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AHCPR announces new funding opportunities

The Agency for Health Care Policy and Research has announced four new funding opportunities, which are described below. The first announcement is for research on the effectiveness and outcomes of hysterectomy and other treatments for noncancerous uterine conditions. The other three announcements are for AHCPR's small grant program, including small research projects, dissertation research, and conference support.

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. Women, racial/ethnic minority individuals, and persons with disabilities are encouraged to apply as principal investigators.

For current grant announcements, go to Funding Opportunities on the AHCPR Web site.

AHCPR welcomes the opportunity to clarify issues or questions from potential applicants. For programmatic questions, contact the individual listed in the announcement of interest. Direct inquiries regarding fiscal matters to Mable L. Lam, Chief of Grants Management Staff, telephone (301) 427-1448; E-mail

MEDTEP Research on Noncancerous Uterine Conditions

AHCPR invites applications to design and conduct collaborative, multisite, randomized controlled trials to compare the effectiveness and outcomes of hysterectomy to those of other common treatments for noncancerous uterine conditions. The conditions of interest are: uterine fibroids (leiomyomata), endometriosis, dysfunctional uterine bleeding, and uterine prolapse.

The administrative and funding instrument will be the cooperative agreement (U0l) in which substantial AHCPR scientific and programmatic involvement with the awardee is anticipated during the performance of the project. The total project period for each application submitted in response to this RFA may not exceed 5 years. The earliest anticipated award date is September 1, 1996.

Dependent upon the availability of funds, AHCPR expects to award up to $3 million to support the first year of approximately three projects under this RFA. This is a one-time solicitation, and funding beyond the initial budget period will depend on annual progress reviews by AHCPR and the availability of funds.

This RFA is part of AHCPR's Medical Treatment Effectiveness Program (MEDTEP), which is a major component of AHCPR's health services research agenda. MEDTEP projects assess the relative effectiveness and costs of available interventions for the prevention, diagnosis, treatment, and management of disease, emphasizing a broad set of outcomes important to patients.

The management of noncancerous uterine conditions includes a variety of invasive and noninvasive treatments, including surgical, pharmacologic, and other treatments. Approximately 530,000 hysterectomies are performed annually for noncancerous conditions, at a cost for hospitalization of over $5 billion. Most hysterectomies are performed for one of several common, noncancerous conditions that often produce pain, discomfort, excessive uterine bleeding, emotional distress, and related symptoms. There has been little research demonstrating the effectiveness of hysterectomy relative to other well-established treatments or compared with watchful waiting. This RFA solicits studies that will directly compare the effectiveness of hysterectomy to other common treatments for noncancerous uterine conditions. AHCPR is also interested in cost analyses of effective treatments evaluated in the proposed trial.

In May 1994, AHCPR convened a public meeting to explore the important unanswered effectiveness questions regarding the proper role of hysterectomy and to examine research priorities in the management of noncancerous uterine conditions. Prospective applicants are encouraged to obtain a copy of the meeting summary (AHCPR Publication No. 95-0067), which includes recommendations for research and references. The conference summary is available from AHCPR.

Applications in response to this RFA must be received in the Division of Research Grants by June 18, 1996. Prospective applicants are asked to submit, by May 1, 1996, a "letter of intent" that includes the name, address, and telephone number of the proposed principal investigator and other key personnel; the identities of proposed consortium members, including any other participating organizations or institutions; a descriptive title of the proposed trial(s); and the number and title of this RFA. Letters of intent are to be addressed to:

Center for Outcomes and Effectiveness Research
Attention: Joanne Book
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 605
Rockville, MD 20852

Applications should be sent to the Division of Research Grants, National Institutes of Health, 6701 Rockledge Drive, Room 1040 - MSC 7710, Bethesda, MD 20857-7710 (20817 for express mail).

This announcement (RFA HS-96-002; AHCPR Publication No. 96-R032) appeared in the NIH Guide to Grants and Contracts on March 1, 1996.

Small Project Grants

AHCPR has updated its small grant program, whereby applications may be reviewed and considered for funding in an accelerated time frame. Small project grants are those with total direct costs of $50,000 or less over the project period. Projects should be accomplished in 1 to 2 years.

AHCPR conducts and supports research that will enhance the quality, appropriateness, effectiveness, and cost-effectiveness of health care services and access to such services. Support for small research grants is part of AHCPRs effort to build research capacity and stimulate the development of innovative and timely research on issues related to the delivery of health care services.

This program provides support for focused research projects, developmental studies, and high-risk projects. These projects include: research, evaluation, demonstrations, and pilot studies. Focused research projects can be descriptive or involve the testing of hypotheses. Projects must be discrete; that is, only projects that can be completed within the budgetary and time constraints imposed by the small grant program are eligible for support. Other projects can include: opportunistic, quantitative analysis of existing secondary data; policy research; evaluations of demonstrations or programs; case studies; historical, legal, or ethical analysis; or primary data collection and analysis.

Developmental studies can involve feasibility studies or pilot projects; they also can include formative or exploratory activities such as construction or modification of a survey instrument, research to test the design of a large-scale study, and collection and analysis of quantitative or qualitative information for the purpose of hypotheses generation.

High-risk projects involve the study of a novel issue or problem or the application of a novel methodological approach. These projects might employ techniques or theories from other fields not traditionally linked to health services research. Such projects have the potential for providing new insights into methodological or substantive issues.

There are no set deadlines for submission of small project grant program applications; rather, they are accepted on an ongoing basis. The earliest possible date of award is 3 months after the receipt of the application by AHCPR.

Applications should be addressed to:

Small Grant Research Projects
Office of Scientific Affairs
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 400
Rockville, MD 20852

AHCPR welcomes the opportunity to clarify any issues or questions from potential applicants. Direct inquiries regarding program matters to the contacts listed by specific program areas in the program announcement.

This program announcement (PAR-96-028; AHCPR Publication No. 96-R041) appeared in the NIH Guide to Grants and Contracts on February 23, 1996.

Dissertation Research

AHCPR's small grant (R03) program for health services dissertation research supports research undertaken as part of an academic program to qualify for a doctorate. Through this support, AHCPR seeks to increase the number of researchers who study health care systems and the cost, quality, and impact of health care services. Applications are accepted from students seeking a doctorate in disciplines relevant to health services research. Total direct costs under this program announcement may not exceed $30,000 for the entire project period.

Application receipt dates are May 1 and November 15, annually. Those considering applying in response to this program announcement are strongly encouraged to discuss their projects with AHCPR program administrators before formal submission. Applications should be sent to:

Small Grant Program: Dissertation Research
Office of Scientific Affairs
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 400
Rockville, MD 20852

Direct inquiries regarding programmatic issues to the Dissertation Program Coordinator at the above address or E-mail

This announcement (PAR-96-016; AHCPR Publication No. 96-R037) appeared in the NIH Guide to Grants and Contracts on January 26, 1996.

Conference Support

This announcement describes the procedures and criteria for the AHCPR small grant program for conferences. Applicants may request full or partial support for conferences. Where partial support of a conference is requested, the review will consider the overall structure and design of the conference as well as the subcomponent for which support is being requested.

Examples of the kinds of conferences eligible for support include: (1) research development conferences which define issues or problems in the delivery of health services and develop a research agenda or strategy for studying them; (2) design and methodology conferences which address methodological and technical issues of major importance in the field of health services research; and (3) dissemination conferences which provide research information to organizations and individuals involved in formulating or evaluating health policy, managing health care programs, and purchasing or using health services.

The first step in the application process is a concept letter. No application will be accepted prior to Agency receipt and review of a concept letter. Concept letters for conference grant support will be accepted on an ongoing basis throughout the year. The letter should not exceed two pages and should provide a brief description of the purpose, significance, content, and audience of the proposed conference. Address concept letters to:

Small Conference Grant Program
Office of Scientific Affairs
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 400
Rockville, Maryland 20852

After reviewing the concept letter, AHCPR will inform potential applicants whether they should submit a formal application for review. AHCPR will respond to a concept letter within 15 days of receipt. Subsequent applications should be submitted to AHCPR's Office of Scientific Affairs at the above address.

Written and telephone inquiries concerning this program announcement are encouraged. Direct inquiries regarding programmatic issues to Christine G. Williams, M.Ed., Acting Director, Center for Health Information Dissemination, Suite 501, at the above address.

This program announcement (PAR-96-015; AHCPR Publication No. 96-R027) appeared in the NIH Guide to Grants and Contracts on January 26, 1996.

Agency launches new Center for Organization and Delivery Studies

The Agency for Health Care Policy and Research is creating a new Center for Organization and Delivery Studies, which will serve as a locus of expertise on the structure, organization, and delivery of health care. The center, to be directed by Irene Fraser, Ph.D., will both conduct and manage a portfolio of quantitative and qualitative research on changes in the organization and delivery of health care brought about by market forces and changes in public programs. Specifically, research conducted and supported by the center will fall into five areas:

  1. Major factors affecting delivery systems and health care organizations: private market forces such as employer value-based purchasing, Federal and State legislative and regulatory actions, and legal factors.
  2. Changes in health care markets.
  3. Managed care, provider service organizations, vertical and horizontal integration, the move toward ambulatory and home care, efforts at clinical integration, and other changes in the structure and organization of delivery systems.
  4. Organizational behavior within these changing institutions.
  5. The impact of particular delivery systems and organizational arrangements on outcomes such as access, cost, and health status.

The center will conduct its own research, build research partnerships (for example, with providers, managed care organizations, foundations, and other research organizations), and manage a grant portfolio. For example, the 10 grants awarded several months ago under AHCPR's market forces grant solicitation will be managed by this center. In building its research portfolio, the center also will welcome new grant applications falling under the five research areas listed above. Proposals may be submitted under the regular investigator-initiated process, the small grant process (described above), or the small conference grant mechanism (also describe above).

An immediate priority for the center will be to lead the field in developing new conceptual frameworks for analyzing the configuration, operation, and impact of emerging health organizations and markets. Because market realities have evolved far more quickly than our ability as researchers to conceptualize and classify them, it is not clear how to isolate and measure those features of the complex new health care organizations that are likely to be most important to use of services, customer satisfaction, health status, and total expenses. The cost of data collection can be very high and should be optimized by systematic conceptual preparation. The center will welcome applications under the small grant program that offer and describe a new conceptual framework and draw inferences about the design of empirical analyses and data collection efforts which might be suggested by such a framework.

For additional programmatic information about the Center for Organization and Delivery Studies, call Michael Hagan, Fred Hellinger, Barry Friedman, or Irene Fraser at (301) 427-1410.

A new AHCPR initiative will assist consumers in choosing health plans

The Agency for Health Care Policy and Research has selected the members of three consortia who will implement a major new initiative to assist consumers in selecting high-quality health care plans and services. The Consumer Assessments of Health Plans Study (CAHPS®) project consists of cooperative agreements, awarded fall 1995, totaling $10 million over 5 years with three consortia headed by Research Triangle Institute, the RAND Corporation, and Harvard University.

According to AHCPR's Administrator, Clifton R. Gaus, Sc.D., surveys by objective, non-government polling firms have shown that most Americans would like to have more information to help them choose hospitals, doctors, and health care plans. AHCPR has brought together national experts in patient satisfaction and survey research to develop and test methods for measuring consumers' satisfaction with their health plans and ways to communicate the results to consumers.

The surveys will be tested at several demonstration sites throughout the country and will focus on a variety of health plans and service delivery settings, including HMOs, fee-for-service plans, and public health clinics offering services to low-income individuals. In addition, AHCPR and the Health Care Financing Administration (HCFA) will jointly support the addition of a CAHPS® module that will be specifically tailored for Medicare beneficiaries.

CAHPS® surveys and reports for consumers based on survey information will be tested at each of these sites. In the final phase of the project, CAHPS® researchers will determine if the survey-based reports for consumers actually improve their ability to select appropriate health plans and services.

CAHPS® differs from other efforts at consumer assessment of health plans in several critical ways. Most existing survey instruments are limited to assessment of consumer satisfaction with plans, but surveys developed under CAHPS® will ask consumers about additional areas of importance to them, including their access to care, use of plan services—or reasons for not using services—and their rating of the quality of care they received and the outcomes of that care.

According to Robert M. Krughoff, president of the Center for the Study of Services/Consumers Checkbook Magazine, consumers who are trying to choose health plans that best meet their needs want to know—and need to know—about current plans members' experience with the plans. The CAHPS® effort is expected to produce a high-quality, broadly accepted set of questionnaires and ways of reporting results—enabling consumers to compare plans on a uniform footing nationwide.

The project also will help managed care organizations with their efforts to provide high-quality care. Virtually all health maintenance organizations (HMOs) depend on patient satisfaction surveys for continuous quality improvement, notes Karen Ignani, president of the American Association of Health Plans.

A related contract awarded by AHCPR to Westat, Inc., will assure that the survey instruments and communication devices developed under CAHPS® get into the hands of consumers, employers, plans, unions, and other interested parties as quickly as possible. Under terms of the Survey User Network (SUN) contract, Westat also will provide technical assistance for users of the survey. Funding for the first year of support is $497,000.

For more information about the CAHPS® and SUN projects or to obtain a list of consortia members, contact Christine Crofton, Ph.D., or Charles Darby, M.A., at (301) 427-1324.

New publications available from AHCPR

The following new publications are now available from the Agency for Health Care Policy and Research.

Bone Densitometry: Patients with Asymptomatic Primary Hyperparathyroidism, Health Technology Assessment No. 6.

Bone loss and osteoporosis are associated with various conditions, such as asymptomatic primary hyperparathyroidism, and treatments, such as prolonged steroid therapy. Bone densitometry is used to measure bone mass density to determine the degree of osteoporosis and to provide an estimate of fracture risk. Bone densitometers measure the radiation absorption by the skeleton to determine bone mass of the peripheral, axial, and total skeleton. Common techniques include single-photon absorptiometry of the forearm and heel, dual-photon and dual-energy x-ray absorptiometry of the spine and hip, quantitative computed tomography of the spine or forearm, and radiographic absorptiometry of the hand.

Part 1 of this health technology assessment addresses important technical considerations of bone densitometers, including radiation dose, site selection, and accuracy and precision, as well as costs and charges. Part 2 presents an evaluation of the clinical utility of bone densitometry in the management of patients with mild primary hyperparathyroidism, a generalized disorder of calcium, phosphate, and bone metabolism due to excessive secretion of parathyroid hormone from the parathyroid gland. Issues addressed are the type and extent of bone loss in these patients, whether they have an increased risk for fracture, and whether parathyroidectomy reduces the risk of fracture.

This health technology assessment was conducted by the Agency for Health Care Policy and Research at the request of the Health Care Financing Administration. Subsequent assessments will address the clinical utility of bone densitometry for steroid-dependent patients, estrogen-deficient women, patients with vertebral abnormalities, and patients with end-stage renal disease.

Copies of Bone Densitometry: Patients with Asymptomatic Primary Hyperparathyroidism, Health Technology Assessment No. 6 (AHCPR Publication No. 96-0004) are available from AHCPR. Send your request to

NMES Findings 26 and 27

AHCPR has published two new reports from the 1987 National Medical Expenditure Survey (NMES-2) series. NMES-2 provides extensive information on health expenditures by or on behalf of American families and individuals, the financing of these expenditures, and each persons use of services during the period January 1 to December 31, 1987. The major components of NMES-2 contain information to make national estimates of health status, use of health services, insurance coverage, expenditures, and sources of payment for the civilian population of the United States.

NMES Findings 26 summarizes the use of and expenditures for dental services by the civilian noninstitutionalized population of the United States in 1987. Estimates include the probability of obtaining care from dentists, dental surgeons, oral surgeons, orthodontists, and dental assistants. Also presented are estimates of the mean number of visits per person and per user, the mean charge per visit, annual expenditures and sources of payment, and out-of-pocket expenses for dental care.

These estimates are examined by age and sex, insurance coverage, race/ethnicity, family income as related to poverty status, employment status, and census region. Results from the 1987 NMES Household Survey are compared with estimates from the 1977 National Medical Care Expenditure Survey to determine if the relationships between dental use, expenditures, and charges and various population characteristics remained stable over the decade.

NMES Findings 27 presents estimates of use, expenditures, and sources of payment for ambulatory and home health services delivered by different types of nonphysician providers to the civilian noninstitutionalized population of the United States. Separate estimates are presented for total use, average charge, total expense, and the percent of expenses paid out of pocket by private insurance, Medicare, Medicaid, and other public programs. Each of these estimates is examined separately by demographic and socioeconomic characteristics of the population, including age, insurance status, sex, ethnic/racial background, family income, area of residence, and region of the country.

Separate estimates are presented for nurses, nurse practitioners, physician assistants, and nurse midwives; psychologists and other mental health counselors; podiatrists; chiropractors; optometrists; physical therapists; and laboratory and x-ray technicians. Per capita expenditure estimates for other types of health services use are presented both for persons using nonphysician services and all other users. These aggregate estimates suggest that in terms of expenditures, nonphysician care is largely complementary to physician services.

Copies of Dental Services: A Summary of Use, Expenditures, and Sources of Payment, 1977 and 1987, National Medical Expenditure Survey Research Findings 26 (AHCPR Publication No. 96-0005), and Nonphysician Health Care Providers: Use of Ambulatory Services, Expenditures, and Sources of Payment, National Medical Expenditure Survey Research Findings 27 (AHCPR Publication No. 96-0013), are available from AHCPR. Send your request to

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