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Funding Opportunity Announcement (FOA) HS-11-002
Technical Assistance Conference Call
December 2, 2010
document summarizes the technical assistance call for the Infrastructure for
Maintaining Primary Care Transformation (IMPaCT): Support for Models of Multi-Sector, State-Level Excellence (U18) funding opportunity announcement (FOA). The FOA is
available at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-11-002.html.
The technical assistance
teleconference was held at the Agency for Healthcare Research and Quality
(AHRQ), Rockville, MD, on December 2, 2010. If after reading this document you
have any questions or comments, please contact Leilani Liggins at leilani.liggins@AHRQ.hhs.gov.
Meyers: Welcome to AHRQ's technical assistance call for RFA-HS-11-002, Infrastructure
for Maintaining Primary Care Transformation (IMPaCT): Support for Models of Multi-Sector, State-Level Excellence (U18). During
this call we will be providing an overview of the FOA, providing answers to
frequently asked questions, and conducting an open forum to respond to
following introductions were made:
Director, Center for Primary Care, Prevention, and Clinical Partnerships, AHRQ.
Advisor for Extramural Research, Office of Extramural Research, Education, and
Priority Populations, AHRQ.
Review Officer, Office of Extramural Research, Education, and Priority
Chief, Grants Management Office, AHRQ.
Program Contact for the FOA, Center for Primary Care, Prevention, and Clinical
Funding Opportunity Announcement (FOA) Information
Meyers: This FOA solicits applications to expand current State-level,
multi-sector efforts to transform primary care practices and develop
sustainable infrastructure for quality improvement in small- and medium-sized
primary care practices.
goal of the FOA is to foster the advancement and evaluation of leading State-level
primary care practice support efforts that may become models for a potential
national primary care extension service. Successful applicants must demonstrate
both their existing successful collaborative efforts and significant existing
infrastructure and activities.
initiative has three major aims: to support and expand existing programs that
assist primary care practices with general quality improvement and practice
change; to encourage program synthesis, evaluation, and sustainability among
existing exemplar programs; and to package and actively disseminate lessons
learned about primary care practice support to other developing multi-sector
efforts around the country.
begin by reviewing some of this FOA's basics:
is utilizing a cooperative agreement mechanism (I will talk more about
this later and we will have time for questions at the end).
intend to make three awards, and if Congress were to direct additional
funds to AHRQ, I would be thrilled to award more.
are limited to $500,000 per year, total costs, for each of 2 years.
Total costs include direct and indirect costs and do not include in-kind
Research Strategy section of the application is limited to 25 pages.
are made to organizations, not to individuals. Eligible institutions for
this FOA include not-for-profit, for-profit, and tribal organizations, as
well as agents of the State or Federal government.
requires there be one, and only one, principal investigator/project
director (PI/PD) per application. The PI/PD should spend at least 20% of
their time on the project (if less, the application must include a
justification for this decision). If you were considering having co-PIs,
you can give folks any titles you want—Research Queen, Implementation Czar—but
your application must identify one, and only one, PI/PD.
there are likely many possible ways of organizing quality improvement
infrastructure for primary care, this initiative focuses on one specific way—one
we at AHRQ believe has great potential and the type that is outlined in the
Affordable Care Act—and that is multi-sector collaboration. Therefore,
application under this FOA must demonstrate the active involvement of:
Department of Health.
entity responsible for administering the State Medicaid program within the State,
if other than the State health department.
- Primary care department or departments of one or more health profession schools
in the State that train primary care professionals.
of these must be included in the application and show active involvement.
AHRQ strongly encourages projects to demonstrate a variety of other
stakeholders, such as:
care professional societies.
Medicare Quality Improvement Organizations.
Health Education Centers.
Primary Care Associations.
important to note that while State government involvement is required, it does
not need to be the lead agency for an application.
who can submit an application? As stated in Section III.1.A, eligible institutions include:
or nonprofit private institutions.
of local or State government.
agencies of the Federal government.
American Tribal governments (Federally Recognized).
note that for-profit organizations described in section 501(c) 4 of the
Internal Revenue Code that engage in lobbying are not eligible.
initiatives, programs that are working with tribes, are most certainly
encouraged to respond to this FOA. In responding, tribes must demonstrate
collaboration with organizations that are responsible for tribal public health,
Medicaid, and a tribal or nontribal academic department of primary care. Finally,
foreign institutions may not submit applications. Foreign institutions may
participate in projects as members of consortia or as subcontractors only.
let's dive into the specifics.
Strategy section of each application must include the following components:
of the existing program.
component, which includes a plan for any program enhancements.
section must demonstrate multi-sector involvement required under this FOA, in
addition to any other groups that are participating. The section should
describe the theoretical and organizational models that underlie the program,
along with the goals of the program. If the program helps primary care
practices adopt a specific model of care, such as the patient-centered medical
home or chronic care model, this should also be described in the mechanisms of
the program. AHRQ is particularly interested in the use of practice facilitators
or coaches, although this is not absolutely required. The application should,
however, describe how the program works directly with individual practices
across the entire State or how the program has been designed to be scalable so
that all practices within the State can be reached.
is important to remember that this section must include a brief discussion of
current or planned efforts to ensure support is provided to minority clinicians
and practices serving minority communities. Applications should discuss how
program goals are established and how stakeholder feedback, including the
experiences of primary care professionals and consumers, is incorporated.
applications should include evidence of the success to date of the program in
achieving its goals.
The Demonstration component of the application is
one of the main sections. This section itself has two subsections: one on
program enhancements and a second on evaluation and sustainability plans.
Recognizing that even successful established
programs are likely to have identified areas for enhancement and gaps that
require filling, applicants may request funds as part of this grant to refine
their program. The application should describe what, if any, specific
enhancement activities will be conducted and funded as part of this grant, how
they were identified, and how they are expected to contribute to the larger
program and its goals.
and Sustainability Plans
applications must describe how the program will be evaluated during the
performance period. Applications will be evaluated on the creativity,
sophistication, rigor, and value of their proposed evaluations. This said, applications
may request, but are not required, to use grant funding to support the proposed
an evaluation is not part of the current program, this is an opportunity to use
funds to conduct it. However, if funds are already in place to conduct an
evaluation, the applicant should describe the evaluation, but does not have to
use grant funding to conduct it.
all applications must either describe an existing plan for program
sustainability or describe a plan for developing one during the grant period.
Funds may be requested to support sustainability planning.
all applications should include a section on its Dissemination component.
must describe a plan for "packaging" their efforts and lessons learned. They
must describe an outreach effort that will result in a minimum of three other States
or State coalitions receiving training about the applicant's program and about
how to develop their own programs.
efforts may include, but are not limited to, developing ongoing mentoring
relationships, building a regional learning collaborative, arranging in-person
site visits, and developing online resources.
developing this FOA, AHRQ recognized that many successful local programs do not
have the staff, time, or resources to share their stories and lessons learned
with others. For this reason, we are requiring that these new resources made
possible by this grant initiative be used for this purpose. Therefore, a
minimum of 25% of requested funds over the 2-year grant period must be devoted
to dissemination activities. It is not required that 25% of funds in each year
be devoted to dissemination, as long as the proposed total expenditure over the
course of the full grant period is equal to or greater than 25%.
Strategy section is limited to 25 pages. The following sections are required (and
the page lengths are suggestions only):
and Background (2-3 pages).
State-Level Program (4-7 pages).
Plan (which includes proposed program enhancements and proposed evaluation and
sustainability planning) (7-12 pages).
Plan (6-10 pages).
Applicants may wish to consider using these specific section titles as headers
and subheaders in their applications.
review a few additional details:
should describe how they will incorporate Federal program officials in
demonstration and dissemination activity planning, execution, and evaluation,
consistent with the nature of a cooperative agreement.
Agreement. The administrative and funding instrument
used for this program is the cooperative agreement U18, an
"assistance" mechanism (rather than an "acquisition" mechanism), in
which substantial AHRQ programmatic involvement with the grantee is anticipated
during the performance of the activities. Under the cooperative agreement,
AHRQ's purpose is to support and stimulate the recipients' activities by
involvement in and otherwise working jointly with the award recipient in a
partnership role; it is not to assume direction, prime responsibility, or a
dominant role in the activities.
should plan to include a Federal program official as a member of their project
leadership team and to conduct at least quarterly teleconferences with the
program official. I recommend you see section VI.2 for additional details about
the cooperative agreement mechanism.
is expected that the PI/PD will devote a minimum of 20% effort to this project.
If an applicant proposes the PI/PD will spend less than 20% effort on this
project, a specific justification that addresses project leadership,
management, and coordination must be included.
should include, as an Appendix, a specific budget breakdown related to the
dissemination plan that demonstrates that a minimum of 25% of the total
requested funds will be directed toward dissemination activity.
applications should also include a separate Appendix that details the central
budget for the ongoing program. This budget helps establish that there is an
existing program. This ongoing program budget is not part of the grant
budget request, although program enhancements, evaluations, and sustainability
planning may be covered by the grant.
are encouraged to include letters of support demonstrating all of the required
and any additional coalition partnerships. These may be included as a third
should budget for at least two senior team members to attend at least one 3-day
AHRQ conference in the Washington, DC, area during the course of the grant.
will use several funding considerations when selecting applications for awards.
As stated in the FOA, these include:
and technical merit of the proposed project, as determined by peer review.
of the proposed project to goals and objectives of the FOA.
of the proposed project to program priorities.
needs of AHRQ and the U.S. Department of Health and Human Services.
AHRQ intends to award no more than one award per State in
response to this FOA, and reserves the right to fund proposals that represent a
diversity of approaches from among applications rated as meritorious.
In preparing your applications, I recommend you pay
particular attention to the Review Criteria that will be utilized by peer reviewers
in determining the merit of your proposal (please see section lV.2 for the full
details). The review criteria include:
reviewers will consider:
of the full range of primary care practices and professionals
in the State and the needs of the public in the State.
of human subjects from research risk.
and security protections for research subjects.
you prepare your application, please remember that AHRQ does not accept
modular budgets. AHRQ uses ONLY the detailed Research & Related
Budget. We do not use the PHS 398 Modular Budget. Applications submitted in
modular budget format will be returned without review.
applications must be submitted electronically using the electronic SF424
(R&R form) created for this FOA. Please see the FOA for instructions on how
to obtain electronic forms and to register your institution and PI/PD. Please
remember that if you have not done this before, the process of registering the institution
and the PI/PD in both eRA Commons and Grants.gov—two separate processes that
must be done—can take several weeks. Please prepare early.
note that specific instructions in the FOA supercede general instructions
that may be found in the SF424 or on the National Institutes of Health (NIH) Web
site. For example, as stated earlier, applications under this FOA are limited
to 25 pages for the Research Strategy section. That is the correct answer.
the transition period will have ended, there will not be a 2-day correction
period following submission. All applications must be submitted before the
are a few key dates highlighted in the FOA:
that someone can submit a letter electronically: January 15, 2011.
of intent receipt date: January 7, 2011.
date for application submission: January 15, 2011.
due date: February 15, 2011.
review date: expected to take place approximately May/June 2011.
anticipated start date for any award: approximately August 2011.
applicants are asked to submit a letter of intent that includes the following
short descriptive title of your proposed application.
name, address, and telephone number of the PI/PD.
of other planned key personnel.
list of participating institutions.
is extremely helpful if the number and title of this funding opportunity is
included in the letter. The letter of intent can be sent by postal mail or
Center for Primary Care, Prevention, and Clinical Partnerships
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Telephone: (301) 427-1500
additional technical assistance, please contact any of the following AHRQ staff,
who will be glad to provide technical assistance:
Can this FOA be used to support the launch of new initiatives?
AHRQ is interested in well-established programs that may serve as models to
others. Applicants must demonstrate existing successful collaborations and
existing activities. Applications may, however, propose expansions and
enhancements to their existing efforts.
Is the primary intent of this grant to assist established programs to further
develop and create dissemination tools or is the intent to assist States with
less infrastructure to develop a statewide primary care transformation and/or
quality improvement program?
The purpose of this FOA is to support the further development of already
existing State-level initiatives, thus catalyzing primary care transformation
and quality improvement that may serve as models for Federal and State
initiatives, and to support the active dissemination of these exemplar models.
We have a State-level initiative to link care coordinators with small primary
care practices. Would this program be of interest to AHRQ?
While primary care practices and the communities they serve may benefit greatly
from shared community-based practice resources, such as care coordinators,
patient educators, social workers, and mental and oral health professionals,
the development of these types of practice resources is not the focus of this FOA.
Applications that focus on State-level initiatives to provide practice support
other than for practice transformation and quality improvement would not be
responsive to the goal of this FOA.
Can we propose a multi-State initiative?
No. While in the future the Federal government may explore creating a national
primary care extension service based on multi-State or regional hubs, this FOA
targets single, whole State-level initiatives.
We have a strong and established program, but it does not yet reach every
primary care practice in the State. Are we eligible to apply?
Maybe. It is not required that a program already have the capacity to reach
every primary care practice in the State. In fact, expanding capacity is an
allowable use of grant funds. Applications must, however, demonstrate State-level
multi-sector collaboration through an existing program. A program that does not
have multi-sector collaboration would not be eligible for this FOA unless it is
arranged as part of preparing your application.
Would a fully formed and integrated State telehealth system, which uses
videoconference technology to bring physicians and patients together, be
considered the existing infrastructure that you are looking for from grant
It depends on how the system is being used. A system for providing care, while
valuable, would not be relevant to this initiative. A system that is used to
connect practice facilitators with practice staff to conduct quality improvement
training would be. To a large extent, however, the infrastructure AHRQ is
looking for is organizational infrastructure, programmatic infrastructure, and
people-based resources to conduct this type of program.
Would a successful applicant need to first identify and agree to partner with
other States prior to submission of the grant application?
There is no requirement that applicants identify the recipients of their
planned dissemination efforts. In their outreach plans, however, or the Dissemination
section, applicants may propose specific recipients for mentoring. If so, a letter
of support would be expected in the third Appendix. All outreach plans, however,
must be designed and funded to reach a minimum of three additional States or State-level
Does AHRQ accept modular budgets?
No. As stated earlier, AHRQ uses only the detailed Research & Related Budget.
We do not use a modular budget. Applications submitted in modular budget format
will be returned without review.
Will the letters of intent, which are due on January 7, 2011, be available for
No. The intent of the letters is to assist AHRQ in preparing for peer review.
How do you define a small- or medium-sized independent primary care practice?
Are you working off a particular definition or is there flexibility?
We do not have a very specific definition of size of a practice. On page 5 of
the printed FOA, we define primary care, primary clinician, and primary care
practice related to size. In general, I would say small and medium are
practices with five or fewer lead primary care clinicians; however, I think
definitions of slightly larger moderate size, such as 10 and under, would be
responsive. In this FOA, we are not as interested in reaching out to large,
well-integrated systems with hundreds of clinicians, as we are in understanding that they already have the infrastructure for quality improvement, where
smaller practices often do not.
We have had a well-established, multi-party collaboration for several years,
and the project itself will begins its implementation stage in April. Would
such a project be considered established or not?
Tough question. I would say it is up to you in your application to make the
best possible case as to why you think, even though you haven't started by the
time you applied, that your project is good enough for the government to say
you are an exemplar and a model. So, AHRQ would not presuppose that if you have
been working for multiple years that you can show the development of your work
as part of meeting your goal. However, the ability to show that you can reach
practices and help them change clearly strengthens your case for being a model
for other States to emulate.
You talk about there being no requirement that applicants identify the
recipient of their planned dissemination efforts, regarding the number of States,
but then you suggest reaching an additional three States. Do we need to name
You do not need to say who they are, but an application that came in and stated,
"we are going to do all of this work with one other State," would not be
responsive. An application that came in and stated, "we are budgeting for five
teams to come and visit us in 2013 and we are going to spend 7 days with them,
and this is what the curriculum is going to be, and we don't know who those
five States are but we will have a national call and we will work with our PI
to select States," would be responsive. A third application that came in and
said, "we propose to work with three States—such and such, such and such, and
such and such—and we will go and visit them, and here is the plan for
dissemination," would also be considered responsive. You do not need to
identify who the other States are, but you need to show that your plan would
reach three or more other State-level initiatives.
My question is also regarding the dissemination element. How do you define
dissemination? Is it sharing lessons learned, sharing tools and resources, or
is it actually pilot testing in a different environment?
The first would be responsive; the second would also be, and sounds much more
robust. If you can do that, that's great, but I think the expectation here is
training the staff, and teaching them what it is and consulting with them, but
not testing there and being there as they do in their module—but sharing the "how
I would like to know whether one proposal can include assistance with
enhancement evaluation and dissemination for more than one single State-level
initiative? In other words, not multiple State-level initiatives, but a single,
whole State initiative in more than one State.
In general, you are proposing that, if you have everything in place, there
could be two completely separate grants because these are multi-sector
collaboratives in more than one State doing all the pieces, and that each of them could come
in independently, but for some reason you want them to come in one application.
You would not get additional funding, such as from NIH, to have these two grants
be linked and get double the money. We cannot let you do that, but if you
wanted to do everything for two States separately, and you show that you have
both State Departments, both Medicaid programs, and both primary care departments,
you still would only have one PI and technically it would be possible. Again,
if that is not clear (this is an unusual case), you can follow up with us
What is the definition of QI?
On page 5, we try to define QI. For the record, I will read it: "quality
improvement is a systematic form of ongoing effort to make performance better.
In medical practice it often focuses on improving health outcomes, improving
efficiency, and improving patient and staff experience."
you have community health workers installed in a practice to enhance the
quality of care for a particular disease, it is sort of different from a
traditional QI practice, but the end result is still the same: trying to
improve the quality of care and outcome. Would that fit in here?
It depends. If the program function is to put community health workers in
clinics all around the State, then I would say no, that it wouldn't be
responsive, because it would be providing support to the practices. The theory that
is guiding this initiative is that in addition to needing resources and the
right people and support to do primary care, practices need an infrastructure
to help them with general QI, and specifically "whole system, whole practice"
transformation toward new models of primary care. That is the piece of QI and
practice transformation this initiative is most targeted toward. We recognize,
however, that some folks may be doing this plus more, or other things that
could include this, and they will move into this systemwide approach. While
AHRQ will not be paying for community health workers, helping practices learn
how to best use community health workers could be one component of practice QI
Is there any possibility of ongoing support from funding sources?
There are no definitive, ongoing plans at the Agency that I could announce
today. However, as I mentioned earlier in this presentation, AHRQ is embarking
on this FOA to inform a new authority given to the Agency under the Affordable
Healthcare Act, which has authorized a very large national support for local
primary care support, which is very similar and outlined in this grant. Whether
that program has appropriate funds in the future is unclear at this point, but
we are certainly hopeful that it would and the work done under this program
would enhance our ability to be successful in meeting that authorization in the
future. Additionally, the reason we are interested in the dissemination
component and bringing other States along might be interpreted by some to mean
that we would like to be able to help those groups in the future take their
next steps as well; that is one interpretation, and certainly has not been
Should the evaluation include evaluation of the effectiveness and impact of the
In general that is not necessary. It is not the target. To the degree that it would
be useful to the team, and they would like to do it—and certainly in general it
is part of the QI paradigm—we would be very receptive to it, but specifically,
the FOA requires an evaluation of the ongoing program and its ability to help
practices, and does not explicitly require an evaluation of the dissemination
Can you respond to whether this funding opportunity will help support existing
small- or medium-sized practices to expand their programmatic elements by helping
practices to transform and also to expand their evaluation, as opposed to
expanding the number of practices involved in their effort?
The program enhancement component does not require reaching out to more
practices. A program enhancement that would help an existing program do more
with the practices it already has would absolutely be responsive to this grant.
All that said, it is important to note that all programs that apply need to
describe in the initial section how the program at large is designed and has
the ability to be scalable to reach all practices in the State. A program applicant
that says, "we will never go beyond Johnson County, Tennessee," would not be
responsive to this FOA. A program applicant in Johnson County, Tennessee, that says,
"we are the pilot county for the State to take this larger" could be
Can you respond to whether the program to be enhanced and disseminated could be
applicable to a subgroup of primary care providers (i.e., pediatric primary
I think a program that specifically targeted one large section of primary care
could be responsive to the application. Clearly the ability to show how it had
relevance and the potential for expansion to other sectors of primary care would
very much strengthen the application. But the fact that at one point in time
the program was a little bit more targeted would not disqualify an application.
Are you looking for specific credentials for the PI/PD?
On the second page of the application, the official language states that the PI/PD
is an individual with the skills, knowledge, and resources to carry out the
proposed research. We are not requiring that the PI/PD have an MD, PhD, MPH, or
any other specific degree.
Current as of December 2010