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CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence (U18)

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Frequently Asked Questions

The following set of questions and answers features responses from the Agency for Healthcare Research and Quality (AHRQ) to questions from the public submitted about the Agency's funding opportunity announcement (FOA) for RFA-HS-11-001: CHIPRA Pediatric Healthcare Quality Measures Program Centers of Excellence (U18).

1. Will this FOA support/fund investigator-initiated measure development?

Answer: No. Please note that we received several inquiries about the acceptability of specific measure topics in response to the FOA. The intent of the FOA is not to support/fund investigator-initiated measure topics. Priorities for measure development and enhancement will be assigned. However, as noted in the FOA, applicants are encouraged to submit up to three examples to illustrate how they would go about meeting the FOA requirements for measure development or enhancement. Awardees may be able to work on topics of particular interest to them if such topics become priorities for the Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program (PQMP).

2. Will the awardees ever actually do the work we write into the proposal (or is it hypothetical work to show our collaborations and approaches)?

Answer: Please see section IV 6. If this question means specific topic or infrastructure examples, then the work may not be able to be done under this FOA, depending on the priorities set by HHS. However applicants may find it possible to use the infrastructure developed under this FOA to do work using other funding sources.

3. In the longer four-year window, will the Centers be given new topic areas in a manner similar to the AHRQ-supported Evidence-based Practice Centers (EPCs)?

Answer: Yes.

4. Should we propose four years' worth of work on a subset of measures or leave room for additional topics to come from AHRQ or the Coordinating Center? The concern is that work on additional measures may be difficult to accommodate within a given set of resources.

Answer: Applicants should demonstrate how they would accomplish the required work during the first two years of the funding period and then propose how they would address additional topics in the third and fourth years.

5. Which measurement topics are included in the legislation? Are they encompassed by the core measures?

Answer: For the topics included in the legislation, please refer to the CHIPRA legislation. The initial core measure set did not encompass all the topics and criteria required by CHIPRA. As noted in the Federal Register notice posting, the initial core set for public comment, valid and feasible measures were not identified for three CHIPRA topics: availability of care, "most integrated settings of health care," and duration of enrollment. Many of the initial core measures did not meet the CHIPRA requirements for being able to collect data on race/ethnicity or special health care needs. Also, most of the measures are underspecified for data collection using health information technology.

6. Are you interested in measures based on surveys (e.g., surveys that might be integrated into the National Survey of Children's Health or the Medical Expenditure Panel Survey [MEPS])?

Answer: CHIPRA calls for measures of family experiences of care, which is a survey-based measure, but we cannot say 'yes' or 'no' to any particular type of measure or approach.

7. The U18 FOA mentions that measure priorities will be developed by a panel. How and who comprises the panel? Does it include members from the National Advisory Committee?

Answer: There is no mention of a panel in the FOA. Priorities will be established by HHS and informed by the public as required by CHIPRA.

8. Will we have any leeway in working with measures that have already been vetted by a national body (e.g., the National Quality Forum [NQF]), or will this work be mostly limited to redefining measures from the core set?

Answer: CHIPRA requires that the PQMP be used to both develop and enhance the core measure set. The priorities for new measures will be set by HHS and informed by the public as required by CHIPRA.

9. What does the priority on integrated health care settings refer to?

Answer: CHIPRA does not provide a definition of "the most integrated health care settings." A related concept is the medical home, which the Subcommittee to the National Advisory Council (SNAC) on Children's Healthcare Quality Measures for Use by Medicaid and Children's Health Insurance Program (CHIP) suggested as a priority for immediate future development, as long as it is conceptualized broadly to address coordination with all settings in which children receive healthcare. However, other approaches to integration of healthcare for children may also be identified as priorities for measure development.

10. The FOA says that measures that are currently tailored to particular programs or populations, (e.g., Early Periodic Screening Diagnosis, and Treatment [EPSDT] recipients) will need to be re-specified. What does that mean? Could it be the development of specific EPSDT measures?

Answer: As noted in the background paper for the initial core set, none of the measures included in the initial core set in their current state (e.g., specifications, population with which used) meet the CHIPRA requirements of being suitable for use in all programs serving children and pregnant women enrolled in Medicaid and CHIP. For example:
  1. Some measures are specified and used only for Medicaid Managed Care plans and there is no known corresponding measure for fee-for-service or Primary Care Case Management (PCCM) programs.
  2. Some measures are specified for submission under the EPSDT program (for those eligible for EPSDT, which now includes CHIP, but may be a different age group from Healthcare Effectiveness Data and Information Systems (HEDIS)-specified measures for example).
  3. Many Medicaid and CHIP enrollees are excluded.
Other examples can be found in the background paper accompanying the initial core set. Thus, all measures have to be re-specified to meet the CHIPRA criterion of being able to measure healthcare quality across all Medicaid and CHIP enrollees.

11. Does every new or existing measure have to assess disparities in children's healthcare quality in terms of race/ethnicity, socioeconomic status, and special healthcare needs?

Answer: Yes. We realize that current information systems do not always capture each of these dimensions for each child. Offerors should describe how they plan to incorporate data about race/ethnicity, socioeconomic status, and special healthcare needs into their measure development given these limitations.

12. How extensive do the practice networks need to be, and do they need to demonstrate the racial make-up of the patient population?

Answer: The practice networks need to be extensive enough to test measures. Offerors should demonstrate how their populations will address disparities in terms of race/ethnicity, socioeconomic status, and special healthcare needs.

13. Will the application need to demonstrate clinical and/or electronic health record access to a critical or minimum number of minority patients?

Answer: Yes.

14. Can you give us any information about the "Coordinating Center"?

Answer: The plans for the Coordinating and Technical Center are in development and cannot be shared at this time.

15. Does participation with one or more of the Centers of Excellence (COE) preclude eligibility for the "Coordinating Center" award?

Answer: No.

16. Could State health or other departments apply for these grants?

Answer: Yes. Please see the complete list of organizations eligible to apply under Section III 1.1A. Eligible Institutions of the FOA.

17. What will be the duration of the projects when awarded?

Answer: Projects will last from Fiscal Year (FY) 2011 and end in FY 2014. Federal Fiscal Years begin on October 1 and end on September 30. For example, federal Fiscal Year 2011 will begin October 1, 2010, and end on September 30, 2011. COE awards for FY 2011 will be made in the first quarter of FY 2011 (between October and December 2010). However, continued yearly funding depends on adequate progress shown by awardees.

18. Is the goal of at least 15 new measures and at least 56 enhanced measures a collective goal (i.e., across all grantees) or an individual grantee goal?

Answer: The goal is at least 15 new measures and at least 56 enhanced measures across all awardees.

19. Is the intent to create seven to nine Centers of Excellence that will take specific priority topics as determined by a public priority setting process, distribute those topics to the Centers, and have each Center develop or enhance the measure(s)?

Answer: Yes.

20. Is the main focus of the proposal to demonstrate capacity for a variety of different quality measures, including development and testing possibilities?

Answer: Yes.

21. Although measures must support both vertical and horizontal data collection, can the specified implementation user group be focused upon the public sector (i.e., State and local public health agencies, local health department, safety-net hospitals and community clinics, safety-net and primarily Medicaid primary care providers)?

Answer: No. We expect testing to occur in more than one setting (i.e., in addition to the public sector).

22. Should proposals describe testing of measures in terms of improved quality or testing of measures in terms of reliability, validity, etc.?

Answer: Both are appropriate and related.

23. Does the project's scope include testing to determine if the use of the measures can lead to improvement (i.e., including them in actual quality improvement activities)?

Answer: There are many ways to use measurement for quality improvement. CHIPRA legislation requires reporting and comparison across States. Such reporting and comparison across States should stimulate quality improvement activities.

24. Do we have to prove that the measure works for our population as well as similar populations?

Answer: Yes.

25. In the PQMP U18 FOA, it states "Consortia of up to three institutions/organizations are strongly encouraged." Is three an upper bound limit?

Answer: There is no limit, upper or lower. More than three would be allowed.

26. Given that each Cooperative Agreement may involve several distinct measurement projects requiring different expertise and relevant users, can the users group and stakeholder group be configured in smaller subgroups relevant to each project—or would it be better to just establish separate expert panels that may also overlap with the user and stakeholder groups.

Answer: Either configuration would be acceptable provided appropriate justification is included in the application.

27. Can proposals have co-principal investigators?

Answer: No. Funded awardees will have the opportunity to identify one alternate for purposes of grant administration and participation on calls and meetings required by the FOA.

28. Can an organization be a subcontractor on one proposal and a lead on another?

Answer: Yes.

29. What is the difference between being a subcontractor and being part of a consortium?

Answer: Consortium and subcontract agreements are types of third party agreements and need to be made in accordance with HHS policy and with institutional policy and practice for similar arrangements regardless of funding source. A consortium arrangement is one in which the third party organization performs a portion of the programmatic activity of the proposed project; the investigator at the consortium institution provides scientific input which could affect the direction of the project. A subcontract agreement is an acquisition agreement in which the third party provides property or services or the conduct of prescribed activities or functions under the grant but does not perform programmatic activity. For budgeting purposes, all third party costs, both direct and indirect, are considered to be direct costs to the applicant organization and appear on the applicant budget under "subawards/consortium/contractual costs." A separate detailed budget is required for each third party.

Note that the applicant organization must perform a substantive role in the conduct of the planned project or program activity and not merely serve as a conduit of funds to another party or parties.

30. Would it be acceptable to propose a project that involved collaborating with other awardees (e.g., to potentially validate measures across different Centers of Excellence)?

Answer: Yes, but the specifics of those arrangements would still have to be negotiated after the awards are made.

31. Can an awardee expand its stakeholders after beginning work on the project?

Answer: Yes.

32. Is it generally understood by AHRQ and by reviewers that key partners are put into the grant at a certain level to ensure collaboration, but that the specific time and resources for each partner/staff will need to be adjusted up or down once AHRQ provides direction as to which projects to pursue?

Answer: Yes.

33. Can our budget reflect a dedicated amount of money to be paid to consultants (on an hourly basis), who would then be available depending on the measures assigned?

Answer: Yes. We encourage you to provide examples of the kinds of consultants you would be engaging and at what level.

34. Since we are using examples for our budgets and we would like to show capacity, would it be acceptable that the total budget may exceed $2 million per year knowing that we would not get to work on all of them?

Answer: The budget for the proposed projects (which may only be exemplary) should not exceed $2 million separately or in total.

35. Given unclear priorities at this time, is a modular budget an acceptable strategy?

Answer: No. AHRQ is not using the modular budget.

36. Would we be able to use grant funds to purchase equipment for our unit?

Answer: As noted in the FOA, "While there is not a specific dollar limit on budgeted equipment or supplies, any funds requested for equipment, hardware, software, and supplies should be well justified."

37. Will budgets be able to be easily moved/adjusted based on the tasks assigned?

Answer: Applicants should write a budget based on their sample projects. Funded awardees will receive a budget based on tasks assigned. Final budgets are negotiated with the AHRQ Division of Grants Management.

38. The grant is not requesting specific study design details that would enable a precise completion on the Human Subjects and Targeted Population forms. Shall applicants characterize the CHIPRA population in their forms with the understanding that more specific sampling parameters will emerge as projects are specified and pursued?

Answer: Yes.

39. What is the process you will use to assign measures to awardees?

Answer: To the extent possible, we will match the measurement priorities to the expertise and capacity of each of the awardees. It will be an ongoing negotiation as the priorities are identified. Awardees may be required to seek additional expertise and capacity to address priorities.

40. Do you anticipate that depending on the priority and whether it's a new measure or an enhanced measure that there will be a different range of time needed for each assignment?

Answer: Yes.

41. If proposals describe examples of how they will use their capacity and expertise to develop measures, what will be the basis for the scientific review?

Answer: The review process as described in Section 5 includes review criteria for the FOA.

42. Are you looking for a breadth of capacity or are you looking for certain types of capacity in specific areas of measure development?

Answer: We are looking for a breadth of capacity across all awardees.

43. Do we already have to be in the midst of the research process to apply for and be awarded the grant?

Answer: No.

44. Is there a recommended or preferred method for organizing the research section of the grant?

Answer: No.

45. Does AHRQ have any online resources for potential principal investigators to view a sample "model" AHRQ U18 proposal?

Answer: No. However, applicants can go to the Grants On-Line Database (GOLD) to get examples of other U-18s and contact Principal Investigators for a copy of funded grants.

Current as of June 2010

The information on this page is archived and provided for reference purposes only.


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