Improving Children's Health Through Health Services Research
Funding Opportunities in Children's Health Services Research
Funding Opportunities in Children's Health Services Research
Improving Children's Health Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research was explored, including public and private funding opportunities, networks for conducting research, and uses of research in policy and practice. The meeting was co-sponsored by the National Association of Children's Hospitals and Related Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR), the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data Harbor, Inc.
A panel of public funding agencies, including the Maternal and Child Health Bureau (MCHB) within the Health Resources and Services Administration (HRSA), the Agency for Health Care Policy and Research (AHCPR), and the National Institute of Child Health and Human Development (NICHD), provided researchers and children's health services professionals with an opportunity to learn about current funding priorities, important sources for potential funding, and how to effectively tap into those sources. The following is a summary of the key points made in each presentation.
Gontran Lamberty, Ph.D., Director of the Research Program at the MCHB, addressed the issue of health services research opportunities available at the bureau. He described MCHB's research program, its history, and the current research agenda of MCHB. He also provided examples of children's health services research (CHSR) projects currently funded by the Bureau.
The MCHB program originated in 1912, when the "Children's Bureau" was established to investigate and report upon matters pertaining to the welfare of children. In 1963, the support of extramural research through grants was officially made a mandate of the Children's Bureau under an amendment to the Title V legislation. Today, MCHB's research program supports applied research related to maternal and child health services that show promise of substantial contribution to the advancement of such services.
The MCHB research grants program is housed within the Division of Research, Training, and Education, Maternal and Child Health Bureau, Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS).
Eligible applicants for MCHB research grants include public or nonprofit organizations of higher learning and public or nonprofit private agencies and organizations engaged in research, or conducting maternal and child health (MCH) research, or children with special health care needs (CSHCN) programs. These applied, extramural, investigator-initiated grants are multidisciplinary in orientation. Many are uniquely focused on the health of minorities and the disadvantaged.The amount of funding available for research grants is approximately $13 million. Deadlines for grant applications are March 1 and August 1.
The MCHB reviews between 100 and 124 new research applications annually. Currently there are 47 active projects receiving funding. The approval rate for new applications is approximately 15 percent. The review process is similar, but independent from, that of the National Institutes of Health (NIH). The types of research funded include:
- Health services (40 percent).
- Behavioral (30 percent).
- Medical/clinical (20 percent).
- Epidemiological (10 percent).
The MCHB's research agenda and program priorities for grant funding were recently revised. They focus on 11 broadly demarcated priority areas, which are further defined by an array of research issues and questions. The 11 priority areas have been selected based on HRSA, MCHB, and the Nation's 2010 goals, as well as from recommendations from the Title V Research Priorities Conference. Many of these areas touch upon potential interests of child health services researchers, such as cost, quality, and behavioral studies related to children with special health care needs.
Application materials and program guidance are available from:
HRSA Grants Application Center
Call toll-free 1-877-477-2123
CFDA number for the program is: 93.110RS.
Additional information may be obtained from:
Gontran Lamberty, Ph.D., Chief, Research Branch, MCHB
Phone: (301) 443-2190
The URL of the Agency's Web site is http://www.mchb.hrsa.gov
Denise M. Dougherty, Ph.D., Coordinator, Child and Adolescent Health Activities at AHCPR, provided a description of the agency, its history, research interests, and grant opportunities available at AHCPR for child health researchers.
In the early 1960's, "gaps" in knowledge existed about health care utilization, cost, and variations in services. With the expansion of health care programs such as Medicare and Medicaid, it was recognized that an agency was needed to conduct research to address these gaps. In 1967, the National Center for Health Services Research (NCHSR) was authorized. It was absorbed into the new Agency for Health Care Policy and Research (AHCPR) in 1989. AHCPR supports research, data development, and other activities to enhance the quality, appropriateness, and effectiveness of health care services.
The AHCPR research pipeline consists of three areas:
- Building new knowledge on priority health issues.
- Building tools and talent.
- Translating research into practice.
With respect to child health research, AHCPR has three strategic goals:
- Improving children's health outcomes through research on outcomes measures, the effectiveness of clinical care, and the organization and systems of care.
- Enhancing quality of care through quality measurement, improvement, and information.
- Research on the access, use, and cost of care.
AHCPR also provides funding for intramural and extramural research, data development, Medical Expenditure Panel Survey (MEPS), Healthcare Cost and Utilization Project (HCUP), and other activities such as tools and clearinghouses, as well as nominations of topics for evidence-based practice centers (EPCs). The budget of AHCPR (and CHSR) has grown steadily over the past few years. In fiscal year (FY) 1998, total AHCPR appropriations were $146.5 million ($15.22 million for CHSR); in FY 1999, $171.4 million ($20.85 million for CHSR); and in FY 2000, the President's request for the agency was $206.2 million ($24.57 million for CHSR).
There are a variety of grants programs and current AHCPR funding announcements of interest to child health services researchers. These include program announcements (PA's) for:
- Small Project Grant Program (PAR-96-028).
- Grants for Health Services Dissertation Research (PAR-98-111).
- National Research Service Award, Individual Postdoctoral Fellowships (PA-94-068).
Other announcements (RFAs) in FY 1999 included:
- Health Care Access, Quality, and Insurance for Low Income Children.
- Translating Research into Practice.
- Measures of Quality of Care for Vulnerable Populations.
AHCPR also has several funding opportunities available through an ongoing program announcement (PA-98-049), which was published in March 1998. The PA includes children as a priority population, and focuses on the impact of changes in organizational and financial arrangements, including the impact of expansions of insurance such as the State Child Health Insurance Program (SCHIP), and the development and evaluation of ways to measure and improve effectiveness, outcomes, quality, and cost of care for children, including children with special health care needs.
In FY 2000, AHCPR planned to spend a total of $11 million for research centers focusing on health care markets and managed care. There are six fellowships for intramural research and career development.
With respect to children, AHCPR will continue to support an inclusion policy for children in AHCPR-supported research. Various proposals for the agency's reauthorization include children as a priority population (including training for child health services researchers), a focus on pediatric asthma, and a child health scholar-in-residence.
Additional information about funding and other aspects of child health services research at AHCPR, renamed the Agency for Healthcare Research and Quality (AHRQ) in December 1999, can be obtained from:
Denise Dougherty, Ph.D., AHRQ
Phone: (301) 427-1868
Dr. Dougherty presented information for NICHD. The National Institutes of Health (NIH) is the principal health research agency of the Federal Government. Begun as a one-room Laboratory of Hygiene in 1887, NIH today is one of the world's foremost biomedical research centers. With headquarters in Bethesda, MD, NIH is a large, complex organization composed of 75 buildings on more than 300 acres.
The mission of NIH is to protect and improve human health. The goal of NIH research is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.
There are 24 separate Institutes, centers, and divisions, that comprise NIH. Central to every Institute is a Director, who is supported by a National Advisory Council, a panel of 12-18 members consisting of leading scientists, health providers, and public leaders, chosen for their interest in matters related to health and disease.
The Extramural Research Program, responsible for more than 81 percent of the NIH budget, utilizes grants and contracts to support research and training in more than 1,700 research institutions throughout the world. Approximately 11 percent of the budget goes to NIH's Intramural Research Program, with more than 2,000 projects conducted, mainly in its own laboratories. In FY 1999, the budget for NIH was $15.6 billion.
The National Institute of Child Health and Human Development (NICHD) is the only institute within NIH that focuses almost exclusively on child health research. The NICHD is composed of six divisions:
- The Division of Scientific Review (DSR).
- The Division of Intramural Research.
- The National Center for Medical Rehabilitation Research (NCMRR).
- The Division of Epidemiology, Statistics, and Prevention Research (DESPR).
- The Center for Research on Mothers and Children (CRMC).
- The Center for Population Research (CPR).
In FY 1999, the total budget for NICHD was $751 million. Its extramural program consists of grants, contracts, and cooperative agreements. With grants, the role of the NIH is that of a patron. With contracts, the NIH functions as a purchaser. With cooperative agreements, NIH serves as a partner. Grants are usually in the form of program announcements (PAs) and requests for applications (RFA's), which are published in the NIH Guide for Grants and Contracts. Investigator-initiated grant proposals are the other type of NIH grant.
The grants process generally includes the following steps:
- The initiator's concept and grant application.
- Assigned by the Center for Scientific Review to the Institutional Review Group.
- Evaluated by the Institute for relevance and program need.
- Presented to the National Council for recommendation for funding.
- Funded by an institute or referred for resubmission.
Application receipt dates vary by type of application. In an attempt to simplify budgets, the NIH has adopted the modular grant policy for applications requesting $250,000 or less, and the funds are requested in modules of $25,000 each. The "Just In Time" procedure is utilized with modular grants to speed up the grant application process.
Research grants review criteria include:
Applications are also reviewed with respect to the following:
- Plans to include children, minorities, and both genders.
- Reasonableness of budget and duration.
- Adequacy of protection for humans, animals, and environment.
Common reasons for disapproval include a lack of new or original ideas, and a lack of sufficient experimental data.
Additional information about NIH, including the grants application process, as well as available grants, can be found on the NIH Web site at: http://www.nih.gov.
Funding Opportunities in Children's Health Services Research. Presentation Summary, Improving Children's Health Through Health Services Research, Chicago, June 26, 1999. http://www.ahrq.gov/research/chsrfund.htm