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AHCPR urges investigators to include children in their research and announces special emphases for small project grants

The Agency for Health Care Policy and Research recently made two announcements affecting its grant program—one calls for investigators to include children in their research projects whenever possible, and the other outlines special emphases for the Agency's small project grant program. Copies of these announcements may be obtained online.

AHCPR Policy on Inclusion of Children in Health Services Research. AHCPR is developing a policy and an implementation plan to encourage greater inclusion of children in health services research. The National Institutes of Health (NIH) and the American Academy of Pediatrics sponsored a joint workshop in June 1996, in which AHCPR participated, concerning the participation of children in clinical research. During the workshop, concerns were raised that treatment modalities developed based on research conducted on adults are being used to treat children for many diseases/disorders without adequate data on children.

One of the outcomes of the workshop was the recommendation that NIH develop a policy for including children in clinical research. NIH published an announcement on this topic in the January 31, 1997 issue of the NIH Guide to Grants and Contracts, volume 26, number 3.

AHCPR's position is that when there is a sound scientific rationale for including children in health services research, investigators should be expected to do so unless there is a strong overriding reason justifying their exclusion from the studies. Although this is the same scientific rationale that is the basis for the policy requiring the inclusion of women and minority populations in research, this policy does not mandate the inclusion of children in all research because the issues and sensitivities surrounding children's participation in research are significantly different from those for women and minorities.

Nonetheless, applicants for AHCPR funding will be expected to address this issue in their applications. If an applicant proposes research that addresses conditions or disorders that affect adults and also may affect children, or that deals with issues in the health care system that are relevant to children, the applicant will be expected to describe the plans for including or justification for excluding children from the research.

We at AHCPR, along with our colleagues at NIH, recognize that the development and implementation of a policy on inclusion of children will require adjustments in administrative mechanisms and, most importantly, the education and preparation of the scientific community, parents, institutional review boards, initial review groups, advisory bodies, and program staff. NIH has formed several working groups on these topics and will share and coordinate efforts with other Public Health Service components. AHCPR will use the results of these efforts and the perspectives of the health services research community in further developing and implementing this policy. Ample advance notice will be provided before formal implementation. In the meantime, investigators are encouraged to consider the inclusion of children in their health services research projects.

Questions or concerns regarding this announcement may be directed to Patricia Thompson, Ph.D., Office of Scientific Affairs; phone (301) 427-1556; E-mail: PThompso@ahrq.gov.

This announcement was published in the May 9, 1997, issue of the NIH Guide to Grants and Contracts, volume 26, number 15, and it can be accessed online.

Program Emphases for the AHCPR Small Project Grant Program. AHCPR encourages applications for the "AHCPR Small Project Grant Program" that address the AHCPR strategic goals outlined below. This program is described in Program Announcement PAR-96-028, published in the NIH Guide to Grants and Contracts, volume 25, number 5, February 23, 1996. The program announcement (AHCPR Publication No. 96-7051) is available online.

AHCPR works with the research community and in collaboration with private and public organizations to generate and disseminate information that will assist health care providers/practitioners, plans, purchasers, patients/consumers, and policymakers.

The Agency is particularly interested in projects on health issues that affect minority populations, women, and children, including clinical conditions prevalent among racial/ethnic minority populations or unique to age or sex; disparities in access to care for minority groups; the impact of particular market changes or delivery and financing arrangements on minority populations, women, and children; and the unique health care needs of children and other vulnerable populations.

The program announcement (PAR-96-028) describes the Small Project Grant Program, which provides support for focused research projects, developmental studies, and high-risk projects. High-risk projects might employ techniques or theories from other fields not traditionally linked to health services research.

This grant program is particularly relevant for new investigators as a means of encouraging individuals to enter the health services research field.

Projects addressing the goals may draw on any appropriate data. A particularly rich data source is the Medical Expenditure Panel Survey (MEPS) supported by AHCPR. Data from the Household and Nursing Home components became available for use by researchers this spring and will be available annually in the future. Information on MEPS data is available from Karen Beauregard, Center for Cost and Financing Studies, AHCPR, (301) 427-1679. We also encourage the use of data from providers, managed care organizations, employers, and other industry sources.

We welcome the opportunity to clarify any issues or questions from potential applicants. Direct inquiries regarding program matters to the contacts listed by specific program areas under "Inquiries" in the program announcement.

AHCPR announces new funding opportunities

The Agency for Health Care Policy and Research recently announced four new funding opportunities, described below, to be awarded in fiscal year 1998. Two of the solicitations are for research project grants, one is for education projects, and one is for National Research Service Award (NRSA) institutional training grants.

In general, applications may be submitted by domestic and foreign nonprofit organizations, public and private, including universities, clinics, units of State and local governments, nonprofit firms and foundations, or a consortium of organizations. See the announcement of interest for more specific information and limitations, if any. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as principal investigators.

Copies of individual grant announcements are available online.

Application receipt dates vary. See the announcement of interest for the applicable receipt date and submission requirements and procedures.

AHCPR welcomes the opportunity to clarify any issues or questions from potential applicants. For programmatic questions, contact the individual listed in the announcement of interest. For inquiries about fiscal matters, contact Mable L. Lam, Grants Management Officer; phone: (301) 427-1448; E-mail: MLam@ahrq.gov.

Effectiveness of Children's Mental Health and Substance Abuse Treatment in the General Health Sector

AHCPR—in cooperation with the National Institute on Drug Abuse (NIDA), the National Institutes of Health (NIH), the National Institute of Mental Health (NIMH), and the Substance Abuse and Mental Health Services Administration (SAMHSA)—invites applications for research on the effectiveness and/or cost-effectiveness of child mental health and substance abuse treatment interventions and guideline-based treatment strategies for children, adolescents, and youth in the general health sector. Evidence-based aids may include algorithms, practice guidelines, treatment protocols, and practice parameters.

AHCPR is particularly interested in research and evaluation projects that will produce results within 1 to 3 years, although longer projects also will be supported. Project support may not exceed 5 years (awards to foreign applicants are limited to 3 years). AHCPR expects to award up to $1.5 million in fiscal year 1998 to support the first year of approximately three to five projects under this RFA. The earliest anticipated AHCPR award date is July 1, 1998.

NIDA expects to award up to $500,000 in fiscal year 1998, NIMH expects to award up to $1 million, and SAMHSA up to $500,000, depending on the quality of the applications, program relevancy, and the availability of funds.

In order to better leverage public funds and to address important health issues that cross both the public and private sectors, creative public-private research partnerships are encouraged. Applicants are free to seek additional funding sources or research collaborators for these projects.

Research conducted under this solicitation will be expected to help build the evidence base on the effectiveness and cost-effectiveness of mental health and substance abuse treatments for children, adolescents, and young people in general health sector settings. Randomized and controlled studies are strongly encouraged. NIMH is interested in studies of the effectiveness of treatments for specific diagnosable mental disorders, such as attention-deficit hyperactivity disorder, affective disorders, obsessive-compulsive disorders, autism, and disruptive behavior disorders. SAMHSA is particularly interested in supporting projects that examine the effectiveness of interventions targeted to children with, or at risk for, serious emotional disturbances (i.e., children who have a diagnosable disorder that affects the degree or level of functioning in the family, school, and/or community that is expected to last for more than 1 year).

The research conducted under this solicitation is expected to take place in real world settings such as pediatric or family practice office or clinic settings, hospital or other emergency facilities, and managed care organizations.

The application receipt date is January 6, 1998. Prospective applicants are asked to submit, by November 13, 1997, a letter of intent that includes a descriptive title of the proposed research; the name, address, and telephone number of the proposed principal investigator and other key personnel; and the number and title of this RFA. The letter of intent should be sent to Charlotte Mullican, Center for Outcomes and Effectiveness Research; phone (301) 427-1495; fax (301) 427-1520; E-mail CMullica@ahrq.gov.

Inquiries about programmatic issues should be directed to the following individuals:

AHCPR:

Ms. Mullican the above E-mail address or by telephone, (301) 427-1495; or: Margaret Coopey, Center for Practice and Technology Assessment; phone: (301) 427-1618; fax: (301) 427-1639; E-mail: MCoopey@ahrq.gov

NIDA:

Dorynne Czechowicz, M.D.
Division of Clinical and Services Research
National Institute on Drug Abuse
5600 Fishers Lane, Room 10A-10
Rockville, MD 20857
Telephone (301) 443-0107
Fax (301) 443-8674
E-mail: dc97@nih.gov

NIMH:

Kimberly Hoagwood, Ph.D.
Division of Epidemiology Services Research
National Institute of Mental Health
5600 Fishers Lane, Room 10C-06
Rockville, MD 20857
Telephone (301) 443-3364
Fax (301) 443-4045
E-mail: khoagwoo@nih.gov

SAMHSA:

Diane L. Sondheimer
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
5600 Fishers Lane, Room 18-49
Rockville, MD 20857
Telephone (301) 443-1333
Fax (301) 443-3693
E-mail: dsondhei@samhsa.gov

This RFA (HS-98-004) was published in the June 13, 1997 NIH Guide to Grants and Contracts, volume 26, number 20.

Health Care Quality Improvement and Quality Assurance Research

AHCPR invites applications for research and demonstration projects on the use of measurement in improving the quality of health care. Applications are sought in three areas: (1) methods and measures to translate scientific information about clinical care into quality measures and strategies to improve clinical practice; (2) studies of the relationship between organizational change and quality measurement and improvement in health care; and (3) studies of how consumers, patients, employers, providers, and insurers use information derived from measuring quality of care to make decisions.

Rapid and profound changes are occurring in the Nation's health care system. There are anecdotes, but not much reliable information, about the effects of these changes on quality of care and the effectiveness of attempts to assess and assure quality. As efforts are made to increase the efficiency with which health care is provided and to curtail unnecessary expenditures, the ability to assess and maintain or improve quality is essential. AHCPR is particularly interested in the following priority populations as a special focus for research under this RFA: minority groups, women, children, persons with chronic diseases or disabilities, and the elderly. The focus of demonstration grant (R18) applications should be on evaluation.

AHCPR is especially interested in projects that will produce results within 1 to 2 years, although a balance is sought between short- and long-term projects, and projects of up to 5 years will be considered. Depending on the availability of funds, AHCPR expects to award up to $2 million in fiscal year 1998 to support the first year of 8 to 10 projects under this RFA. The earliest anticipated award date is February 1, 1998.

Prospective applicants are asked to submit by August 1, 1997, a letter of intent that includes the name, address, and telephone number of the proposed principal investigator and other key personnel; a descriptive title of the application; and the number and title of this RFA. Send letters of intent to Elinor Walker, Center for Quality Measurement and Improvement; fax: (301) 427-1341.

Inquiries regarding programmatic issues should be directed to Ms. Walker by phone at (301) 427-1311.

Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by September 16, 1997.

This RFA (HS-98-003) was published in the June 13, 1997, NIH Guide to Grants and Contracts, volume 26, number 20.

AHCPR Institutional Training Innovation Incentive Award Program

AHCPR invites applications for incentive awards for innovative approaches to health services research training. The intent is to support the design and implementation of new models for training health services researchers that address emerging issues in health care policy and delivery and to respond to the changing analytic needs of health care providers, payers, and policymakers. The awards represent seed money to support developmental efforts not readily supported by existing training mechanisms. They are aimed at developing and sustaining novel and unique educational approaches geared to enhancing established health services research training programs.

Applications may address a wide spectrum of activities, including seminars, structured short-term research experiences designed to motivate and acquaint students with alternative career opportunities in health services research, hands-on research experiences in nonacademic settings, cross-institutional collaboration to develop training curricula or other innovative strategies to advance areas where current capacity is limited, comprehensive and integrated curriculum and faculty development within and between academic institutions or between academic and nonacademic settings, and the development of model programs to strengthen the recruitment and retention of minority health services research trainees. Applicants are encouraged to develop partnerships with traditionally minority academic institutions and health professional organizations to foster collaboration and experiential training.

The total project period for each application submitted in response to this RFA may not exceed 5 years, and the earliest anticipated award date is May 1, 1998. AHCPR expects to award up to $1 million in fiscal year 1998 for approximately 20 projects under this RFA. Awards will reflect a balance between short- and longer-term projects, and the average annual award will approximate $50,000 in direct costs.

Existing health services research training programs with established track records are eligible to compete for these innovative awards. Applicants are encouraged to address activities, such as: curriculum and/or faculty development; development of partnerships with nonacademic organizations and community health care providers; ways to facilitate recruitment and retention of minority trainees; and short-term training—such as seminars offered within or outside of the existing grantee institution, workshops, summer institutes, or short courses— ranging from 1 day to several weeks and focusing on state-of-the-art research techniques and methodologies for conducting applied health services research.

Prospective applicants are asked to submit, by July 10, 1997, a letter of intent that includes a descriptive title of the proposed project; the names, addresses, and telephone numbers of the proposed training program director and other key personnel; and the number and title of the RFA. Send letters of intent to Karen Rudzinski, Ph.D., NRSA Project Officer; E-mail training@ahrq.gov.

Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by September 23, 1997.

Questions regarding programmatic issues should be directed to Dr. Rudzinski at the above E-mail address or by phone at (301) 427-1529.

This RFA (HS-98-002) was published in the June 13, 1997, issue of the NIH Guide to Grants and Contracts, volume 26, number 20.

National Research Service Award—Institutional Grants

AHCPR awards National Research Service Award (NRSA) institutional training grants (T32) to eligible institutions to develop research training opportunities for qualified individuals selected by the institution who have demonstrated an interest in health services research and who seek to prepare for careers in the systematic examination of the organization, provision, financing, and effectiveness of health care services. NRSA institutional training grants assist domestic institutions in supporting predoctoral and postdoctoral academic training. The awards allow trainees to gain 1 or more years of experience in applying research methods to the evaluation of health services. AHCPR-sponsored NRSA awards emphasize multidisciplinary health services research training that provides trainees with rigorous academic and health services research experiences.

Predoctoral research training must lead to the Ph.D. degree or a comparable research doctoral degree. Predoctoral research training must emphasize fundamental training in areas relevant to health services research.

Postdoctoral research training is for individuals who have a Ph.D., M.D., D.D.S., or comparable doctoral degree from an accredited domestic or foreign institution. Research training at the postdoctoral level must emphasize specialized training to meet national priorities in health services research.

Only domestic nonprofit private and public institutions may apply for grants to support predoctoral and postdoctoral health services research training programs. Institutions may apply for support for predoctoral students, postdoctoral students, or a combination. The research training program director at the institution will be responsible for the selection and appointment of trainees and for the overall direction of the program.

Institutions currently approved for receipt of AHCPR institutional training support beyond FY 1997 in response to applications they submitted under AHCPR's previous program announcement (PAR-95-002, published in the NIH Guide to Grants and Contracts, volume 23, number 36, October 14, 1994) are eligible to apply under this RFA. Institutions that choose not to apply will still continue to receive support under conditions stipulated in their existing grant. However, upon completion of the existing grant projects, they will not be able to apply for competing grant support from AHCPR until the Agency announces a new RFA.

Depending on the availability of funds, AHCPR expects to award up to $3,500,000 in FY 1998 to support the first year for approximately 15 to 24 projects under this RFA.

Institutional NRSA research training grants normally are awarded in 12-month increments with support for additional years based on satisfactory progress and the continued availability of funds. An award received in response to this RFA will supersede previous AHCPR-approved NRSA institutional awards that extend beyond FY 1997.

Trainee appointments are normally made in 12-month increments, and no individual trainee may receive more than 5 years of aggregate NRSA support at the predoctoral level and 3 years of aggregate NRSA support at the postdoctoral level, including any combination of support from institutional training grants and individual fellowship awards.

As specified in the NIH Revitalization Act of 1993, NRSA recipients incur a service payback obligation only during their first 12 months of postdoctoral support; the second and subsequent years of postdoctoral NRSA training serve to pay back a postdoctoral service payback obligation.

National Research Service Awards provide funds in the form of stipends to predoctoral and postdoctoral trainees to help defray living expenses during the research training experience. Sponsoring institutions receive an allowance to cover some of the trainees expenses.

Prospective applicants are asked to submit, by July 10, 1997, a letter of intent to Karen Rudzinski, Ph.D. The letter of intent should include the names, addresses, and telephone numbers of the proposed program director and other key personnel and the number and title of the RFA. Programmatic inquiries also should be directed to Dr. Rudzinski at the above E-mail address or by phone at (301) 427-1529. Applications submitted under this RFA must be received in the Division of Research Grants, NIH, by September 23, 1997.

This RFA (HS-98-001) was published in the June 13, 1997, issue of the NIH Guide to Grants and Contracts, volume 26, number 20.

AHCPR funds new grants

The following small project grants were funded recently by the Agency for Health Care Policy and Research. Readers are reminded that the results of studies usually are not available or published until a project is completed or nearing completion.

Assessing health data needs in a changing environment
Project director: William D. White, Ph.D.
Organization: University of Illinois, Chicago, IL
Project No.: AHCPR grant HS09526
Period: 6/1/97 to 5/31/98
Funding: $55,758

Barriers to African-American participation in research
Project director: Vickie L. Shavers-Hornaday, M.S.
Organization: University of Iowa, Iowa City, IA
Project No.: AHCPR grant HS09597
Period: 6/1/97 to 5/31/98
Funding: $25,307

Care-seeking and consultation with spine specialists
Project director: Timothy S. Carey, M.D.
Organization: University of North Carolina at Chapel Hill, Chapel Hill, NC
Project No.: AHCPR grant HS09370
Period: 7/1/97 to 6/30/98
Funding: $55,796

Communication skills training for primary care programs
Project director: Donald J. Cegala, Ph.D.
Organization: Ohio State University, Columbus, OH
Project No.: AHCPR grant HS09520
Period: 6/1/97 to 5/31/98
Funding: $72,974

Comparing hospital and office-based primary care
Project director: David Blumenthal, M.D.
Organization: Massachusetts General Hospital, Boston, MA
Project No.: AHCPR grant HS09369
Period: 6/1/97 to 5/31/98
Funding: $71,813

Comparing regulatory and competitive hospital controls
Project director: John E. Schneider, M.A.
Organization: University of California, Berkeley, Berkeley, CA
Project No.: AHCPR grant HS09599
Period: 6/1/97 to 5/31/98
Funding: $31,177

Comprehensive hemophilia care cost and utilization
Project director: Denise Globe, D.C.
Organization: University of California, Los Angeles
Los Angeles, CA
Project No.: AHCPR grant HS09600
Period: 6/1/97 to 5/3/198
Funding: $32,356

Domestic abuse, health status, and HMO health care use
Project director: Diana Shye, Ph.D.
Organization: Kaiser Foundation Research Institute, Oakland, CA
Project No.: AHCPR grant HS09525
Period: 6/1/97 to 5/31/98
Funding: $78,158

Effects of managed care on patient travel patterns and size of hospitals
Project director: Glenn A. Melnick, Ph.D.
Organization: RAND Corporation, Santa Monica, CA
Project No.: AHCPR grant HS09523
Period: 6/1/97 to 5/31/98
Funding: $75,212

Employer-paid health insurance and labor market changes
Project director: Lisa Ann Cubbins, Ph.D.
Organization: University of Cincinnati, Cincinnati, OH
Project No.: AHCPR grant HS09521
Period: 6/1/97 to 5/31/99
Funding: $38,177

Factors influencing hospital contracting with managed care plans
Project director: Jack Zwanziger, Ph.D.
Organization: University of Rochester, Rochester, NY
Project No.: AHCPR grant HS09529
Period: 6/1/97 to 5/31/98
Funding: $36,688

Feasiblity of new approaches to pain assessment and management in primary practice
Project director: Tim A. Ahles, Ph.D.
Organization: Dartmouth College, Hanover, NH
Project No.: AHCPR grant HS09368
Period: 6/1/97 to 5/31/98
Funding: $80,961

Health care access for deaf persons
Project director: Steve Barnett, M.D.
Organization: Highland Hospital, Rochester, NY
Project No.: AHCPR grant HS09539
Period: 7/1/97 to 6/30/98
Funding: $67,000

Immunization barriers: A study of pediatric nurse practitioners
Project director: Richard K. Zimmerman, M.D.
Organization: University of Pittsburgh, Pittsburgh, PA
Project No.: AHCPR grant HS09527
Period: 6/1/97 to 5/31/98
Funding: $74,883

Impact of health insurance on use and equity
Project director: Hugh R. Waters, M.S.
Organization: Johns Hopkins University, Baltimore, MD
Project No.: AHCPR grant HS09614
Period: 6/1/97 to 5/31/98
Funding: $23,727

Impact of internal structural changes on hospital costs
Project director: Stephen L. Walston, M.P.A.
Organization: University of Pennsylvania, Philadelphia, PA
Project No.: AHCPR grant HS09581
Period: 7/1/97 to 6/30/98
Funding: $29,915

Medicaid managed care and the Oregon health plan
Project director: Alison R. Buist, M.A.
Organization: Johns Hopkins University, Baltimore, MD
Project No.: AHCPR grant HS09606
Period: 7/1/97 to 6/30/98
Funding: $31,996

Organization typology of emerging health organizations
Project director: Stephen M. Shortell, Ph.D.
Organization: Northwestern University, Evanston, IL
Project No.: AHCPR grant HS09524
Period: 6/1/97 to 5/31/98
Funding: $72,715

Types of comanagement for patients with chronic disease
Project director: Robert J. Reid, M.D.
Organization: Johns Hopkins University, Baltimore, MD
Project No.: AHCPR grant HS09587
Period: 6/1/97 to 5/31/98
Funding: $29,351

Underinsurance and mortality
Project director: Peter Franks, M.S.
Organization: Highland Hospital, Rochester, NY
Project No.: AHCPR grant HS09522
Period: 7/1/97 to 6/30/98
Funding: $66,828

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