GRANTS FOR HEALTH SERVICES DISSERTATION RESEARCH Release Date: March 13, 2000 PA NUMBER: PAR-00-076 Agency for Healthcare Research and Quality (formerly AHCPR) Application Receipt Dates: May 5, 2000, September 15, January 15, May 15, annually. PURPOSE The Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR), announces its continued interest in supporting the health services dissertation research small grant program. This program supports research undertaken as part of an academic program to qualify for a doctorate. The mission of AHRQ is to support, conduct, and disseminate research that improves access to care and the outcomes, quality, cost, and utilization of health care services. The research sponsored and conducted by the Agency provides better information that enables better decisions about health care. Research that promotes the improvement of health care quality will be the Agency’s highest priority during the next few years. Accordingly, the Agency has identified the following three strategic goals, each of which will contribute to improving the quality of health care for all Americans: o support improvements in health outcomes o strengthen quality measurement and improvement o identify strategies to improve access, foster appropriate use, and reduce unnecessary expenditures AHRQ programs and products are designed to be responsive to the needs of consumers, patients, clinicians, and other providers, institutions, plans, purchasers, and public and private policy makers at all levels for evidence-based information they may need to improve quality and outcomes, control costs, and ensure access to needed health care services. A copy of AHRQ’s strategic plan is available at http://www.AHRQ.gov AHRQ will accept applications from students seeking a doctorate in areas relevant to health services research. Total direct costs, under this announcement, must not exceed $30,000 for the entire project period. This Program Announcement (PA) describes the procedures and criteria for the program. It updates and supersedes "Grants for Health Services Dissertation Research," PAR-98-111, published in the NIH Guide, September 15, 1998. HEALTHY PEOPLE 2010 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2010," a PHS-led national activity for setting health improvement priorities for the United States. AHRQ encourages applicants to submit grant applications with relevance to the specific objectives of this initiative. Potential applicants may obtain a copy of "Healthy People 2010" at http://www.health.gov/healthypeople . Nondiscrimination The AHRQ Dissertation program is conducted in compliance with applicable laws that provide that no person shall, on the grounds of race, color, national origin, sex, disability, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination. Applicant organizations are required to have appropriate Assurance of Compliance forms filed with the Office of Civil Rights, Office of the Secretary, DHHS before a grant may be made to that institution. The Division of Research Education, Office of Research Review, Education, and Policy (ORREP), should be contacted with any questions concerning compliance (see INQUIRIES). ELIGIBILITY REQUIREMENTS To qualify for an award under this PA, the student (Principal Investigator) must be enrolled in an accredited research doctoral degree (e.g., Ph.D., Sc.D., Dr.P.H., Ed.D.) program in health services research, including areas such as social, behavioral, biostatistical, epidemiological, economic, educational, policy, management, medical, nursing, or health sciences, which require a dissertation based on original research. To be eligible, the dissertation must be a major part of the training program and be in an area of interest to AHRQ with demonstrated relevance to the delivery of health care in the United States. All requirements for the doctoral degree, other than the dissertation, must be completed by submission date. The applicant may be either a public or private nonprofit institution that will administer the grant on behalf of the proposed Principal Investigator, alternatively the proposed Principal Investigator may apply as an individual. If the investigator is not a U.S. citizen and does not have a permanent resident visa, he/she must apply through a public or private nonprofit institution. AHRQ will make the final determination of eligibility for support. A dissertation research grant is usually awarded for 12 months or less, but may be awarded for up to 17 months. The proposed Principal Investigator may request support only for the time necessary to complete the dissertation. Further, the applicant must commit to a minimum of 40 hours per week on dissertation work. Clinical or other professional pursuits in addition to work on the dissertation must not exceed 12 hours per week. A statement affirming these time commitment plans must be included with the budget justification. An investigator who receives support for dissertation research under a grant from the AHRQ may not simultaneously receive support under a predoctoral program training grant, an individual fellowship grant, or any other dissertation grant awarded by AHRQ or any other agency of the U.S. Department of Health and Human Services. Other current or pending sources of support should be explicitly listed. Awards are usually announced no earlier than 5 months after receipt of the application. MECHANISM OF SUPPORT This PA will use the small research grant (R03) mechanism. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the proposed Principal Investigator (the doctoral candidate). The total direct costs must not exceed $30,000 for the entire project period. AHRQ will return without review any application that exceeds this amount to the applicant. No supplemental funds will be awarded. Funds Available AHRQ sets aside funds each year for the Dissertation Research Program. In general, AHRQ expects to award up to 30 dissertation research grants per fiscal year (October 1 to September 30). The number of awards will be contingent on the availability of funds, the quality of the applications, and Agency priorities. RESEARCH OBJECTIVES Through the Dissertation Research Grant Program, AHRQ seeks to expand the number of researchers who conduct health services research in areas identified in the "AHRQ Health Services Research Program Announcement" published in the NIH Guide on March 26, 1998. This announcement is available on the AHRQ web site under Funding Opportunities (http://www.AHRQ.gov) The PA outlines broad research interests as they relate to: supporting improvements in health outcomes, at both the clinical and system levels, strengthening quality measurement and improvement including the use of evidence-based practice information and tools, identifying strategies to improve access, foster appropriate use, and reduce unnecessary expenditures including research on the organization, financing, and delivery of health care and the characteristics of primary care practices, methodological advances in health services research, especially cost-effectiveness analysis, and ethical issues across the spectrum of health care delivery. A special focus is on health issues related to priority populations including racial and ethnic minorities, women, children, older adults, low income groups, individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care. Applicants who have questions regarding the relevance of their research topics to AHRQ goals should contact by telephone, electronic mail or letter staff listed under INQUIRIES. Applications judged by staff to be non-responsive to this PA will be returned without review. SPECIAL REQUIREMENTS Allowable Costs Expenses allowed under the AHRQ Health Services Dissertation Research program follow the guidelines described in the application for a Department of Health and Human Services (DHHS) grant. Allowable costs include the following: the investigator"s salary, direct project expenses such as travel, data purchasing, data processing, and supplies. Fees for maintaining matriculation or other fees imposed on those preparing dissertations are allowable costs, provided the fees are required of all students of similar standing, regardless of the source of funding. Although all of the above costs are allowable, the following guidelines should be followed: o No salary support will be given for the dissertation committee. o All data costs are to be included in the $30,000 total direct cost limit of the solicitation. o Travel costs are allowable for one professional conference. o Personal computer and statistical consultant service costs at a level not to exceed 80 hours are allowable. o Support for a research assistant is generally not permitted. In rare circumstances it may be approved if the justification is acceptable to AHRQ staff. Applicants applying through institutions receive facilities and administrative (F&A) costs in addition to the direct costs of the project. For calculating F&A costs, dissertation research grants are considered training grants. Therefore, according to DHHS policy, the institution will receive F&A costs based solely on 8 percent of the total allowable direct costs exclusive of tuition and related fees, health insurance, and expenditures for equipment. Other Conditions The following conditions apply to dissertation grants: A Principal Investigator who discontinues or suspends a project during the grant period must inform the AHRQ immediately in writing. AHRQ may suspend or terminate the grant as requested by the Principal Investigator or on its own initiative. The dissertation and an Executive Summary of it constitutes the final report of the grant. The dissertation must be officially accepted by the faculty committee or university official responsible for the candidate"s dissertation and must be signed by the responsible officials. Two copies of the dissertation must be submitted to the Division of Scientific Review, AHRQ, listed under Application Procedures. The dissertation and all financial status reports must be submitted in English. The grantee is encouraged to report all publications resulting from the grant to AHRQ even after completion of the grant. Further, the grantee should cite AHRQ support in the dissertation and all publications resulting from the dissertation grant. AHRQ Data Usage AHRQ encourages research applications that will use data from the Medical Expenditure Panel Survey (MEPS), the Healthcare Cost and Utilization Project (HCUP), and other AHRQ data. MEPS is a rich data source for health care utilization, expenditure, and insurance information, directly linking data about persons and their families with information obtained from their employers, insurers, and health care providers. It is the third in a series of nationally representative surveys of medical care use and expenditures in the United States. The 1996 MEPS updates previous survey data to reflect the changes that have occurred over the past decade. MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost and source of payment for services, and information on the types and costs of private health insurance held by and available to the U.S. population. It provides a foundation for estimating the impact of changes in sources of payment and insurance coverage on different economic groups or special populations of interest, such as the poor, elderly, uninsured, and racial and ethnic minorities. Some data from the Household and Nursing Home Components of the 1996 MEPS became available for use by researchers beginning in March 1997. The release schedule for other data through calendar year 1998 is available from the Data and Survey section of the AHRQ Web site (see above address). The HCUP includes two data bases covering 1988-95, with 1996 data available in early 1999. These all-payer databases were created through a Federal-state-industry partnership to build a multistate health care data system. Both data bases contain patient-level information for inpatient hospital stays in a uniform format with privacy protections. The Nationwide Inpatient Sample (NIS) is a national sample of about 900 hospitals. The State Inpatient Database (SID), available from the partner states, contains inpatient records for all community hospitals in 17 states, and ambulatory surgery data from five states. These data bases can be directly linked to county-level data from the Health Resources and Services Administration"s Area Resource File and to hospital-level data from the Annual Survey of the American Hospital Association. Information on MEPS and HCUP-3 is available from the Data and Surveys section of the AHRQ Web site and AHRQ staff (see Inquiries). Data Privacy Pursuant to section 903(c) of the Public Health Service Act (42 USC 299a- 1(c)), information obtained in the course of any AHRQ-study that identifies an individual or entity must be treated as confidential in accordance with any promises made or implied regarding the use and purposes of the data collection. Applicants must describe in the Human Subjects section of the application procedures for ensuring the confidentiality of such identifying information. The description of the procedures should include a discussion of who will be permitted access to the information, both raw data and machine readable files, and how personal identifiers and other identifying or identifiable data will be safeguarded. The grantee should ensure that computer systems containing confidential data have a level and scope of security that equals or exceeds those established by the Office of Management and Budget (OMB) in OMB Circular No. A-130, Appendix III - Security of Federal Automated Information Systems. The National Institute of Standards and Technology (NIST) has published several implementation guides for this circular. They are: An Introduction to Computer Security: The NIST Handbook, Generally Accepted Principals and Practices for Securing Information Technology Systems, and Guide for Developing Security Plans for Information Technology Systems. The circular and guides are available on the web at http://csrc.nist.gov/publications/nistpubs/800-12/handbook.pdf. Rights in Data AHRQ grantees may copyright or seek patents, as appropriate, for final and interim products and materials including, but not limited to, methodological tools, measures, software with documentation, literature searches, and analyses, which are developed in whole or in part with AHRQ funds. Such copyrights and patents are subject to a Federal government license to use and permit others to use these products and materials for AHRQ purposes. In accordance with its legislative dissemination mandate, AHRQ purposes may include, subject to statutory confidentiality protections, making research materials, data bases, and algorithms available for verification or replication by other researchers, and subject to AHRQ budget constraints, final products may be made available to the health care community and the public by AHRQ, or its agents, if such distribution would significantly increase access to a product and thereby produce public health benefits. Ordinarily, to accomplish distribution, AHRQ publicizes research findings but relies on grantees to publish in peer-reviewed journals and to market grant- supported products. Important legal rights and requirements applicable to AHRQ grantees are set out or referenced in the AHRQ’s grants regulation at 42 CFR Part 67, Subpart A (Available in libraries and from the GPO’s website http://www.access.gpo.gov/nara/cfr/index.html). INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS It is the policy of AHRQ that women and members of minority groups should be included in all AHRQ-supported research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. All investigators proposing research involving human subjects should read the "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 and in the NIH Guide for Grants and Contracts of March 18, 1994. AHRQ follows the NIH Guidelines. Investigators may obtain copies from the above sources or from the AHRQ contractor listed under INQUIRIES, or from the NIH Guide Website http://grants.nih.gov/grants/guide/index.html AHRQ is also encouraging investigators to consider including children in study populations, as appropriate. AHRQ announced in the NIH Guide of May 9, 1997, that it is developing a policy and implementation plan on the inclusion of children in health services research. This notice is available through the AHRQ Web site (see above address) under Funding Opportunities and through InstantFax (see instructions under INQUIRIES). AHRQ program staff may also provide information concerning these policies (see INQUIRIES). APPLICATION PROCEDURES Applicants should use the research grant application form PHS 398 (rev. 04/98) in applying for these grants. (State and local government applicants may use form PHS-5161-1, Application for Federal Assistance (rev. 05/96), 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)-435-0714, email: grantsinfo@nih.gov . AHRQ applicants are encouraged to obtain application materials from the AHRQ Publications Clearinghouse (see INQUIRIES). The PA title and number must be typed on line two of the face page of the application form and the YES box must be marked. The PHS 398 type size requirements (p.6) will be enforced rigorously and non- compliant applications will be returned. The completed, signed, typewritten original application, including the Checklist, and three signed photocopies in one package must be sent to: Center for Scientific Review National Institutes of Health 6701 Rockledge Drive, Room 1040, MSC 7710 Bethesda, MD 20892-7710 or Bethesda, MD 20817 (for express/courier service) At the time of submission, two additional copies of the application must also be sent to: Division of Scientific Review/Dissertation Program Office of Research Review, Education and Policy Agency for Healthcare Research and Quality 2101 East Jefferson Street, Suite 400 Rockville, MD 20852-4908 The next application receipt is May 5, 2000. After that, receipt dates will be September 15, January 15, and May 15 annually. No application can be submitted more than once, even in revised form. Special Instructions The proposed Principal Investigator for a dissertation grant is encouraged to have the application administered through an institution whenever feasible. This may be either the degree-granting institution or another nonprofit institution with which the proposed Principal Investigator is professionally affiliated. In determining which institution is more appropriate, the student must consider the extent to which the resources of the designated institution are capable of supporting the proposed research effort. In addition to the instructions in the PHS 398 form, the following special instructions should be followed: o The graduate student should be identified as the Principal Investigator. o The section entitled Research Plan, excluding references, may not exceed 20 pages. o The only acceptable appendix material is a copy of the survey instrument(s) being used in the proposed research project. o A list of literature citations is required, but will not be counted toward the 20 page limit requirement for the Research Plan. o A letter from the faculty committee or the university official directly responsible for supervising the dissertation research must be submitted with the grant application. The letter must certify that: 1. The dissertation faculty committee has approved the dissertation proposal. If this certification is not received, the application will be withdrawn administratively but can be resubmitted for the subsequent dissertation application round. 2. The candidate demonstrates future career objectives and potential as a health services researcher. 3. An institutional infrastructure exists to support the candidate and proposed research project. 4. The grant application represents the dissertation proposal. 5. A collaborative process was established between the applicant and advisors in the development, review, and editing of the research application. 6. The applicant has completed all requirements for the doctoral degree, except the dissertation, prior to submission of the application. o The applicant should include a brief cover letter with the application, which discusses his/her career goals, his/her background and interest in health services research, how the proposed dissertation will contribute to career goals and the field of health services research, and the relevance of the proposed dissertation to AHRQ priorities and interests, as described above. o Section C of the application should be used as an extension of the literature review or publications of the faculty committee as they relate to this research. The application must identify all members of the faculty committee by listing the names on Form BB. As explained in form PHS 398, a brief biographical sketch (see page FF) and listing of Other Support (see page GG) should be provided for dissertation committee members, consultants, and other key personnel. Applicants should give special attention to the sections of the application dealing with human subjects protection and gender and minority representation. For those projects involving human subjects or individually identifiable data, IRB approval at the time of application submission is required. Application Preparation (for Using HCFA Data) For applications that propose to use Medicare or Medicaid data that are individually identifiable, applicants should state explicitly in the Research Design and Methods section of the Research Plan (form PHS 398) the specific files, time periods, and cohorts proposed for the research. In consultation with the Health Care Financing Administration (HCFA), AHRQ will use this information to develop an estimate of the cost of borrowing the data. This estimate will be included in the estimated AHRQ cost of funding the grant and may affect the fundability of the application. To avoid double counting, applicants should not include the cost of the data in the budget. Small grant applicants should be aware that the direct cost of the grant plus the cost of HCFA data cannot exceed $55,000. (This limit is based on the statutory limit on small grants of $50,000 in section 922(d)(2) of the PHS Act plus discretionary supplements limited in aggregate to 10% of the direct costs.) Applicants should be aware that for individually identifiable Medicare and Medicaid data, Principal Investigators and their grantee institutions will be required to enter into a Data Use Agreement (DUA) with HCFA to protect the confidentiality of data in accordance with standards set out in OMB Circular A-130, Appendix III Security of Federal Automated Information Systems. The use of the data is restricted to the purposes and time period specified in the DUA. At the end of this time period, the grantee is required to return the data to HCFA or certify that the data have been destroyed. Grantees must also comply with the confidentiality requirements of Section 903(c) of the PHS Act. See the Data Privacy section for details on these requirements as well as references to Circular A-130 and its implementation guides from the National Institute of Standards and Technology. In developing research plans, applicants should allow time for refining, approving, and processing their data requests. Requests may take 6 months from the time they are submitted to complete. Applications proposing to contact beneficiaries or their provider require the approval of the HCFA Administrator and may require meeting(s) with HCFA staff. HCFA data are provided on IBM mainframe tapes using the record and data formats commonly employed on these computers. Applicants should either have the capability to process these tapes and formats or plan to make arrangements to securely convert them to other media and formats. Questions regarding HCFA data should be directed to the AHRQ program official listed under INQUIRIES. REVIEW CONSIDERATIONS Upon receipt, AHRQ staff will review applications for completeness and relevance to the AHRQ mission. Incomplete applications and applications proposing research in areas outside the mission of the Agency will be returned to the applicant without further consideration. Applications that are complete will be evaluated for scientific and technical merit by an appropriate peer review group convened in accordance with AHRQ peer review procedures. 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 Review criteria for grant applications are: significance and originality from a scientific or technical viewpoint, adequacy of the method(s), availability of data or adequacy of the proposed plan to collect data required for the project, adequacy and appropriateness of the plan for organizing and carrying out the project, qualifications and experience of the Principal Investigator, reasonableness of the proposed budget and the time frame for the project in relation to the work proposed, adequacy of the facilities and resources available to the applicant, the extent to which women, minorities, and if applicable children, are adequately represented in study populations, and as applicable, the adequacy of the proposed means for protecting human subjects. In evaluating the above criteria, strong emphasis is placed on the reviewers" assessment of the applicant"s potential as a future contributor to health services research, including the quality and relevance of the written proposal, the caliber of the infrastructure to provide necessary guidance and support to the student, the dissertation chair or faculty advisor evaluation of the student in the certification letter, and faculty biosketches. Summary Statements on applications are prepared by AHRQ staff using the comments of the reviewers, and are generally completed and provided to the applicant within 16 weeks of receipt of applications. AWARD CRITERIA AHRQ sets aside funds each fiscal year for the Dissertation Research Program. Applications will compete for available funds with all other recommended applications. Factors that influence the final funding decisions on applications for support of dissertations include: reviewers" evaluation of the application, the applicant’s potential to contribute to the field, program balance, and the availability of funds. The earliest anticipated date of an award will generally be 5 months after the due date of the application. It is anticipated that some awards will specifically be made to highly meritorious applicants pursuing research which addresses ethnic and racial minority populations, health care issues related to children or older adults, or to individual investigators from predominantly minority or other geographically under-represented institutions (i.e., institutions that are not traditional recipients of AHRQ-supported health services research grants). Similarly, it is anticipated that some awards will be made to applicants from discipline-specific departments (e.g., economics, biostatistics, sociology, epidemiology, anthropology, political science) whose faculty and students may conduct health services research. INQUIRIES Copies of this PA and copies of the grant application form PHS 398 (rev. 4/98) are available from: AHRQ Publications Clearinghouse P.O. Box 8547 Silver Spring, MD 20907-8547 Telephone: (800) 358-9295 TDD Service: 888-586-6340 The PA is available 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 InstantFAX table of contents, which has the document order number (not the same as the PA number). The PA 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. Written and telephone inquiries concerning this PA are encouraged. Direct inquiries regarding programmatic issues, including information on the inclusion of women, minorities, and children in study populations to: Dissertation Program Specialist Division of Research Education Office of Research, Review, Education, and Policy Agency for Healthcare Research and Quality 2101 East Jefferson Street, Suite 400 Rockville, MD 20852-4908 Telephone: (301) 594-1449 E-Mail: training@AHRQ.gov Direct inquiries regarding fiscal matters to: Al Deal Grants Management Specialist Agency for Healthcare Research and Quality 2101 East Jefferson Street, Suite 601 Rockville, MD 20852-4908 Telephone: (301) 594-1843 FAX (301) 594-3210 E-mail: Adeal@AHRQ.gov Inquiries Concerning Data Sources: MEPS Household Component Nancy Krauss Center for Cost and Financing Studies Telephone: (301) 594-0846 E-mail: nkrauss@AHRQ.gov MEPS Nursing Home Component Jeffrey Rhodes Center for Cost and Financing Studies Telephone: (301) 594-0891 E-mail: jrhodes@AHRQ.gov HCUP-3 Kelly Carper Telephone: (301) 594-3075 E-mail: kcarper@AHRQ.gov, hcupnis@AHRQ.gov, hcupsid@AHRQ.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Number 93.226. Awards are made under authorization of Title IX of the Public Health Service Act (42 U.S.C. 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.


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