This information is provided for academic health centers considering applying for RFA-OD-09-010, Building Sustainable Community-Linked Infrastructure to Enable Health Science Research (RC4). To ensure efficient use of Recovery Act funds as well as maximize the likelihood of sustainability beyond the funding period, projects should build upon existing infrastructure and resources wherever feasible. Of particular interest are collaborative projects that build on activities currently supported by NIH or other Health and Human Services resources and networks. Examples of these existing resources are provided below.
Agency for Healthcare Research and Quality (AHRQ)
ACTION (PDF - 495 KB): Accelerating Change and Transformation in Organizations and Networks (ACTION) includes 15 large, diverse partnerships nationwide that represent over 160 collaborating organizations that study, regulate and/or deliver health care that form networks focused on rapid-cycle, field-based implementation research. Organizations within ACTION provide care to a total of over 100 million persons and represent a wide array of care settings, providers, health conditions, care recipients and other stakeholders. ACTION networks include large integrated delivery systems, health plans, hospitals, physician practices (including very large as well as smaller practices), nursing homes, home health agencies, other care providers, as well as nationally-recognized researchers and implementation experts. ACTION supports research that provides evidence of positive change in the way all people receive and benefit from care in hospitals, physicians' offices, long term care facilities, pharmacies, safety nets and other health care settings and health plans nationwide.
Primary Care Practice-based Research Networks: PBRNs are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice (http://www.ahrq.gov/research/pbrn/pbrninit.htm). PBRNs engage primary care clinicians and the communities they serve in both research and quality improvement activities and strive to build an evidence-based culture in primary care practice to improve the health of all Americans. Many PBRNs involve active participation and leadership from Academic Health Centers. Over 100 PBRN networks participate in the AHRQ PBRN Initiative and are registered with the Agency.
Community Quality Collaboratives: The Agency for Healthcare Research and Quality has selected 24 local, multi-stakeholder regional quality improvement collaboratives to participate in an Agency-sponsored, evidence-based learning network. A fundamental requirement of the selected collaboratives is active participation by representatives from four key stakeholder groups: providers, private and public purchasers, health plans and consumer organizations committed to pursing a community-wide system of quality improvement. A corollary to this fundamental requirement is that any significant impact, including those in the CE domain, can best be accomplished and sustained by the active engagement of at least these 4 stakeholders, and particularly perhaps by consumer organizations. In aggregate, the 24 communities involve over 500 health care leaders and represent over 124 million lives, more that one-third of the US population.
Centers for Education and Research on Therapeutics: The CERTs program is a national initiative to increase awareness of the benefits and risks of new, existing, or combined uses of therapeutics (drugs, biologics and medical devices) through education and research. The program currently consists of 14 Research Centers, a Coordinating Center (CC) and a Steering Committee that includes members from the RCs, the private sector, and government. The CERTs Program is merit-based and peer-reviewed; it began in 1999 in response to a broad legislative mandate that includes a specific directive “to provide objective clinical information to: (1) health care practitioners and other providers of health care goods or services; (2) pharmacists, pharmacy benefit managers and purchasers; (3) health maintenance organizations and other managed health care organizations; (4) health care insurers and governmental agencies; and (5) patients and consumers.” As a consequence, the CERTs partner extensively with multiple organizations and groups, including community-based settings such as pharmacies, warfarin clinics, home health providers, and community health centers serving underserved and minority populations.
DEcIDE: The Developing Evidence to Inform Decisions about Effectiveness research network is a component of AHRQ’s Effective Health Care program that focuses on generating new scientific evidence and analytic tools to assist stakeholders with making health care decisions. The DEcIDE network is comprised of 13 academic research centers that conduct accelerated practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of health care interventions. Activities performed by the DEcIDE network reflect the general principle that providers, policy makers, and patients should have the best available evidence upon which to make choices about health care items and services. The program began in 2005 and represents the nation’s largest network devoted to clinical effectiveness research. DEcIDE centers form partnerships with multiple stakeholder groups to plan, develop, implement, and disseminate research that will provide actionable information for patients, communities, and health care providers, especially those affiliated with the Medicare, Medicaid, and the State Children's Health Insurance programs. Stakeholder groups include patients, providers, community health programs, pharmacies, practice-based research networks, state Medicaid Medical Directors, consumer organizations, professional societies, and others working in primary care settings.
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
Health Centers Program
In 2007, funding to health center grantees was $1.7 billion. Health centers served over 16 million patients at an average cost per patient of about $562, and provided over 63 million patient visits. The Federal grant is about 20 percent of average Health Center revenues which total approximately $9 billion. Currently, nearly 1,100 health center grantees operate more than 7,000 service delivery sites in every State, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. More than half (53 percent) of all health centers serve rural populations.
Maternal and Child Health Services Block Grant Program
More than 34 million individuals were served by Title V in 2007 including over 31 million infants and children. To assess the impact of its investment, the program tracks 18 national performance measures such as newborn metabolic and hearing screening rates, rates of low birth weight, rates of immunization, rates of children with special health care needs receiving coordinated care services, rates pf childhood overweight/obesity, and rates of prenatal care. In addition, State partners are required to identify their own State-specific priority performance measures.
National outcomes that reflect the impact of the MCH Block Grant funds on maternal and child health include the following: (1) the national rate of infant deaths per 1,000 live births, which has decreased steadily from 9.2 in 1990 to 6.9 in 2005; (2) the national rate of neonatal deaths per 1,000 live births, which has decreased from 6.5 in 1990 to 4.6 in 2005; (3) the number of uninsured children, which has decreased from 10.0 million in 1994 to 8.7 million in 2006; (4) the percent of pregnant women who receive prenatal care in the first trimester, which increased from 75.8 percent in 1990 to 83.9 percent in 2005; (5) the percent of very low-birth weight babies who are delivered at facilities for high-risk deliveries and neonates, which increased from 70.6 percent in 1998 to 73.4 percent in 2005; (6) the number of children receiving Title V services who are enrolled in and have Medicaid and SCHIP coverage, which increased from 4.0 million in 1998 to 11.0 million in 2006; and (7) the number of children served by the MCH Block Grant per $1 million in funding, which increased from 30,906 in 2002 to 41,868 in 2006.
Healthy Start Program
Since its inception in 1991, Healthy Start has served hundreds of thousands of families. In Healthy Start projects in 1998, first trimester entry into prenatal care by project participants was only 41.8 percent; by 2006 it had increased to 68 percent, a 63 percent increase. From 2006-2007, 22 Healthy Start communities reported no infant deaths among program participants.
Ryan White HIV/AIDS Program (RWHAP)
RWHAP is able to reach people where many providers in America's healthcare system do not serve. In 2006, almost 60 percent of Ryan White HIV/AIDS Program clients lived below the Federal Poverty Level, and 32 percent had no insurance.
The RWHAP is comprised of five parts, including funding for Metropolitan Areas; States; Communities; Children and Families; and support for excellence in HIV/AIDS care, which includes a community-based dental partnership program, as well as AIDS education and training centers. Any of these components may be appropriate for building or expanding community infrastructures to enable health science research.
Rural Health Care Services Outreach Grant Program
Rural Hospital Flexibility Grant Program
INDIAN HEALTH SERVICE
Native American Research Centers for Health (NARCH Grants)
NATIONAL INSTITUTES OF HEALTH
Clinical and Translational Science Awards (CTSAs)
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
Addiction Technology Transfer Centers (ATTCs)
Screening, Briefing Intervention, and Referral to Treatment (SBIRT)
Primary and Behavioral Health Care Integration (PBHCI)
Children’s Mental Health Initiative (CMHI)
The Minority Educational Initiative (MEI)
The Sober Truth on Preventing Underage Drinking Act (STOP Act) Grant program