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Applications due April 22 in response to three new RFAs

The Agency for Health Care Policy and Research recently announced the following three new grant programs. Applications in response to these announcements are due by April 22, 1999.

Health care for children from low-income families. AHCPR and the David and Lucile Packard Foundation will work together to fund studies that will help purchasers and designers of health insurance and delivery systems improve health care for low-income children. The David and Lucile Packard Foundation is a private family foundation that was created in 1964. AHCPR and the Packard Foundation together plan to award up to $2 million in fiscal year 1999 to support the first year of approximately five to eight projects under this Request for Applications (RFA). AHCPR and the Packard Foundation expect to spend $6 million on the projects over the course of 3 years.

Most studies conducted so far on the impact of financing and delivery changes have not looked at the broader system-wide effects—for example, how changes in the Medicaid program might affect the provider network in a community and in turn affect health care for the entire population of low-income children and families in that community. Studies to be funded under this RFA should provide information that will be useful in designing and modifying the State Children's Health Insurance Program (SCHIP) and other health care programs for low-income children.

SCHIP, enacted as part of the Balanced Budget Act of 1997, represents the largest expansion in children's health coverage since passage of Medicaid over 30 years ago. SCHIP is providing $24 billion over 5 years, beginning with fiscal year 1998, to help States offer affordable health insurance to uninsured children in working families that earn too much for Medicaid but not enough to afford private coverage. Most participating States offer some form of managed care, and the features of such plans vary considerably.

Applicants under this announcement should focus on how the features of insurance programs (such as the scope of benefits packages and premium and cost-sharing requirements) and the organization of health care delivery systems associated with these programs (such as the network of providers, the procedures to access pediatric subspecialists, or the mechanisms to link to social services) affect access to services and the quality of care received by low-income children. Studies will fall into one or both of two categories: enrollee studies that examine the impact on low-income children enrolled in insurance programs, and community studies that examine the impact on a low-income community's health care delivery system and all children that it serves.

Because the awards will be cooperative agreements, awardees are expected to work with each other and with Agency and Packard Foundation staff for the purpose of strengthening individual studies and generating generalizable results across projects, locations, and populations.

The RFA, "Health Care Access, Quality and Insurance for Low-Income Children," (RFA HS-99-005) was published January 20, 1999, in the NIH Guide for Grants and Contracts.

Assessing quality improvement strategies. AHCPR is seeking research proposals to assess health care quality improvement strategies, including education, the use of information systems, continuous quality improvement, behavioral interventions, academic detailing, and use of regulations. AHCPR will award up to $2 million in fiscal year 1999 to support the first year of four to seven grants.

Applicants under this RFA should focus on evaluating strategies that target areas where the greatest improvements in health and functional status can occur, reliable and valid measures exist, and a variety of strategies are being employed. Moreover, applicants are encouraged to develop working partnerships with others now engaged in health care quality improvement efforts through established mechanisms, such as peer review organizations, quality improvement organizations, purchasers' groups, health plans, accrediting bodies, and academic researchers. Furthermore, awardees will be encouraged to collaborate with each other to examine issues affecting generalizability, analyses of pooled data measures of the impact of interventions, and other cross-cutting questions.

The RFA "Assessment of Quality Improvement Strategies in Health Care," (RFA HS-99-002), was published in the January 22, 1999 issue of the NIH Guide for Grants and Contracts.

Therapeutics research centers. AHCPR is seeking applications from nonprofit organizations to serve as Centers for Education and Research on Therapeutics (CERTs) under a 3-year demonstration program. The goal of the program is to develop free-standing centers that conduct research and educate medical practitioners and other health care decisionmakers. The program is aimed at increasing clinician and patient awareness of the benefits, risks, and effectiveness of new uses, existing uses, or combined uses of therapeutics—drugs, biologics, and medical devices.

AHCPR expects to award up to $2 million in FY 1999 to support the centers, which were authorized by the Food and Drug Administration (FDA) Modernization Act of 1997 (P.L. 105-115). These cooperative agreements will be administered in consultation with FDA.

The new centers will evaluate therapeutics and conduct state-of-the-art clinical, laboratory, and health services research. In addition, one of the centers will be selected as the coordinating center for the program.

AHCPR funds are intended to provide basic support for each center. Although research projects initially may be supported by these core funds, centers are ultimately expected to support research with funds obtained from sources other than the CERTs demonstration program. Potential funding sources include other AHCPR grants programs, as well as grant programs of other Federal agencies and other funding bodies, such as foundations.

This announcement, "Centers for Education and Research on Therapeutics (CERTs)," (RFA HS-99-004), was published in the NIH Guide for Grants and Contracts on January 20, 1999.

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