TRANSLATING RESEARCH INTO PRACTICE II
 
Release Date:  December 16, 1999

RFA:  HS-00-008

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 know as the 
Agency for Health Care Policy and Research (AHCPR), invites applications to 
conduct cooperative agreement demonstration projects which specifically 
focus on evaluating strategies for translating research into practice 
through the development of partnerships between researchers and health care 
systems and organizations (e.g., purchaser groups, integrated health 
service delivery systems, academic health systems, managed care programs 
including HMOs, practice networks, worksite clinics).  The objective of 
such partnership arrangements is to help accelerate and magnify the impact 
of the research on clinical practice and patient outcomes in applied 
settings. The intent of the RFA is to support the evaluation of currently 
planned or recently initiated programs whose goal is to improve the 
outcomes, quality, effectiveness, efficiency and/or cost-effectiveness of 
health care based on findings derived from sound research.  A second goal 
of the RFA is to demonstrate that the translation of research into practice 
leads to measurable and sustainable improvements in health care.  The 
presence of strong partnership arrangements is essential to help accelerate 
and magnify the impact of the research on clinical practice and patient 
outcomes in applied settings.  This RFA builds on the Translating Research 
Into Practice (TRIP) I and Assessment of Quality Improvement Strategies in 
Health Care RFAs by focusing on health care systems and organizations and 
supporting the development of sustainable and replicable models and tools 
for translating research into practice to improve the quality, outcomes, 
effectiveness, efficiency and cost-effectiveness of health care.  

Applicants will be required to address one or more conditions of high 
national priority based on a specified set of criteria: conditions/settings 
where the most improvement can occur, conditions/settings where wide 
variability in practice currently exists, conditions that are common and/or 
costly, conditions/settings for which wide disparities in care exist for 
racial/ethnic minorities, and conditions which account for a large burden 
of disease and poor quality of life.  Of particular interest are 
interventions that use the strengths of information systems for 
implementing evidence-based strategies for health care improvement.  A 
funding priority for this RFA will be a focus on at least one of the six 
specified areas of the President=s Race and Disparities Initiative (infant 
mortality, cancer screening and management, cardiovascular disease, 
diabetes, HIV infection/AIDS, and child and adult immunizations), mental 
health and pediatric asthma.   In addition, a  modest amount of funds will 
be set aside for applicants who have been funded by AHRQ (under an existing 
or prior grant or contract, e.g., PORTs, PORT-IIs, and other research 
projects), but have not implemented strategies for translating their 
findings into practice on a large scale.  This set-aside will support 
partnerships with national organizations (e.g., professional organizations, 
patient organizations, purchasing coalitions, multi-state health care 
systems, or others) to disseminate and implement the findings.

The projects should focus on applied research with the objective of 
developing sustainable and reproducible strategies to translate research 
into practice effectively and efficiently.  Towards this goal, it is 
expected that successful applicants will evaluate their implementation 
programs using appropriate concurrent comparison groups, document the costs 
and resources associated with the programs, identify key components of the 
model and organizational conditions that resulted in successful 
implementation, and evaluate transferability to other settings.  A clear 
measure of success will be that participating health care organizations 
absorb successful models as a continuing initiative beyond the end of the 
project.  It is expected that the health care organization will provide in-
kind contributions during the funded period of the project and provide 
evidence for the sustainability of the intervention after the period of the 
grant.  In addition to the project-specific evaluation carried out by the 
grantee, an external organization will carry out an evaluation across all 
of the funded projects.  Its focus will include examinations of the 
sustainability of efforts and the likelihood of their replication.  One of 
the most important goals of the Agency in implementing the TRIP-II 
initiative is to facilitate collaboration and partnerships between 
organizations or entities with the responsibility for providing or 
purchasing health care and the clinical and health services research 
communities to improve the quality, efficiency, effectiveness and/or cost-
effectiveness of health care.
 
HEALTHY PEOPLE 2000
 
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 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 2000" (Full Report:  Stock 
No. 017-001-00474-0) or "Healthy People 2000" (Summary Report: Stock No. 
017-001-00473-1) through the Superintendent of Documents, Government 
Printing Office, Washington, DC 20402-9325 (telephone 202-512-1800). 
 
ELIGIBILITY REQUIREMENTS
 
Applications may be submitted by domestic or foreign, public or private 
organizations, including American Indian/Alaska Native organizations, 
universities, clinics, units of State, Tribal and local governments, and 
eligible agencies of the Federal Government.  Under recently enacted 
reauthorization legislation, AHRQ is authorized to enter into cooperative 
agreements with for-profit organizations as well as with public and not-
for-profit entities.  Thus, for-profit organizations are invited to respond 
to this notice with research applications for cooperative agreements.   
Such applications will be administered in accordance with Subpart E of 45 
CFR Part 74 and 42 CFR Part 67 Subpart A.  The latter regulation will be 
amended in the near future to reflect this change in Agency name and 
authority.

AHRQ encourages investigators and new investigators (as defined in the PHS 
398 application instructions) who are women, members of minority groups and 
persons with disabilities to apply as Principal Investigators. 

MECHANISM OF SUPPORT
 
The administrative and funding instrument to be used for this program will 
be a cooperative agreement (U18), an "assistance" mechanism (rather than an 
"acquisition" mechanism), in which substantial AHRQ scientific and/or 
programmatic involvement with the awardee is anticipated during performance 
of the activity.  Under the cooperative agreement, the AHRQ purpose is to 
support and/or stimulate the recipient's activity by involvement in and 
otherwise working jointly with the award recipient in a partner role, but 
it is not to assume direction, prime responsibility, or a dominant role in 
the activity.  Details of the responsibilities, relationships and 
governance of the study to be funded under cooperative agreement(s) are 
discussed later in this document under the section ATerms and Conditions of 
Award. A
 
The total project period for applications submitted in response to the 
present RFA may not exceed 3 years.  The anticipated award date is 
September 30, 2000. 
 
This RFA is a one-time solicitation.   AHRQ has not determined whether or 
how this solicitation will be continued beyond the present RFA.
 
FUNDS AVAILABLE

AHRQ expects to award up to $7.0 million in total costs (direct costs plus 
facilities and administrative costs) in fiscal year 2000 to support the 
first year of approximately 12-18 projects under this RFA.  The actual 
number of applications funded is dependent on the number of high quality 
applications and their individual budget requirements; it is not the intent 
of AHRQ that the awards be equal in size.  The expected size of each award 
is $300,000-1,500,000 in total annual costs. 

From the $7.0 million, the Agency will allocate up to $3.5 million for 
projects that translate research findings to improve the quality of care 
for minority populations, up to $1.2 million for the translation of 
research on pediatric asthma into practice and up to $1.05 million for 
implementation of previous AHRQ research (from an existing or prior grant 
or contract) findings on a national level.  Applicants for set-aside funds 
should explicitly note their intent to have a specific project considered 
for these funds.  For the purposes of this RFA, minority populations refer 
to racial and ethnic groups for whom disparities in health care and 
outcomes have been documented compared with the United States non-minority 
population.  These include Blacks/African Americans, Hispanic Americans, 
American Indians, Alaska Natives, Asian Americans and Pacific Islanders.  

Also, applicants are encouraged to focus on pediatric asthma or one or more 
of the six clinical areas identified in the President=s Initiative on Race 
and the U.S. Department of Health and Human Services= Initiative to 
Eliminate Racial and Ethnic Disparities in Health: infant mortality, cancer 
screening and management, cardiovascular disease, diabetes mellitus, HIV 
infection and AIDS, and immunizations for both children and adults.  (See 
http://raceandhealth.hhs.gov/ for further information on these 
initiatives.)  Pediatric asthma refers to the care of patients under 18 
years of age.  Applicants who are interested in focusing on other 
conditions should justify their choice with respect to the following 
criteria: conditions/settings where most improvement can occur, 
conditions/settings where wide variability in practice exists, conditions 
that are common and/or costly, conditions/settings for which wide 
disparities in care exist for racial/ethnic minorities, and conditions 
which account for a large burden of disease and poor quality of life.  
Funding for implementation of AHRQ research findings will be targeted at 
the evaluation of large-scale dissemination and translation efforts for 
existing grants or previously funded AHRQ projects including, but not 
limited to, the Patient Outcomes Research Teams (PORTs), Evidence-Based 
Practice Center (EPC) evidence reports, the National Guideline 
ClearinghouseJ (http://www.guidelines.gov) and investigator-initiated 
research.  Projects focused on improving care for minority populations may 
either focus exclusively on those populations or compare the relative 
effectiveness of alternative implementation strategies for different 
population subgroups. 

Although this program is provided for in the financial plans of AHRQ, 
awards pursuant to this RFA are contingent on the availability of funds for 
this purpose.  Funding beyond the initial budget period will depend on 
annual progress reviews by AHRQ and the availability of funds.

RESEARCH OBJECTIVES
 
Background

The translation of research findings into sustainable improvements in 
clinical practice and outcomes remains one of the largest hurdles in 
improving the quality, efficiency, effectiveness and cost-effectiveness of 
health care.  For example, despite a plethora of randomized clinical trial 
data and national guidelines from the early 1990s supporting early 
administration of beta-blockers for acute myocardial infarction, McLaughlin 
and colleagues in 1996 documented that only 53 percent of eligible patients 
at 37 hospitals actually received beta-blockers (ref. #1).  In 
additionally, these researchers estimated that 18,000 people die each year 
due, in part, to failure to receive beta-blockers after acute myocardial 
infarction (ref. #2).  For pediatric asthma, despite findings that show 
that having a written management plan for parents lowers the risk of 
emergency room visits and hospitalizations, a community-based survey in 
inner city New York reported that only half of the children with asthma had 
received written instruction (ref. # 3 and 4).  Similarly, in a study 
examining the conformance of current patterns care for persons with 
schizophrenia with treatment recommendations, it was found that the rates 
at which patients' treatment conformed to the recommendations were modest 
at best, generally below 50 percent (ref.# 5).  More broadly, a recent 
review of published studies on the quality of care received by Americans 
found that approximately 60 percent of patients with chronic conditions 
received recommended care (ref. # 6).  

This translational hurdle exists despite a wide range of strategies for 
implementing research into practice: continuing medical education (CME), 
provider reminder systems, interactive educational meetings, audit and 
feedback, local opinion leaders, local consensus process, academic 
detailing, financial incentives, reimbursement arrangements, guidelines, 
organizational and structural changes, computer decision support systems, 
patient-mediated interventions, continuous quality improvement initiatives, 
and multifaceted interventions combining several strategies.  It appears 
that different strategies work best in different contexts and are 
influenced by the health care setting, patient, administration and 
practitioner perceptions, and the desired behavior change.  A recent review 
of these interventions concluded that there are no >magic bullets= for 
improving health care (ref. #7).  Another systematic review of the 
effectiveness of health services interventions concluded that while most 
strategies are effective under some circumstances, none is effective under 
all circumstances (ref. #8).  These realities compound the translational 
hurdle.  For example, a recent paper reported that there may be up to seven 
unique barriers to guideline implementation that need to be addressed and 
overcome in order to obtain meaningful quality improvement via this 
strategy (ref. # 9).

Despite the inherent difficulties in translating research into practice, 
the President=s Advisory Commission on Consumer Protection and Quality in 
the Health Care Industry, in its 1998 report, recommended a continual 
emphasis: AThe purpose of the health care system must be to continuously 
reduce the impact and burden of illness, injury and disability, and to 
improve the functioning of the people of the United States@ (ref. #10).  
The emphasis on the continuous nature of improving the quality of care 
speaks to the need for sustainable efforts based on evidence of 
effectiveness.  Although there are published reports documenting the 
efficacy of implementation strategies, there remains a paucity of evidence 
regarding the long term sustainability, replicability and effectiveness in 
applied settings.  The broad agreement of consumers, business, labor, 
health care providers, health plans, State and local governments, the 
Federal government, and health care quality experts on the need to 
accelerate the uptake of evidence-based high quality practice across the 
health care system is summarized by the Commission and the focus of this 
RFA: AMore complete and rapid dissemination of effective health care 
practices should be supported by encouraging public and private 
organizations to collaboratively share knowledge of innovations, synthesize 
evidence on effective health care practices, develop practice protocols, 
disseminate this information, and provide technical assistance to 
practitioners.@

Objectives and Scope

External demands for improved health care through translation of research 
into practice have stimulated important but isolated examples of changes in 
organization and practice.  There is broad agreement among purchasers, 
researchers, health plans and quality improvement organizations about an 
urgent need to accelerate the uptake of evidence-based findings and tools 
into practice, but there is considerable uncertainty about the most 
effective mechanisms for doing so.  In addition, there is collective 
concern among all stakeholders that examples of success in translating 
research into practice are difficult to replicate or sustain over time. 
Projects funded under this Cooperative Agreement are expected to identify, 
refine and evaluate successful strategies for translation of research 
findings into practice such that the efforts are sustainable, can be 
rapidly transferred to or replicated in other settings, and can lead to 
demonstrable improvements in care quality, outcomes, efficiency, or cost-
effectiveness.  Sustainable efforts are those that continue beyond the 
period of funding support and will persist despite the rapid changes in 
staff and conditions that health care organizations are facing today.  

This RFA builds on the Translating Research into Practice (TRIP-I) RFA 
(http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-99-003.html), 
published on January 8, 1999 and the Assessment of Quality Improvement 
Strategies in Health Care RFA 
(http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-99-002.html), 
published on January 22, 1999.  Projects funded under the first RFA (TRIP-
I) address a variety of health care problems primarily through randomized 
controlled trials.  TRIP II is aimed at applying and rigorously evaluating 
some of the techniques and methods developed in idealized practice settings 
or those based on theoretical constructs in research translation now being 
employed but never evaluated.  The evaluation will serve to document the 
implementation techniques and identifying factors, such as organizational 
and clinical characteristics, associated with success.  The assessment of 
translational efforts in institutions with a number of Acultures@ is of 
particular interest because of the heterogeneity within and across many 
organizations.  Such institutions are those that consist of groups with 
varying approaches to practice organization, structure and policy because 
of their differences in size, mix of practitioners, staffing ratios, 
support staff, information technology, reimbursement and philosophy (e.g., 
 solo practitioners, small group, large multi-specialty and hospital-based 
practices, and in-patient and community-based care).

The success of TRIP II will depend, in part, on the presence or 
establishment of substantial relationships between health care systems and 
organizations, and researchers.  The systems and organizations include but 
are not limited to purchaser groups, integrated health care delivery 
systems, large group practices, community health centers, managed care 
organizations, practice networks and worksite clinics.  Such relationships 
will enable the rigorous evaluation of planned and ongoing implementation 
efforts which may not otherwise occur.  These evaluations are necessary in 
determining whether research translation efforts are truly effective in 
applied settings, rather than being dependent on intuition and assumptions 
of success.  For example, rigorous evaluation of dissemination-only 
strategies such as conferences and dissemination of unsolicited material 
demonstrated that, contrary to widespread belief, these techniques were 
ineffective (ref. # 11).  Reciprocal relationships between researchers and 
decision-makers in health care organizations will potentially increase the 
impact of studies funded under this program by addressing and incorporating 
decision-makers= needs and ideas on practice improvement.  It also 
indicates a level of commitment for the organizations to the study and its 
results, suggesting that the implementation strategies, if successful, will 
be sustained and replicated following the study=s completion.  Finally, 
because decision-makers in different organizations often face similar 
challenges and communicate with each other, it is hoped that funded 
projects will together address how this program=s findings can spread 
rapidly across health care organizations and systems.

Up to $3.5 million will be devoted to projects that translate research 
findings to improve the health care of minority populations.  This RFA 
complements the Measures of Quality Care for Vulnerable Populations RFA 
(http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-99-001.html), 
published on December 22, 1998 and the Understanding and Eliminating 
Minority Health Disparities RFA 
(http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-00-003.html),  
published on October 20, 1999.  The latter is aimed at strengthening the 
science base on which strategies can be developed to eliminate the 
disparities.  In addition to evaluating the application of interventions 
proven to be effective in non minority populations to racial and ethnic 
minority populations, the TRIP II RFA may also use sub-group analyses to 
evaluate the impact of implementation methodologies on the health care and 
outcomes of minorities.  Lessons learned from care of these groups may be 
applicable to the United States population as a whole. 

A particular interest for AHRQ in this RFA will be the use of information 
technology in translating research findings into policy and care.  The 
potential for technology to address this need has long been recognized  and 
has been developed to some extent but its use has yet to become widespread. 
 Its use is attractive because the technology can be implemented rapidly, 
and may be more easily transferable and sustainable than implementation 
strategies that are dependent on individuals and personal interactions 
(ref. # 12).  Such technology and systems may play an especially important 
part in transferring knowledge of Awhat works@ across organizations or 
separate components of a single organization, or enhancing the translation 
of research into practice for individuals whose care requires transitions 
across settings.

While interest in translating research into practice on a national scale 
has intensified, successful health care improvement efforts have been 
largely local and infrequently replicated. As noted above, up to $1.05 
million will be set aside to support partnerships between researchers and 
national organizations (e.g., professional organizations, patient 
organizations, purchasing coalitions, multi-state health care systems, 
multiple Quality Improvement Organizations, and others) for the purpose of 
translating AHRQ-funded research into practice.  Applicants wishing to 
pursue this set-aside may do so in one of two ways:

1.   develop a component of the overall research project that adopts and 
adapts strategies from their more focused effort for use by the project and 
supports further partnership with national partner organization(s) to 
foster implementation on a broader scale; or 

2.   start from existing models of effective translational efforts of 
research previously funded by AHRQ and replicate or transfer them to a 
national level.  

In either approach, applicants must develop a plan for measuring changes in 
care patterns at a national level as a result of the 
dissemination/replication strategy.

Research Methods

Because of this RFA=s major objective of refining and assessing sustainable 
and transferable strategies to implement research findings and evidence-
based tools and information, study methods must be adequately rigorous, 
reflecting the research question and the evidence needs of organizations 
that might implement similar interventions, and ensuring internal and 
external validity, and reliability.  Studies of clinical interventions will 
be expected to employ concurrent comparison groups rather than historical 
controls because of the threat that secular trends pose to internal 
validity, especially in this era of rapid changes in our health care 
system.  Strategies for addressing selection bias among participants, such 
as randomization at the level of the patient, practice or other 
organizational unit, pseudo-randomization, or matching must be included.  
Studies of organizational and structural interventions, though less 
amenable to randomization and concurrent control groups, will also be 
expected to address challenges to internal validity.

In developing their study methods, applicants should consider the types of 
research findings or evidence-based tools that others may need in order to 
decide whether and how to apply a certain intervention.  To the extent 
possible, investigators are encouraged to focus on the primary endpoints of 
improvements in health and reduction in disease burden.  Nevertheless, 
because many interventions to improve practice affect distal outcomes such 
as mortality, focus on proximal outcomes, in addition to provider knowledge 
and behavior, process measures, resource utilization, quality and patient 
satisfaction may be appropriate.  Such evidence may be derived from studies 
ranging from intervention to description and include qualitative as well as 
quantitative results.  Qualitative methods, including case studies, 
interviews and focus groups, may be valuable for identifying underlying 
reasons for the gap between the knowledge base and practice as well as 
factors associated with successful interventions.  For example, in a study 
of the effectiveness of a computerized reminder system for prevention of 
complications associated with AIDS, potential users of the research may be 
interested in the structural and organizational characteristics of the 
practice settings, the expertise and attitudes of the providers, and the 
demographics of the patient population as well as the clinical and 
organizational processes and outcomes.  Because of the multidimensional 
challenges involved in translating research into practice, research teams 
should include expertise from a variety of disciplines, from both clinical 
and social science fields.  Assessment of cost and cost-effectiveness is of 
special importance.  Sub-group analyses may be necessary to evaluate the 
effectiveness of interventions to improve care for racial and ethnic 
minorities.  To the extent possible, applicants should submit proposals 
that build on available data, will generate early results, and are modest 
in terms of time, scale, and cost.  

The study of interventions to translate research findings into improving 
the care of children poses a number of challenges.  These include the need 
for larger sample sizes because of the relative infrequency among children 
of some of the conditions and associated primary physical outcomes that are 
a focus of the Race and Disparities Initiative (e.g., infant mortality, 
cancer, diabetes, cardiovascular disease, HIV/AIDS); the relative paucity 
of validated methods for assessing case mix/disease severity and outcomes; 
the multi-layered system of health care for children (involving schools and 
public clinics as well as hospitals and physicians= offices); and the role 
of adult care givers in children=s access, outcomes and quality (ref. # 
13).      

Potential Data Sources

On June 17, 1999, a Request for Expressions of Interest (RFEI) was 
published in the Federal Register in order to identify health care systems 
and organizations that had developed or were planning to develop programs 
to translate research into practice in the six focus areas of the 
President=s Initiative to Eliminate Racial and Ethnic Disparities in 
Health, mental health and pediatric asthma, who did not have established 
relationships with a research team, and would be willing to partner with a 
research team to develop a proposal for this RFA.  The objective of the 
RFEI was to facilitate development of relationships between researchers and 
health care systems and organizations for this as well as future efforts.  
Such relationships are instrumental to evaluate implementation in applied 
settings and to address research questions that may arise in the future. 

A list of organizations that responded to the RFEI and their locations is 
below:

Alliance Continuing Care Network, New York, NY; American Speech-Language 
Hearing Association, Rockville, MD; Carolina Medical Review, Columbia, SC; 
Children=s National Medical Center, Washington, DC; Clinical Directors 
Network, New York, NY; Clinical Regional Advisory Network (CRAN), Inc., 
Kenbridge, VA;  Florida Association of Homes for the Aging, Health and 
Services, Inc., Tallahassee, FL; Healthcare Education and Research 
Foundation, Inc., St. Paul, MN; High Plains Research Network, Denver, CO; 
Iowa Department of Public Health, Des Moines, IA; Office of Medicaid 
Management, New York State Department of Health, Albany, NY;  Ramah Navajo 
School Board, Inc., Pine Hill, NM; Rural Wisconsin Health Cooperative, Sauk 
City, WI; U.S. Quality Algorithms, Inc. (Aetna U.S. Healthcare), Blue Bell, 
PA; Village Care of New York, Inc., New York, NY; and Medical Affairs Tenet 
Health System, Dallas, TX.

Details including the organizations= contact information, and information 
about the patient population, provider settings, data collection capacity, 
data availability and specific conditions or populations of interest (if 
any) are listed at the following Web site: 
( http://www.ahrq.gov/fund/partners.htm ).  Investigators are also 
encouraged to develop or build on existing relationships with organizations 
and systems on their own.  They are not required to work with RFEI 
respondents. 

Applicants are expected to demonstrate that they either routinely collect 
and maintain data necessary for such research, or have the capacity to 
collect such data within the time and budget limits of the cooperative 
agreement.  The specific data required for any project will be determined 
by the study purpose.  However, there are five general types of data that 
organizations may use to conduct research on translating evidence into 
practice and may already have available:  1) enrollment data (including 
some basic demographic data); 2) administrative claims or encounter-level 
data (e.g., diagnosis and procedure codes, charges); 3) more detailed 
clinical data, including data on laboratory and diagnostic tests, and 
medications; 4) survey data (e.g., satisfaction, health status etc.); and, 
 5) qualitative and quantitative data on characteristics of providers and 
organizations delivering care.  The accuracy and completeness of these 
types of data and the extent to which they can be linked will influence 
their usefulness for research.  Applicants must be able to identify the 
specific data that will be used or collected for the project, demonstrate 
that they are already available or can be collected, and describe how the 
data can be cleaned, linked, and developed into an analytic file capable of 
answering the study questions. 
 
Sample Study Questions

Research questions should address how the implementation of research 
findings and evidence-based information in everyday health care affects the 
outcomes, quality, effectiveness, efficiency and/or cost-effectiveness of 
health care.  Evidence-based information can be used as the basis for 
clinical and organizational policy, purchasing, and other managerial 
decisions. The effect of the use of research evidence at any of these 
levels of decision making is included in this solicitation.

The evaluation should assess the effects in terms of changes in clinical 
behavior, quality of care, changes in outcomes and health status, and 
organizational changes.  Outcome measures might include morbidity, 
functional ability, disease status, complications rates, health care costs 
and utilization, and consumer satisfaction.  Consideration should be given 
to the effect of local circumstances such as specific populations, diverse 
health settings, resources constraints, and political context on both the 
implementation process and the outcomes of care that are achieved.  

Evidence-based interventions may include, but are not limited to, 
structural and organizational changes such as alterations in staffing and 
duties, changes to financial incentives, comprehensive quality 
management/improvement systems, computerized drug information and dosage, 
clinician reminders, audit and feedback methods, interactive systems to 
facilitate shared decision-making, computer systems to deliver educational 
materials at the point of clinical decision making, clinical practice 
guidelines and protocols, the introduction of new technologies, the 
limitation of types of technologies or equipment, and disease management 
systems.

Settings include in-patient, acute care, primary care and specialty care, 
including physician offices, clinics, community nursing and the worksite, 
home health care, other community care sites and transitions between health 
care settings.

Examples of research questions include:

o   Can integrating clinical practice guidelines for asthma management into 
an electronic medical record at the point of care reduce unexpected ED 
visits and improve patient outcomes for pediatric asthma?


o   Will providing Ajust in time@ evidence-based clinical practice 
guidelines in ambulatory clinic settings improve clinician compliance with 
recommendations and patient satisfaction, and improve outcomes?

o   Can clinical or organizational strategies known to be effective in one 
type of setting be transferred to different settings and/or conditions?

o   How can the use of evidence-based strategies enhance compliance 
throughout an entire health care system or region?

o   Can reassignment of roles improve rates of adult immunization and 
cancer screening?

o   What clinical and/or organizational components of disease management 
programs are most effective - and for which populations?

o   Can coupling of guidelines with computer decision support systems and 
provider reminder systems enhance implementation of known interventions to 
reduce the mortality rate of acute myocardial infarction?

o   What are the best ways to improve the adoption of efficacious mental 
health interventions across a variety of mental health service settings?

o   What strategies are most effective and/or cost-effective or cost-
beneficial in increasing the appropriate use of screening mammography, 
particularly in older and minority populations?

o   Can patient kiosks focused on preventive care be used to improve rates 
of adult immunization and cancer screening in a racially and ethnically 
diverse patient population?

o   Will coverage for visits by home health nurses improve compliance with 
medications, environmental recommendations and self-management, and reduce 
emergency room visits for children with severe asthma?

o   Can admissions be reduced and patient compliance with heart failure 
recommendations be improved by training translators in elements of disease 
management in community health centers?

o   Are interactive educational meetings via the Internet and 
teleconferencing effective and cost-effective for the management of 
diabetes for geographically isolated populations such as Native Americans 
and Alaska Natives?

In addition, studies may address how organizational research can be 
translated into practice,  the impact of organizational variables on 
clinical translation and the organizational and structural context of 
successful interventions needed to facilitate replication.

SPECIAL REQUIREMENTS

Study Organization

To promote the development of successful projects, some of which will be 
collaborative, multi-site, and multi-organizational, applicants should 
describe how their efforts will be organized and coordinated.  Applicants 
should develop a time-line for project activities and include the 
percentage of effort for key staff, as part of the budget justification.  
The distribution of effort and funds across organizations should be clearly 
defined and justified with a discussion of the capabilities and strengths 
of each.

Work with the Coordinating Center, Steering Committee and Evaluators

AHRQ will house the Coordinating Center for these projects, which will be 
composed of representatives of three AHRQ Centers collaborating on this 
RFA: the Center for Outcomes and Effectiveness Research, the Center for 
Practice and Technology Assessment and the Center for Quality Measurement 
and Improvement.  Other AHRQ Centers may be invited to join the 
Coordinating Center depending on the focuses of studies funded under this 
RFA.  The Coordinating Center will undertake activities to strengthen 
individual studies, facilitate synergism between the studies and achieve 
the major objectives of this initiative: to accelerate and magnify the 
impact of research to implement evidence-based findings into applied 
settings, and to develop sustainable and reproducible strategies to 
translate research into practice effectively and efficiently.  The 
Coordinating Center will organize semi-annual meetings of the initiative=s 
Steering Committee to discuss common issues such as methodologies in 
implementation and in evaluation of implementation efforts, the development 
of a common data set with which projects can be compared or pooled, and 
dissemination of results.  Examples of categories of common data elements 
include: descriptors of the patients, providers, practice setting and 
organizations; measures of costs and benefits of the interventions; 
enumeration of the target population for the intervention (denominator); 
and measures of patient and provider satisfaction.   The Coordinating 
Center will collect tools that can be adopted or adapted by organizations 
interested in replicating the efforts of sites involved with these 
projects.  Such material may include time-lines and flow-sheets of steps, 
patient and provider material, methodologies for automated records review 
and data collection forms.  In addition, the Coordinating Center will 
develop other means for disseminating the results of the studies and 
magnifying their potential impact.  Finally, the Coordinating Center will 
organize a meeting at the end of the third year of funding at which 
investigators will present and discuss findings.  Applicants should include 
funds necessary to attend meetings and work with the Coordinating Center in 
their budget requests; willingness to participate with the Center must be 
stated.

A Steering Committee, composed of the principal investigator(s) of each 
grant, the co-
investigator(s) representing the health care organization or system for 
each grant, and six AHRQ staff, representing the three collaborating 
Centers mentioned above will be the main governing board of the study and 
will have primary responsibility for developing common data elements across 
projects, facilitating interactions between investigators and promoting 
strategies to disseminate and translate findings from these studies.  The 
principal investigators from each grant and the AHRQ Program Officials will 
have one vote.  The chairperson will be selected by the Coordinating 
Committee.  Subcommittees will be established by the Steering Committee, as 
it deems appropriate, with representatives from AHRQ and individual 
studies.

The Coordinating Center will also develop a task order contract through 
which external contractors will evaluate the success of the RFA at 
fulfilling its main objectives.  Specific factors that will be addressed in 
the evaluation include whether the relationships between researchers and 
health care organizations/systems are substantive and sustainable, whether 
changes in practice are sustainable, whether systems developed within an 
institution to facilitate improved care for one condition can be applied to 
other conditions, whether the systems and interventions can be applied 
externally and whether the tools that are developed or refined in the 
studies and disseminated by the Coordinating Center are useful to potential 
external users.

Terms and Conditions of Award
 
These special Terms of Award are in addition to and not in lieu of 
otherwise applicable OMB administrative guidelines, HHS grant 
administration regulations at 45 CFR Parts 74 and 92, 42 CFR Part 67 
Subpart A, and other HHS, PHS grants administration policy statements.  
Applicants should be familiar with the Agency=s grant regulations, 42 CFR 
Part 67 Subpart A, and particularly sections 67.18-67.22.  
 
Consistent with the U18 concept defined under Mechanism of Support, the 
dominant role and prime responsibility for the activity resides with the 
awardee(s) for the project as a whole, although specific tasks and 
activities in carrying out the studies will be shared among the awardees 
and the AHRQ Program Official(s).
 
1.  Awardee Rights and Responsibilities
 
o   Awardees will have primary and lead responsibilities for the project as 
a whole, including research design, and protocol and instrument 
development, participant recruitment and follow-up, data collection, 
quality control, interim data and safety monitoring, final data analysis 
and interpretation, preparation of publications, appropriate dissemination 
of project findings, as well as collaboration with other awardees, and AHRQ 
Program Official(s).

o   The project team will attend semi-annual meetings of the Steering 
Committee.

o   The Principal Investigator will provide access to tools and data in a 
timely fashion to the Coordinating Committee and External Evaluators as is 
needed to achieve their objectives.

o   The Principal Investigator will submit a quarterly progress report to 
the responsible AHRQ program official.  

Awardees will retain custody of and have primary rights to the data 
developed under these awards, subject to Government rights of access 
consistent with current HHS, PHS, and AHRQ policies.
 
2.   AHRQ Staff Responsibilities 
 
The AHRQ Program Official(s) will have substantial scientific/programmatic 
involvement in development of a common data set with which projects can be 
compared or pooled, and in dissemination of results.  The dominant role and 
prime responsibility for the activity resides with the awardee(s) for the 
project as a whole, although specific tasks and activities in carrying out 
the studies will be shared among the awardees and the AHRQ Program 
Official(s). 

AHRQ reserves the right to terminate or curtail a study in the event of 
substantial shortfall in participant recruitment, follow-up, data 
reporting, quality control, or other major breach of the protocol; human 
subject ethical issues that may dictate a premature termination, and 
unwillingness to participate in investigator meetings, submit quarterly 
progress reports; or provide data and instruments to the Coordinating 
Center or evaluators.

3.  Collaborative Responsibilities 
 
Collaborative protocols will be developed by the Steering Committee.  Data 
will be submitted centrally to the Coordinating Center.  Protocols will 
define rules regarding access to data and publications.  Awardees will be 
required to accept and implement common protocols and procedures approved 
by the Steering Committee.
   
4.  Arbitration

Any disagreement that may arise on scientific/programmatic matters (within 
the scope of the award), between award recipients and AHRQ may be brought 
to arbitration.  An arbitration panel will be composed of three members -- 
one selected by the Steering Committee (with the AHRQ member not voting) or 
by the individual awardee in the event of an individual disagreement, a 
second member selected by AHRQ, and the third member selected by the two 
prior selected members.  This special arbitration procedure in no way 
affects the awardee's right to appeal an adverse action that is otherwise 
appealable in accordance with the PHS regulations at 42 CFR Part 50, 
Subpart D and HHS regulation at 45 CFR Part 16.

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 
Principles 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.

The application of these standards to subcontractors and vendors should be 
addressed as necessary.

Important legal rights and requirements applicable to AHRQ grantees are set 
out or referenced in the Agency=s grants regulations at 42 CFR 67, Subpart 
A.

Rights in Data

In keeping with AHRQ'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 AHRQ funds are to be 
made available to AHRQ promptly and without restriction, upon request by 
AHRQ.  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.  These purposes may also include the 
development of an electronic clearinghouse that would enable outside 
organizations to adopt or adapt methods, tools and instruments in their own 
implementation efforts.  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 INVOLVING STUDY 
POPULATIONS

It is the policy of the 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 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 have been published in the Federal Register of 
March 28, 1994 and in the NIH Guide for Grants and Contracts of March 18, 
1994.  To the extent possible, AHRQ requires adherence to these NIH 
Guidelines.

Investigators may obtain copies from the above sources or from the AHRQ 
Publications Clearinghouse listed under INQUIRIES, or from the NIH Guide 
Website http://grants.nih.gov/grants/guide/index.html.

AHRQ also encourages 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 Website http://www.AHRQ.gov (Funding 
Opportunities) and InstantFAX (see instructions under INQUIRIES).

AHRQ Program staff may also provide additional information concerning these 
policies (see INQUIRIES). 

LETTER OF INTENT
 
Prospective applicants are asked to submit, by March 10, 2000, a letter of 
intent that includes a descriptive title of the proposed research, name, 
address, and telephone number of the Principal Investigator, the identities 
of other key personnel and participating institutions, and 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 consideration of any subsequent applications, the information 
allows AHRQ staff to estimate the potential review workload and to 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 the Joanne Book (see address under 
INQUIRIES).

APPLICATION PROCEDURES
 
The research grant application form PHS 398 (rev. 4/98) is to be used in 
applying for these 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.  Applicants are encouraged to read 
all PHS Form 398 instructions prior to preparing an application in response 
to this RFA. 

Applications 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, 
E-mail/Internet: grantsInfo@nih.gov.
 
AHRQ applicants are encouraged to obtain application materials  from the 
AHRQ Publications Clearinghouse  (see INQUIRIES).

The RFA label and line 2 of the application form (rev. 4/98) should both 
indicate the RFA number.  The RFA label must be affixed to the bottom of 
the face page.  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 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.  Please note this is in pdf format.

The PHS 398 type size requirements (p.6) will be enforced rigorously and 
non-compliant applications will be returned and not reviewed.

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
                   (20817 for express/courier service)
 
At the time of submission, two additional copies of the application, 
labeled AAdvanced Copy(s)@  must be sent to:

Joanne Book
Center for Outcomes and Effectiveness Research
Agency for Healthcare Research and Quality
6010 Executive Blvd., Suite 300
Rockville, MD  20852
Telephone:  (301) 594-4039 
FAX:  (301) 594-3211
 E-mail Address:jbook@ahcpr.gov 

Applications must be received by April 27, 2000.  An application received 
after that 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 1 week prior to the deadline date.  If an application is 
received after that date, it will be returned to the applicant without 
review. 

Conference for Prospective Applicants

AHRQ plans to convene a special technical assistance workshop to assist 
potential applicants.  The purpose of this conference is to give background 
information and respond to questions about the preparation of an 
application in response to this RFA.  The workshop will be held in 
Rockville, MD on February 2, 2000.  Attendance is not a prerequisite to 
applying.  Attendees must pay for their own travel and accommodation costs. 
 The workshop will be open to any individual or organization intending to 
apply.  Attendees are encouraged to submit questions prior to the session. 
 A synthesis of pertinent Questions and Answers discussed at the 
prospective applicants= meeting will be available from the AHRQ 
Publications Clearinghouse, listed under AInquiries@ and the agency=s web 
page.  For further information on the conference, contact Joanne Book at 
the address listed above. 

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 a cost estimate for obtaining 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.  

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 IIIBSecurity 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 Joanne Book, whose 
contact information is listed under INQUIRIES.

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 but are not 
responsive to the RFA will be returned to the applicant without further 
consideration; applicants may submit these applications as investigator-
initiated R01 grant applications to AHRQ to compete with other unsolicited 
applications at the next review cycle. 

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. 

All applications will be judged on the basis of the scientific merit of the 
proposed project and the documented ability of the investigators to meet 
the RESEARCH OBJECTIVES of the RFA.  Although the technical merit of the 
proposed project is important, it will not be the sole criterion for 
evaluation of a study.  Other considerations, such as importance and 
timeliness of the proposed study and access to patients/data will be part 
of the evaluation criteria.

General Review Criteria
 
The goals of AHRQ-supported research are to enhance the outcomes, quality, 
and cost, use and access of our health care system.  The reviewers will 
comment on the following aspects of the application in their written 
critiques in order to judge the likelihood that the proposed research will 
have a substantial impact on the pursuit of these goals.  Each of these 
criteria will be addressed and considered by the reviewers in assigning the 
overall score, weighting them as appropriate for each application.  Note 
that the application does not need to be strong in all categories to be 
judged likely to have a major scientific impact and thus deserve a high 
priority score.  For example, an investigator may propose to carry out 
important work that by its nature is not innovative but is essential to 
move a field forward.
 
1.  Significance.  Does this study address an important problem as defined 
by the specific criteria above.  If the aims of the application are 
achieved, how will scientific knowledge be advanced?  What will be the 
effect of these studies on the concepts or methods that drive this field?  
How will health care and health outcomes be demonstrably improved?  What is 
the potential for the intervention to improve health care for a large 
number of individuals?
 
2.  Approach.  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of the 
project?  Are the proposed data sources appropriate and adequate?  Does the 
applicant acknowledge potential problem areas and consider alternative 
tactics?
 
3.  Innovation.  Does the project employ novel concepts, approaches or 
method?  Are the aims original and innovative?  Does the project challenge 
existing paradigms or develop new methodologies or technologies?
 
4.  Investigator.  Is the investigator appropriately trained and well 
suited to carry out this work?  Is the work proposed appropriate to the 
experience level of the principal investigator and other researchers (if 
any)?  Is the project (or workplace) well organized?
 
5.  Environment.  Does the scientific environment in which the work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements? Is there evidence of institutional 
support?

The initial review group will also examine: the appropriateness of proposed 
project budget and duration; the adequacy of plans to include both genders, 
children, and minorities and their subgroups as appropriate for the 
scientific goals of the research and plans for the recruitment and 
retention of subjects; the provisions for the protection of human and 
animal subjects; and the safety of the research environment.

Special Review Criteria

o   Degree to which the research will improve our understanding of how we 
can narrow the gap between what is known and what is done in the real world 
of health care.

o   Appropriateness of methods to address research hypotheses and needs of 
those who may be interested in applying the results of the study.

o   Demonstration of substantial commitment by the health care 
organization/system to the implementation effort and to sustaining the 
intervention and specific improvements beyond the duration of this study in 
a constantly changing environment, including use of in-kind support and 
letters of support from clinical and administrative staff.

o   Extent to which results will be transferable or reproducible in other 
health care systems.

o   Likelihood of the development of systems that can be applied to 
implementation of research findings for a variety of conditions and in a 
range of settings, and the sustain ability of such systems.

o   Demonstration of ability to recruit an adequate number of patients and 
providers.

o   Extent to which the project builds-on or establishes meaningful 
linkages between researchers and health care systems/organizations with the 
expectations that such relationships will exist beyond the study period.

o   Development of new infrastructure including talent, relationships, 
tools, methods and data systems necessary to accelerate, magnify and track 
the impact of the research on clinical practice and patient outcomes.

o   What is the potential for the intervention to improve health care for a 
large number of individuals?

o   Plans for dissemination and implementation of findings within and 
outside of the project=s organization.

o   Development of additional ideas on how best to achieve the goals of 
this cooperative study. 

o   Demonstrated willingness to work as part of the cooperative study, with 
the AHRQ Program Official(s), the Coordinating Center, the Steering 
Committee and external evaluators.

For applicants interested in implementing AHRQ-funded findings nationally, 
the partnering organization must be either a co-investigator or a 
subcontractor to the researcher.  Clear plans for tracking changes in care 
over time must be identified.

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) availability of funds; 3) program balance with respect to conditions, 
populations and strategies for improving implementation studied, regional 
representation, and targeting understudied areas with unmet evaluation 
needs; 4) compatibility with other awardees with respect to cooperative 
activities; 5) fulfillment of set-aside funding targets; and, 6) policy 
relevance. 

INQUIRIES
 
Copies of this RFA are available from:

AHRQ Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Telephone: 1-800-358-9295

The RFA is available on AHRQ=s Web site, http://www.AHRQ.gov under Funding 
Opportunities 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 instant fax, please call  at (301) 594-6344.

AHRQ welcomes the opportunity to clarify any issues or questions from 
potential applicants who have read the RFA.  Written and telephone 
inquiries concerning this RFA are encouraged.   Direct inquiries regarding 
programmatic issues, including information on the inclusion of women, 
minorities, and children in study populations to:

Joanne Book
Center for Outcomes and Effectiveness Research
Agency for Healthcare Research and Quality
6010 Executive Blvd., Suite 300
Rockville, MD  20852
Telephone:  (301) 594-4039 
FAX:  (301) 594-3211
E-mail Address: jbook@ahcpr.gov

or

Diane Brown
Center for Practice and Technology Assessment
Agency for Healthcare Research and Quality
6010 Executive Blvd., Suite 300
Rockville, MD  20852
Telephone:  (301) 594-4019 
FAX:  (301) 594-4027
E-mail Address: dbrown@ahcpr.gov

Applicants interested in focusing on mental health are encouraged to 
contact NIMH=s Dissemination Research Program.  The program supports 
studies on the array of influences that affect the adoption of valid mental 
health research findings into clinical practice and mental health service 
system policy.  This program supports research aimed at determining the 
impact, efficacy, quality, and effectiveness of knowledge dissemination 
interventions delivered across the spectrum of mental health service 
settings.  Areas of support include: analysis of the strategies and factors 
influencing the adoption and utilization of mental health research 
knowledge; descriptive and comparative evaluations of individual and multi-
faceted knowledge dissemination interventions and methodologies; 
longitudinal and follow-up studies to determine factors that contribute to, 
and militate against, efficacious short and long-term change in practice 
and policy; evaluation of the effectiveness of knowledge dissemination 
interventions and strategies on service delivery systems that address 
rural, minority, and other underserved populations.  For further 
information, contact:

Harold Goldstein, Ph.D.
Chief, Dissemination Research Program
National Institute of Mental Health
6001 Executive Blvd., Rm. 7133, MSC 9631
Bethesda, MD 20892-9631
Telephone:  (301) 443-3747 
FAX:  (301) 443-4045
E-mail Address: hgoldste@mail.nih.gov

Direct inquiries regarding fiscal matters to:
 
Joan Metcalfe
Grants Management Specialist
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone: (301) 594-1841
FAX: (301) 594-3210
Email: jmetcalf@ahcpr.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

1.   McLaughlin TJ, Soumerai SB, Wilson DJ, Gurwitz JH, Borbas C, 
Guadagnoli E, McLaughlin B, Morris N, Cheng SC, Hauptman PJ, Antman E, 
Casey L, Asinger R, Gobel F.  Adherence to National Guideline for Drug 
Treatment of Suspected Acute Myocardial Infarction: Evidence for 
Undertreatment in Women and the elderly.  Arch Intern Med 1996;156:799-805.

2.   Soumerai SB, McLaughlin TJ, Spiegelman D, Hertzmark E, Thibault G, 
Goldman L. Adverse Outcomes of Underuse of beta-blockers in elderly 
survivors of acute myocardial infarction. JAMA 1997; 277:115-21.

3.   Lieu TA, Quesenberry CP, Capra AM, Sorel ME, Martin KE, Mendoza GR.  
Outpatient Management Practices Associated with Reduced Risk of Pediatric 
Asthma Hospitalization and Emergency Department Visits.  Pediatrics 
1997;100:334-41.

4.   Warman KL, Silver EJ, McCourt MP, Stein RE.  How Does Home Management 
of Asthma Exacerbations by Parents of Inner-City Children differ from NHLBI 
Guideline Recommendations?  Pediatrics 1999;103:422-27.

5.   Lehman A, Steinwachs D, and the Survey Co-Investigators of the PORT 
Project.
Patterns of Usual Care for Schizophrenia:  Initial Results from the 
Schizophrenia Patient Outcomes Research Team (PORT) Client Survey. 
Schizophrenia Bulletin, 24:11-20, 1998.

6.   Schuster MA, McGlynn E, Brook RH.  How Good is the Quality of Health 
Care in the United States ? Milbank Quarterly 1998;76:517-63.

7.   Oxman AD, Thomson MA, Davis DA, Haynes RB.  No magic bullets: a 
systematic review of 102 trials of interventions to improve professional 
practice.  Can Med Assoc. J, 1995;153:1423-31.

8.   NHS Center for Reviews and Dissemination.  Effective Health Care.  
Getting Evidence into Practice.  February 1999;5(1).

9.   Cabana MD, Rand CS, Power NR, Wu AW, Wilson MH, Abboud PC, Rubin HR.  
Why Don=t Physicians Follow Clinical Practice Guidelines?  A Framework for 
Improvement.  JAMA 1999;282:1458-65.

10.   Http://www.hcqualitycommission.gov

11.   Oxman AD, Thomson MA, Davis DA, Haynes RB (1995).  No Magic Bullets: 
A systematic Review of 102 Trials of Interventions to Improve Professional 
Practice.  Can Med Assoc J;153(10):1423-1431.

12.   Hunt DL, Haynes RB, Hanna SE, Smith K (1998).  Effects if Computer-
based Clinical Decision Support Systems on Physician Performance and 
Patient Outcomes.  A Systematic Review.  JAMA;280:1339-46.

13.   Forrest CB, Simpson L, Clancy C (1997).  Child Health Services 
Research.  Challenges and Opportunities.  JAMA;277(22):1787-1793.


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