of
translating research into practice. The plan should specifically include a
discussion of potential methods for evaluating the extent to which practices
implement clinical preventive recommendations.
o Development of specific strategies, including the use of computer-based
information systems, to accelerate the diffusion of new research knowledge
into actual practice. The final plan should include a menu of strategies that
the network has used successfully in the past or could be capable of using in
the future. To the extent possible, the plan should also include the
projected costs of each strategy.
IV. Predictable Network Funding
o Exploration of potential sources of ongoing funding for the PBRN research
infrastructure, including professional organizations, academic institutions,
governmental sources, foundations and other private sources such as
pharmaceutical companies and clinical research organizations.
o Development of a five year business plan demonstrating how core
administrative functions of the network can be supported even in the absence
of major funding for project-specific research.
Qualifications
PBRNs should document in their applications that they meet, at minimum, the
following qualifications:
o The PBRN organizational structure includes, or will include, a core of at
least 15 ambulatory practices and/or 15 clinicians located in the U.S. and
devoted principally to the primary care of patients.
o The network has an accepted statement of its purpose and research mission
that includes an ongoing commitment to the research endeavor.
o A director has been identified who is, or will be, responsible for most
administrative, financial and planning functions.
o The director is, or will be, supported by a staff of at least one person.
o A mechanism (such as a community advisory board) is planned or in place to
solicit advice/feedback from the communities of patients served by the PBRN.
o An organizational structure exists, or will exist, that transcends a
single study, including multiple systems of communication with and among
participating practices in the form of regularly produced newletters, e-mail
or list-serves, conference calls, and/or face-to-face meetings of various
combinations of network members.
Data Privacy
Application materials will include citations for federal data security
standards and background materials on the AHRQ confidentiality statute
[section 903(c) of the Public Health Service Act (42 USC 299a-1(c)] that
protects and restricts disclosure of identifiable information about
individuals or entities collected in the course of any AHRQ-funded study.
Should planning activities or pilot projects undertaken as part of this
initiative involve confidential, identifiable data, the grantee must ensure
that computer systems containing these data have a level and scope of security
that equals or exceeds those established by the Office of Management and
Budget (OMB) in OMB Circular No. A-130, Appendix III - Security of Federal
Automated Information Systems . The National Institute of Standards and
Technology (NIST) has published several implementation guides for this
circular. They are: An Introduction to Computer Security: The NIST Handbook,
Generally Accepted Principals and Practices for Securing Information
Technology Systems, and Guide for Developing Security Plans for Information
Technology Systems. The circular and guides are available on the web at
http://csrc.nist.gov/publications/nistpubs/800-12/handbook.pdf.
Rights in Data
To encourage dissemination of AHRQ products by grantees, application materials
will include information on copyrighting or seeking patents, as appropriate,
for final and interim products and materials. Examples of such products and
materials are methodological tools or measures or software with documentation,
literature searches, and analyses, which are developed in whole or in part
with AHRQ funds. Such copyrights and patents will be subject to a Federal
government license to use and permit others to use these products and
materials for AHRQ purposes.
Important legal rights and requirements applicable to AHRQ grantees are set
out or referenced in the AHRQ’s grants regulation at 42 CFR Part 67, Subpart A
(Available in libraries and from the GPO’s website
http://www.access.gpo.gov/nara/cfr/index.html).
INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS
It is the policy of AHRQ that women and members of minority groups be included
in all AHRQ-supported research projects involving human subjects, unless a
clear and compelling rationale and justification are provided that inclusion
is inappropriate with respect to the health of the subjects or the purpose of
the research. AHRQ is also encouraging investigators to include children in
study populations whenever appropriate. Planning and development projects
should consider how to facilitate the collection of data pertaining to these
populations. Further information about these inclusion policies is available
through the AHRQ Website http://www.ahrq.gov (Funding Opportunities) and
InstantFAX (see instructions under INQUIRIES).
LETTER OF INTENT
Prospective applicants are asked to submit, by March 10, 2000, a letter of
intent that includes a descriptive title of their proposed project, the name,
address, and telephone number of the Principal Investigator, other key
personnel and participating institutions, and the number and title of the RFA
in response to which the application may be submitted.
Although a letter of intent is not required, is not binding, and does not
enter into the consideration of any subsequent application, the information
allow AHRQ staff to estimate the potential review workload and avoid conflict
of interest in the review. AHRQ will not provide responses to letters of
intent.
The letter of intent is to be sent to Kelly Morgan (see address under
APPLICATION PROCEDURES).
APPLICATION PROCEDURES
The research grant application form PHS 398 (rev. 4/98) is to be used in
applying for these planning and development grants. State and local
government applicants may use PHS 5161-1, Application for Federal Assistance
(rev. 5/96), and follow those requirements for copy submission.
Application kits are available at most institutional offices of sponsored
research. They may also be obtained from the Division of Extramural Outreach
and Information Resources, National Institutes of Health, 6701 Rockledge
Drive, MSC 7910, Bethesda, MD 20892-7910, telephone (301) 710-0267, email:
grantsinfo@nih.gov
AHRQ applicants are encouraged to obtain application materials from the AHRQ
Publications Clearinghouse (see INQUIRIES).
The RFA label available and line 2 in the PHS 398 (rev. 4/98) application form
should both indicate RFA number. The RFA label must be affixed to the bottom
of the face page of the original application. Failure to do so could result
in delayed processing of the application such that it may not reach the review
committee in time for review. In addition, the RFA title and number must be
typed on line 2 of the face page and the Yes box must be marked. The sample
RFA label available at
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has been modified to
allow for this change.
Applicants are encouraged to read all PHS Form 398 instructions carefully
prior to preparing an application in response to this RFA.
The PHS 398 type size requirements (p.6) will be enforced rigorously and non-
compliant applications will be returned.
Application Preparation
Complete information about the proposed planning effort must be submitted with
the application. The narrative portions of the PBRN application, described
below under Research Plan, should be limited to twenty-five pages of text.
The application should be a complete document that includes all essential
information necessary for its evaluation. While additional explanatory
material may be submitted as appendices, such appendices should not be used to
bypass page limitations in the application because only selected reviewers
will receive copies of the appendices.
Since the form PHS 398 was developed for research grant applications, the
following supplemental instructions should be used as a guide in the
preparation of the application.
1) Under Performance Sites (page 2), list only the official name of the
PBRN and the address of the PBRN office. A complete listing of the clinicians
and practice sites involved in the network should be attached to the
application as an appendix.
2) Detailed Budget. In general, allowable budget items for these planning
and development grants are limited to a portion of the salaries of the
planning director, consultation fees, key administrative and clerical support
personnel, travel and per diem expenses for outside consultants/advisors,
supplies, travel and per diem expenses for the planning director and/or other
key personnel to be involved in 3 meetings in Washington, D.C. with CPCR
staff, and other justifiable operating expenses of the planning effort. The
level of effort of personnel should reflect the commitment of the individual
to the planning process. The purchase of equipment is discouraged, and any
request for equipment must be well justified. Budget requests submitted under
this part of the RFA should not exceed $75,000 in direct costs.
3) Biographical Sketches. Include in this section a biographical sketch of
the planning director (equivalent of Principal Investigator) and other key
personnel to be involved in the planning effort.
4) Resources available to the PBRN should be described once, either in a
separate section following the biographical sketches or included in the
narrative text (see below).
5) Research Plan. This narrative part of the application should contain the
following elements:
Section I. The Practice-Based Research Network
a) Description of the existing or planned PBRN. Describe the practices
included in the current or developing network, including geographical
distribution of practices, types of clinicians, and patient population served
by the practices. As noted above, a complete up-to-date listing of network
clinicians and practice addresses should be included as an appendix to the
application.
b) Current or proposed infrastructure supporting the PBRN. Describe and
discuss the existing or planned infrastructure that supports the PBRN research
effort. This discussion (which may alternatively be included in the Resources
section of the application) should include details of any computer-based or
other information systems currently in use (or planned) to collect and
aggregate research data or communicate with clinicians. The current, or
proposed, director and any network support staff should be identified,
including a description of their qualifications and source of salary support
(if any). If the network is affiliated with an academic department or other
research unit, the relationship with that institution should be described,
including a list of consultants and other resources available to the network
as a result of the affiliation. Senior officials in any PBRN-affiliated
organizations(s) should provide a letter documenting support for the proposed
planning and development process. These and other letters of support should be
included as an appendix and referenced in this section of the application.
The discussion should also include references to the existing, or proposed,
mechanism for obtaining advice/feedback from the communities of patients
served by the network practices.
c) Progress to date in conducting research. Include a summary of the
research completed to date by the PBRN, including sources and amounts of
funding received for the research. A complete list of publications (if any)
resulting from PBRN research should be included as an appendix and referenced
in this section of the application. Emerging PBRNs should describe their
research goals and objectives and provide examples of specific projects their
networks are interested in (and capable of) pursuing.
d) Progress to date in translating research into practice. Describe any
formal or informal systems or mechanisms within the PBRN, current or planned,
to disseminate the results of research to network clinicians and evaluate the
impact of this information on practices.
Section II. The Proposed Planning Effort
a) Description of the planning director and his/her responsibilities and
authority to carry out the proposed planning process for the PBRN. Discuss
the selection of this individual as planning director (equivalent of principal
investigator) and his/her future role in the PBRN. This section should
present an adequate description of his/her qualifications and administrative
experience.
b) Description of the planning committee. If an internal planning committee
is being proposed, list and discuss the membership. List any external
consultants to the planning committee.
c) Description of other key personnel and their duties. Discuss the
selection and duties of the key personnel supporting the planning director and
planning committee.
d) Description of issues that will need to be resolved through the planning
and development process. Discuss the issues/obstacles that must be considered
in the planning and development process. An example of such an issue is
anticipated change in the practice environment (e.g., managed care penetration
in the area) affecting the practices involved in the network.
e) Detailed description of the planning proposed. Include discussions of the
proposed approach to planning activities for each of the Areas of Focus.
Submit a signed, typewritten original of the application, including the
Checklist, and three signed photocopies, in one package to:
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD 20892-7710
Express/courier service zip code (20817)
At the time of submissions, two additional copies of the application, labeled
Advanced Copies must also be sent to:
Kelly Morgan
Center for Primary Care Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Suite 201
Rockville, MD 20852-4908
Telephone: (301) 594-1782
FAX: (301) 594-3721
E-mail address: kmorgan@ahrq.gov
Applications submitted under this RFA must be received by April 27, 2000. An
application received after the deadline may be acceptable if it carries a
legible proof-of-mailing date, assigned by the carrier, and the proof-of-
mailing is not later than one week prior to the deadline date. If an
application is received after that date, it will be returned to the applicant
without review.
REVIEW CONSIDERATIONS
Upon receipt, applications will be reviewed for completeness and
responsiveness. Incomplete applications will be returned to the applicant
without further consideration. Applications that are complete and responsive
to the RFA will be evaluated for scientific and technical merit by an
appropriate peer review group convened by AHRQ in accordance with AHRQ peer
review procedures. If the application is not responsive to the RFA, it will
be returned to the applicant without review. 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.
General Review Criteria
Applications will be assessed in two general areas: 1) technical merit of the
proposed planning process, and 2) potential of the new or existing PBRN to
enhance its capacity to conduct research and translate research findings into
practice. Peer reviewers will be asked to specifically comment in these two
areas. An unacceptable evaluation in either category can be grounds for
disapproval of the application. The final priority scores will reflect the
peer reviewer’s overall assessment based on their judgements of the two review
areas.
1. The technical merit of the proposed planning process.
a) Clarity and appropriateness of planning goals and objectives,
b) Extent to which the application appropriately defines the problems that
need to be resolved in the planning process,
c) Extent to which the proposed detailed planning effort has clear and
appropriate goals consistent with the stated goals of AHRQ and is of adequate
scope with regard to the Areas of Focus,
d) Qualifications of the proposed planning director to lead the planning and
development effort and his/her leadership experience, administrative skills
and research background,
e) Qualifications and appropriateness of the key personnel designated to
assist the planning director, and,
f) Appropriateness of the membership and stated functions, as well as
potential effectiveness, of the proposed internal planning committee (or
advisors to the planning director).
2. The potential of the PBRN to enhance its capacity to conduct primary care
research and translate research findings into practice.
a) Adequacy of the commitment of network practices to primary care research,
as evidenced by published findings from PBRN studies or letters of support
from participating clinicians,
b) Adequacy of the patient populations served by the PBRN practices to
support primary care research, and the potential for research that includes
minority and/or underserved populations,
c) Adequacy and stability of the PBRN’s administrative, organizational and
management capabilities, and,
d) Extent to which the award of grant funds will enhance the ability of the
PBRN to plan future activities for enhancing primary care research and
translating research findings into practice.
The initial review group will also examine the appropriateness of the proposed
project budget.
AWARD CRITERIA
Applications will compete for available funds with all other applications
under this RFA. The following will be considered in making funding decisions:
(1) quality of the proposed project as determined by peer review, (2) program
balance and the desire to fund a group of networks that capture the full scope
of primary care practice, including providers from multiple disciplines and
populations of all ages, and, (3) availability of funds.
INQUIRIES
Copies of this RFA and all currently active AHRQ grant announcements are
available from:
AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone: 800-358-9295
TDD service: 888-586-6340
E-mail: info@ahrq.gov
This RFA is also available on AHRQ’s Web site, http://www.ahrq.gov, and
through AHRQ InstantFAX at (301) 594-2800. To use InstantFAX, you must call
from a facsimile (FAX) machine with a telephone handset. Follow the voice
prompt to obtain a copy of the table of contents, which has the document order
number (not the same as the RFA number). The RFA will be sent at the end of
the ordering process. AHRQ InstantFAX operates 24 hours a day, 7 days a week.
For comments or problems concerning AHRQ InstantFAX, please call (301) 594-
6344.
AHRQ welcomes the opportunity to clarify any issues or questions from
potential applicants who have obtained and read the RFA. Written and
telephone inquiries concerning this RFA are encouraged. Direct inquiries
regarding programmatic issues should be addressed to:
David Lanier, M.D.
Center for Primary Care Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Suite 201
Rockville, MD 20852-4908
Telephone (301) 594-1489
FAX (301) 594-3721
E-mail address: dlanier@ahrq.gov
Direct inquiries regarding fiscal and eligibility matters to:
George Skip Moyer
Grants Management Specialist
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Suite 601
Rockville, MD 20852
Telephone: (301) 594-1842
FAX: (301) 594-3210
E-mail address: smoyer@ahrq.gov
AUTHORITY AND REGULATIONS
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 USC 299-299c-6). Awards are administered under the PHS Grants
Policy Statement and Federal Regulations 42 CFR 67, Subpart A, and 45 CFR
Parts 74 and 92. This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or Health Systems Agency review.
The PHS strongly encourages all grant and contract recipients to provide a
smoke-free workplace and promote the non-use of all tobacco products. In
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking
in certain facilities (or in some cases, any portion of a facility) in which
regular or routine education, library, day care, health care or early
childhood development services are provided to children. This is consistent
with the PHS mission to protect and advance the physical and mental health of
the American people.
REFERENCES
Starfield B. Primary Care: Concept, Evaluation, and Policy. New York:
Oxford University Press, 1992.
AHCPR Task Force. Putting Research into Practice. Report of the Task Force
on Building Capacity for Research in Primary Care. AHCPR Publication No. 94-
0062. August, 1993.
Nutting PA. Practice-Based Research Networks: Building the Infrastructure of
Primary Care Research. Journal of Family Practice 42:199-203, 1996.
Nutting PA, Beasley JW, Werner JJ. Practice-Based Research Networks Answer
Primary Care Questions. Journal of the American Medical Association 281:686-
8, 1999.
Wasson JH, Jette AM, Johnson DJ, et al. A Replicable and Customizable
Approach to Improve Ambulatory Care and Research. Journal of Ambulatory Care
Management 20(1):17-27, 1997.
Green LA, Lutz LJ. Notions about Networks: Primary Care Practices in Pursuit
of Improved Primary Care. Conference on Primary Care Research: An Agenda for
the 1990s. J Mayfield and M Grady (eds), U.S. Department of Health & Human
Services, September 1990.
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