PARTNERSHIPS FOR QUALITY

RELEASE DATE:  May 10, 2002

RFA:  HS-02-010

Agency for Healthcare Research and Quality (AHRQ)
 (http://www.ahrq.gov)

LETTER OF INTENT RECEIPT DATE: June 20, 2002

APPLICATION RECEIPT DATE: July 17, 2002

THIS RFA CONTAINS THE FOLLOWING INFORMATION:

o   Purpose of this RFA
o   Project Objectives
o   Mechanism(s) of Support
o   Funds Available
o   Eligible Institutions
o   Individuals Eligible to become Principal Investigators
o   Special Requirements
o   Where to send Inquiries
o   Letter of Intent
o   Submitting an Application
o   Peer Review Process
o   Review Criteria
o   Receipt and Review Schedule
o   Award Criteria
o   Required Federal Citations
o   References 

PURPOSE OF THIS RFA

The Agency for Healthcare Research and Quality (AHRQ) invites applications 
designed to accelerate the pace with which research findings are translated 
into improved quality of care and the health care system's ability to deliver 
that care.  The recent Institute of Medicine report on quality of health care 
(1), is one of numerous calls for using available knowledge to more quickly 
close the gap between the level of quality that is possible and that which is 
currently achieved.  Systematic reviews have shown that new scientific 
knowledge does not automatically lead to improved patient care; that 
knowledge must be linked with supportive environments and incentives for 
change; and systemic approaches are required for improved health care 
services (2, 3). 

In recent years, the Agency expanded its research portfolio beyond studies of 
what works best in medical practice, health care organization and payment to 
include evaluation of the effectiveness of alternative strategies for using 
this knowledge to improve health care.  The Agency's portfolio now includes 
multiple studies that evaluate the effectiveness of improvement strategies, 
and a growing body of scientific literature has emerged (4, 5). 

The Partnerships for Quality RFA provides a mechanism for collaboration 
between and among the member organizations of the Partnership, including 
AHRQ, to translate research findings into practice and policy. The unifying 
goal is a strong commitment to the improvement of health care services and 
their security, safety, outcomes, quality, effectiveness, and 
cost-effectiveness. Member organizations, including AHRQ, will utilize the 
cooperative agreement mechanism to:

o   identify and prioritize aims for improvement based on member need and 
existing evidence of effectiveness; 
o   translate, disseminate, and implement research findings with a strong 
preference for findings that have resulted from prior Agency-sponsored 
research; 
o   annually identify, create and expand opportunities for collaboration and 
coordinated efforts in response to new, emerging or ongoing issues related to 
the security, safety, quality, effectiveness or outcomes of care; and 
o   estimate the impact of the implementation effort on policies, processes, 
and/or outcomes as well as key stakeholders in the care process being 
addressed; and facilitate AHRQ's understanding of the health services 
research needs and concerns held by policy and decision makers representing 
Partnership member organizations.

In addition, supplemental funds are expected to be available to improve the 
security of the United States population by improving the readiness of the 
healthcare system to respond to bioterrorism.

Agency funds are anticipated to support multi-year projects, with additional 
set-aside funds to support partnership projects that focus on improving the 
quality of the health care system's preparedness in the event of a 
bioterrorist event.

The purpose of the Partnerships program is to support models or prototypes of 
change led by organizations or groups with the immediate capacity to 
influence the organization and delivery of health care as well as measure and 
evaluate the impact of their improvement efforts.  Such organizations could 
include, but are not limited to, health care professional organizations; 
accrediting and certifying bodies; provider groups; practice networks; 
disease-specific advocacy groups; health insurers; and employer coalitions or 
purchaser collaboratives (including coalitions of State or public purchasers 
or other State or local organizations).  Also encouraged as applicants are 
consortia of such organizations or others whose influence or potential impact 
working alone would be relatively modest  (for example, a collaboration among 
Quality Improvement Organizations working with nursing homes, or a coalition 
of State Medicaid agencies or health departments).  A consortium may include 
organizations of more than one of the types mentioned.  Recognizing the 
diversity and complexity of health care delivery arrangements, the Agency 
wishes to establish partnerships among a variety of organizations or groups 
and their stakeholders, to target evidence-based change in care to a range of 
settings delivering care to a large number of people over a very wide 
geographic area. Through these partnerships, AHRQ seeks opportunities to 
accelerate current or proposed improvement initiatives, including empirical 
assessment of their impact.  Developing or strengthening partnerships may be 
one of the aims of the application.  While there are no specific matching 
requirements, the Agency expects that since these are partnerships, the 
grantee organization will devote substantial resources to this effort.

The partnerships are primarily focused on improvements in the delivery and 
outcomes of health care, through a focus on priority health conditions, such 
as diabetes and heart disease, and priority health issues, such as long term 
care and bioterrorism.  (Targets are discussed in greater detail in this 
section below.)  Partnerships may choose to focus on evidence-based 
improvement in bioterrorism preparedness using specific set-aside funds.  
Maximal system responsiveness to bioterrorism will require effective linkages 
between the health care system and the public health infrastructure.  Using 
available evidence-based information, such as  AHRQ's evidence reports on 
effective training models for bioterrorism preparedness and the role of 
decision support systems for improved responsiveness to bioterrorism (see 
summary at http://www.ahrq.gov/clinic/epcsums/biotrsum.htm), partners will be 
expected to evaluate and disseminate vital health care information, models of 
effective health care delivery, and results of research to their members.  
Applicants choosing to include a project on bioterrorism preparedness will be 
required to clearly delineate this project from other proposed projects and 
include a request for supplemental resources for the bioterrorism 
preparedness effort as part of the overall budget in order to qualify for the 
set-aside funds.

PROJECT OBJECTIVES  

The ultimate objectives of this program are to design, support and facilitate 
change that, according to evidence, is likely to lead to documented 
improvements in health care security, safety, and quality; ensure that these 
improvements become part of the ongoing practice of health care providers and 
clinicians; and disseminate improvements beyond targeted selected population 
groups.  Achieving these objectives will require the capability to assess 
current practice; select targets in terms of health care settings, 
conditions, populations, and/or elements of the care process; plan and 
institute changes in organizations, incentives, and individual clinical 
practices that will motivate and support the desired changes; document the 
effects; determine the resource implications; and institutionalize the 
process.  Documentation of results must include benefits to patients and also 
costs and benefits to individual providers and to the organizations that are 
likely to have a bearing on long-term adoption and sustainability of the 
changes.  In other words, it is desirable to (1) institute policy, 
organizational, or operational efforts that will motivate and support changes 
in practice to improve quality,  and (2) provide evidence that the changes in 
quality are cost-beneficial to the relevant participants so that they can be 
expected to continue, independent of this or other grant funding.

The Partnership grants are intended to use a phased approach – an initial 
planning phase of one year (Phase I) and continued implementation during 
Phase II, which may comprise up to three additional years.  Phase I of the 
grant is intended to allow the applicant to (1) conduct planning, testing, 
and organizational development and preparation that will further the overall 
aims to be addressed, as well as preliminary evidence of implementation; (2) 
demonstrate by the end of month 6 that the aims can be accomplished if 
further funding is awarded; and (3) present, also by the end of month 6, full 
baseline information if not included in the application.  Phase I may be used 
to create or expand partnership arrangements with stakeholders or 
collaborators.  Funding for Phase II will be determined by the progress 
achieved during Phase I.  Thus it is desirable that Phase I  be designed to 
have stand-alone outcomes that are useful in promoting quality improvement by 
the applicant and its partners and have potential informational value for 
others, even without further funding for Phase II.  

Projects are expected to adopt one of three models: one type of project would 
be short-term, having a single, relatively limited target.  These projects 
would be expected to have relatively modest budgets and short durations (two 
years or less).  A second model might have a complex plan of multiple targets 
requiring a sequence of interventions over a longer period (up to 4 years).  
A third project model would expand over time, adding additional targets or 
partners in a planned sequence over a period not to exceed 4 years.  The 
project models would support the inclusion of information technology (IT) as 
a tool to transmit evidence-based information, provide decision support for 
patients and providers, and support quality improvement initiatives in health 
care settings.   AHRQ is interested in projects from partner(s) who will 
disseminate and translate IT interventions with known efficacy into clinical 
practice. 

Projects requesting bioterrorism funds should address how the core 
partnership will be supplemented by set-aside funds in order to work with 
their members to improve health system preparedness for bioterrorism.

Partnership projects may target specific conditions or diseases, specific 
population or patient groups (for example, see Special Requirements, below), 
specific processes, specific care sites, specific components of quality or a 
combination of these.  Improvement grants may focus on priority health 
conditions, including cancer, diabetes, heart disease, chronic kidney 
disease, or respiratory disease, as well as priority health issues, including 
maternal and child health, mental health, long-term care and bioterrorism.  
Some of these priority conditions and priority issues will fall within the 
categories that will be  addressed by the National Health Care Quality Report 
currently under development.  The selection of these targets was 
conceptualized in a matrix presented in "Envisioning the National Health Care 
Quality Report."  The matrix includes specific components of health care 
quality adopted from the "Crossing the Quality Chasm" report including 
safety, effectiveness, patient-centeredness, and timeliness.  The matrix also 
includes consumer perspectives on health care needs, adapted from a variety 
of sources.  Consumer perspectives are categorized to include staying 
healthy, getting better, living with illness or disability, or coping with 
the end of life (6).  Applicants wishing to include projects related to 
bioterrorism preparedness should clearly identify the specific processes and 
settings that are being addressed as well as the populations under study.

Targeted population groups must be justified, with specific reference to the 
scientific literature, the IOM Chasm Report, or a similar foundation, such as 
analysis of data in the public domain.  Analysis of proprietary data not 
available for verification by others may be useful for planning, but would 
not be considered sufficiently robust, in the absence of other evidence, to 
justify selection of a target.  Justification should address the importance 
of the target as well as the evidence base supporting the relationship to 
outcome of the quality measure proposed, such as set out in the Guide to 
Clinical Preventive Services (7).

The interventions to be employed or tested must be selected and justified on 
the basis of published evidence of their success in analogous health care 
settings and with attention to what is known of the process of translation of 
research into practice.  The literature includes many discussions of these 
issues (for example, references 8 and 9).   Specific desired results of the 
interventions must be identified, together with a description of how results 
will be used to effect or consolidate changes in infrastructure, operations, 
and/or policy.  A rationale must be presented for the entire project that 
indicates exactly how the results are expected to occur–that is, relating the 
selected targets and interventions to the results in a logical way, 
incorporating available evidence.   Baseline measures must be provided or 
convincingly projected to be available in a reasonable time period, and the 
capability to measure results must be demonstrated.  The planning phase 
(Phase I) is expected to produce a detailed strategy for evaluation of the 
interventions in terms of their success and their long-term viability in the 
organization, and full baseline information if not provided in the 
application.  AHRQ wishes to draw from these projects evaluative information 
as to the context of the project (that is, the baseline or antecedent 
condition prior to the activities implemented to improve care, also referred 
to as "the intervention").

For supplemental projects to the core partnership, intended for the 
bioterrorism set-aside, a number of resources exist to design effective 
strategies to improve preparedness. Using available evidence for improvement, 
such as AHRQ's evidence reports on best methods for training clinicians and 
the role of information systems and decision support, as well as evidence 
from other Department of Health and Human Services initiatives, the Partners 
would be expected to improve clinical readiness for bioterrorism preparedness 
through collaborative activities, including:  

o evaluating and adapting models of effective training for front-line 
clinical staff; evaluation of regional models for system preparedness;
 
o reinforcing effective linkages between the health care system and the 
public health infrastructure to detect and respond to a bioterrorist event; 
examining health care system preparedness issues, such as surge capacity and 
workforce projections to meet needs; and 

o evaluating the role of information technology for providing critical real-
time clinical decision support information for front-line physicians and 
nurses.    

The Agency considers Partnership projects to require attention to the use of 
methods to motivate, recognize, reward, and support quality; broad 
participation in planning and evaluation efforts on the part of those 
directly or indirectly affected; sensitivity to local context (such as 
barriers at the micro level); collaborative work to identify and align the 
needs and capabilities of stakeholders; and system changes to sustain quality 
improvements.  Incentives based on payment policies are extensively discussed 
in the IOM Chasm Report (10).  
The use of specific tools or measures developed by AHRQ, or with AHRQ 
support, is strongly encouraged.  For example, to the extent that 
benchmarking and feedback are employed, AHRQ recommends consideration of the 
use of Achievable Benchmarks of Care (11).  Other examples are evidence 
reports, information available from the National Quality Measures 
Clearinghouse,  AHRQ quality indicators (Prevention Quality Indicators, 
Inpatient Quality Indicators, and Patient Safety Indicators), or CAHPS.  For 
information about these tools, applicants may consult the AHRQ Web site (see 
above) or contact AHRQ for programmatic assistance (see Where to Send 
Inquiries, below).

Project Organization.  Applicants must demonstrate sufficient organizational 
and technical capability and other resources and sufficient influence over 
practice to provide reasonable likelihood of succeeding in their stated aims 
and sustaining this success beyond the period of the grant.  Planned or 
ongoing efforts to improve quality of care must be described fully in terms 
of their current organizational underpinnings, committed resources, and 
changes envisioned under the grant.  The potential impact sought from a 
Partnership is significant improvement in quality of care for a substantial 
part of the population of the United States.  AHRQ is seeking projects that 
will, in aggregate, affect the quality of care of patients numbering in the 
hundreds of millions.  Prospective applicants should consider this aggregate 
aim in terms of what contribution they might make to that number as one of 
ten projects.

Evaluation, Reporting and Dissemination: AHRQ intends that funded projects be 
models, and as such yield information that may be useful to other 
organizations.  Evaluation relevant to an individual project must be a part 
of all plans, with an emphasis on acquiring information that will permit 
assessment and reporting of progress against approved aims as well as 
internal decisionmaking by the grantee and consortium members.  Cost and 
other resource dimensions must be addressed in evaluation at this level.  The 
application should also provide for cooperation with the coordinating 
committee in evaluation of the entire program. Otherwise, planning and 
conducting evaluation at the programmatic level is an AHRQ activity and is 
not part of the responsibilities of the projects, though advice and 
consultation will be sought from projects.   Dimensions to be addressed in 
evaluation at that level will be context (antecedent or baseline conditions); 
input (intentions and interests considered, including legislative mandates); 
process (implementation activities and the changes they themselves produced); 
and products, including unanticipated consequences.  AHRQ staff will be 
responsible for designing and steering that process, working with the 
projects as part of the Agency's programmatic responsibilities.  This in no 
way reduces the rights and responsibilities of grantees with respect to their 
individual projects. 

Information provided in the application and in progress reports that is 
designated as proprietary and damaging to the organization if publicly 
released will be protected, but an approach must be outlined for sharing 
information with other grantees in the course of the projects, collaborative 
activities with other projects with overlapping targets or similar 
interventions, and dissemination of useful information to the general public 
and to clinical and administrative decisionmakers in analogous circumstances.  
There must also be provisions for sharing with researchers sufficient data to 
verify published findings. 

Timetable.  In each year of the grant, the Agency will require a progress 
report on January 15.  Except in the final year of funding, a continuation 
request including a cumulative progress report will be due each June 1, and a 
third progress report will be required September 30.  (In the final year of 
funding, the June 1 submission will be a progress report but no continuation 
application, and no progress report will be due September 30, but a final 
report will be due 90 days after termination.)   The progress report will 
follow a format to be prescribed by AHRQ, but will include not only completed 
activities but plans for the remainder of that year and any changes foreseen 
in future year plans.  Projects that include set-aside bioterrorism funds 
will require a separate section of each progress report related to 
bioterrorism preparedness activities.     

The continuation application submitted during Phase I  for Phase II funding 
will be subjected to peer review to determine if adequate progress has been 
made toward achieving Phase I aims, as approved in the original application, 
or acceptable revisions of these aims (such revisions to be evaluated based 
on the review criteria published in this announcement, as applicable).  
Progress evaluation will include fulfillment of Awardee Rights and 
Responsibilities (see Special Requirements, below).  Reviews may or may not 
include site visits.  It is anticipated that not all Phase I awards may 
receive Phase II continuation awards, but continuation applications are 
noncompetitive, and there is no plan to reduce the number of Phase II 
grantees.  No continuation award will be denied without a site visit.   Phase 
II awards may be denied for inadequate progress in Phase I or if reduction or 
reallocation of resources is found by the Agency to be necessary.  Phase I 
grantees who do not receive Phase II awards will be invited to continue 
attending grantee meetings and may continue to receive technical assistance 
through Agency arrangements, depending on availability of resources.

During Phase II, the second progress report of each year (due June 1) is part 
of the continuation application.  It will summarize all progress for the year 
to date and provide updated and detailed plans for the next year.  It will be 
reviewed for progress against original or revised project aims and for 
cooperation in joint activities with the Agency and other Partners, such as 
attendance at meetings (see Awardee Rights and Responsibilities, under 
Special Requirements below).  As is the case in Phase I, these reviews will 
be noncompetitive; there is no plan to reduce the number of projects.  Unlike 
Phase I progress reports, Phase II progress reports will emphasize 
implementation rather than planning.  Formats for progress reports will be 
specified by AHRQ with assistance from such experts as it may choose and in 
consultation with the Principal Investigators.  If a project is terminated 
after Phase I, a final report will be required, but the grantee will be 
invited to continue to take part in meetings and receive technical 
assistance, subject to resource limitations. 

Budget and Related Issues.  Although no specific matching requirements are 
included in this RFA, these grants are seen as partnerships and as furthering 
and facilitating efforts already underway or in advanced stages of planning.  
Therefore it is expected that grantee organizations and consortia will devote 
substantial amounts of their own resources to this effort.  Collection of new 
data must be supported from these resources, though grant funds may be used 
for planning, instrument development, and analysis.  A coordinating 
committee, including the grantees, will meet approximately twice annually 
(see Special Requirements, below).  Dates and times will be established as 
far ahead as possible, and in consultation with PIs.   Budgets must take into 
account the obligation to attend these meetings, and provide the means for 
the grantee to host, at least one time in the course of the project, a one-
and-one-half day coordinating committee meeting.   Applications that include 
a project under the bioterrorism set-aside should also include in that budget 
the cost of attending one meeting of all bioterrorism project grantees.

MECHANISM OF SUPPORT

This RFA will use the cooperative agreement (U18) award mechanism under which 
the Principal Investigator retains the primary responsibility and dominant 
role for planning, directing, and executing the proposed project, with AHRQ 
staff being substantially involved as a partner with the Principal 
Investigator, as described under the section "Cooperative Agreement Terms and 
Conditions of Award."  This RFA is a one-time solicitation.  

FUNDS AVAILABLE

Partnerships:  The total amount requested in Phase I of an application may 
not exceed $100,000 for the Partnership (see below re supplemental funding 
for bioterrorism preparedness).  Up to 10 applications will be funded.  Phase 
II requests may be for an additional 1-3 years, with a suggested budget of 
$200,000 to $400,000 per year, depending on the scope of the project.  For 
example, an application that would correspond with the first of the three 
project models discussed above (under Project Objectives) would be expected 
to requested in the range of 2 years' total support, at a maximum of $100,000 
for the first year, and $200,000 for the second.

Continuation awards for subsequent years will be contingent on performance as 
reviewed each year.   Because the nature and scope of the proposed projects 
will vary from application to application, it is anticipated that the size 
and duration of each award will also vary.  Although the financial plans of 
AHRQ provide for support of  this program, awards pursuant to this RFA are 
contingent upon the availability of funds and the receipt of a sufficient 
number of meritorious applications.  There are no plans to reissue this RFA.  

Bioterrorism Preparedness Supplements:  Up to $1 million per year total costs 
will be set aside for Partnership supplements to enhance health system 
responsiveness to bioterrorism.  If the Partnership includes projects 
specifically related to bioterrorism preparedness, applicants may be eligible 
for $100,000 in Phase I funding through the set-aside funds.  Subsequent 
years of funding for the bioterrorism-related projects is anticipated to be 
$100,000 per year.

ELIGIBLE INSTITUTIONS

Your institution may submit an application if it has any of the following 
characteristics: (Individuals are not eligible applicants under this RFA.)

o   Domestic
o   Public or private institutions
o   For-profit or not-for-profit
o   Faith-based organizations

It is AHRQ's intention in funding these cooperative agreements to assist 
grantees in influencing directly the behavior of organizations and clinicians 
delivering health care to large numbers of patients.  For this reason, 
individual academic institutions are ineligible to be primary grantees, 
though they may serve as partners or as valuable members of consortia, 
including a consortium of academic medical centers providing health care to 
large numbers of people.   An important aim is to bring change to geographic 
areas larger than that of any single State; therefore, units of individual 
State or local governments may not apply except as members of consortia.   
Examples of the kinds of organizations AHRQ anticipates as applicants are 
given under Purpose, above.

Important Note:  Under recently enacted reauthorization legislation, AHRQ is 
authorized to enter into cooperative agreements with for-profit organizations 
as well as with public and not-for-
profit entities.  Thus, for-profit organizations are eligible to respond to 
this notice with applications for cooperative agreements.  Such applications 
will be administered in accordance with Subpart E of 45 CFR Part 74 and 42 
CFR Part 67 Subpart A.  The latter regulation has not yet been amended to 
reflect these changes in Agency name and authority.  (See December 6, 1999, 
AHRQ reauthorization at http://www.ahrq.gov/hrqa99a.htm).

Although eligible, for-profit organizations considering submission of an 
application should read carefully the Special Requirements section below 
concerning responsiveness and competitiveness, below.
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed project is invited to develop and submit application for 
support on behalf of an eligible applicant organization with which he or she 
is affiliated.  Individuals from underrepresented racial and ethnic groups as 
well as individuals with disabilities are always encouraged to apply for AHRQ 
programs.

SPECIAL REQUIREMENTS

Responsiveness and Competitiveness 

Although for-profit organizations are eligible to apply, in order to maximize 
numbers of patients affected, individual entities, the Agency encourages 
applications from consortia of insurers, employers, hospitals, or integrated 
delivery systems, rather than from individual entities, in order to maximize 
numbers of patients affected.  Also responsive  might be organizations such 
as pharmacy benefit managers or provider alliances handling such functions as 
purchasing and quality improvement, if they are influential and have strong 
and close affiliations with substantial numbers of care providers serving 
large numbers of patients. The Agency discourages commercial vendors, such as 
those purveying IT systems or continuing education, from applying except as 
members of consortia.

Terms and Conditions

These special Terms of Award are in addition to and not in lieu of otherwise 
applicable OMB administrative guidelines, HHS grant administration 
regulations at 45 CFR Parts 74 and 92, 42 CFR Part 67 Subpart A, and other 
HHS, PHS grants administration policy statements. Applicants should be 
familiar with the Agency''s grant regulations, 42 CFR Part 67 Subpart A, and 
particularly sections 67.18-67.22. 

Awardee Rights and Responsibilities

The awardee will conduct activities in accordance with the terms and 
conditions of the Notice of Grant Award, and cooperate with other key 
parties, including designated AHRQ program staff.  An overall coordinating 
committee will be formed, composed of PIs and AHRQ staff, with a subcommittee 
for projects that include bioterrorism preparedness.  The purpose of the 
coordinating committee is discussed in this section below.

Meetings of the coordinating committee will be held approximately twice each 
year (with the possible exception of year 1).  Time and place of meetings 
will be determined by AHRQ, consulting with and providing adequate notice to 
grantees.  PIs are required to attend these meetings; substitutes are not 
acceptable.  Meeting attendance and cooperation in collaborative efforts is 
an important measure of performance.  The meetings will be hosted either by 
AHRQ or by a grantee.  AHRQ may include in these meetings additional experts 
or staff of AHRQ or other Federal programs.  Grantees may request additional 
attendance by other key staff or collaborators.  Expenses for grantee meeting 
attendance will be paid from grant funds.     Telephone conferences with 
subsets of the coordinating committee may also be required from time to time.  
In working with the coordinating committee, PIs will actively participate in 
the formulation of plans to promote collaboration across projects and to 
respond as appropriate to new developments and findings from AHRQ activities.  

Other principles, rules, and organizational structure of the committee will 
be established by AHRQ in consultation with the grantees.

Within limits of available resources, AHRQ intends to provide for technical 
assistance regarding methods, tools, and strategies for use in planning, 
implementing, or evaluating the interventions, selecting additional targets 
or collaborators, or disseminating results.   

From time to time, developments and findings from other AHRQ activities may 
offer opportunities for amending project plans to incorporate new or 
different activities, either within an individual project or collaboratively 
between two or more projects.  AHRQ will work with grantees to effect such 
amendments.

The responsibility for planning, carrying out, and reporting on the activity 
resides with the awardee, but AHRQ Program Officials will be kept informed 
during the intervals between required progress reports when events of 
significance occur.  They will also be kept apprized of and, on request, 
invited to attend all planned project meetings as observers and resource 
people; provided with minutes of all such  meetings; and notified of all 
changes in project plans, together with the underlying rationales.  AHRQ may 
also wish to conduct an evaluation of the program as a whole, or to 
disseminate information on the combined experience of the several projects.  
Awardees are required to cooperate in such efforts even after completion of 
the grants.  To the extent that such cooperation has financial implications, 
suitable arrangements will be made by AHRQ.

Progress reports will be required January 15, June 1, and September 30 of 
each year; if the date falls on a Sunday, the due date will be the extended 
to Monday.  AHRQ, in consultation with the projects, will prescribe the 
format for progress reports.  The report due June 1 will be part of the 
annual continuation application, except in the final year of the project 
period.  The final report of the final year of the project will be due within 
90 days of termination; instructions and format for that report will be 
provided during the project's final year.

Based on periodic review of grantee progress, awards may be terminated in 
cases of documented under-performance, lack of participation in collaborative 
activities (such as nonattendance at meetings), or human subject ethical 
issues where the awardee has been given adequate notification about 
performance and failed to take corrective actions.  

AHRQ Staff Responsibilities

The cooperative agreement (U18) is an "assistance" mechanism (rather than an 
"acquisition" mechanism) in which substantial AHRQ scientific and/or 
programmatic involvement with the awardee is anticipated during performance 
of the activity.  Under the cooperative agreement, the AHRQ purpose is to 
support and/or stimulate the recipient's activity by involvement in and 
otherwise working jointly with the award recipient in a partner role, but it 
is not to assume direction, prime responsibility, or a dominant role in the 
activity.  Cooperative activities are intended to strengthen individual 
projects and at the same time  generate collaboration across projects.  AHRQ 
involvement will include an advisory and technical assistance  role in 
prioritization of targets and choice of interventions.  In addition to 
monitoring performance of the projects and providing technical assistance, 
one AHRQ staff aim will be to bring about uniformity in measurement and 
definitions, where there are similarities among project targets.  Another 
will be to encourage and facilitate incorporation of new AHRQ findings and 
tools into project activities, when appropriate.  An additional aim will be 
to synthesize, through project reporting and results and through interaction 
with project staff at coordinating committee meetings and on other occasions, 
a broad set of evaluative findings and "lessons learned" to guide future 
work.  Annual meetings, as discussed under Awardee Rights and 
Responsibilities above, will be designed to further such aims.

Coordinating Committee

The purpose of the coordinating committee is to facilitate collaboration 
among projects.  Among other activities, it is intended to develop uniformity 
in measures among projects with similar targets or interventions; share 
information about barriers and successes; facilitate technical assistance; 
and further evaluation within and across projects.  As discussed above, 
details of structure and process not specified in this RFA will be worked out 
among participants during Phase I of the projects.
Arbitration
 
Any disagreement that may arise on scientific/programmatic matters (within 
the scope of the award), between award recipients and AHRQ may be brought to 
arbitration. An arbitration panel will be composed of three members -- one 
selected by the individual awardee, a second member selected by AHRQ, and the 
third member selected by the two prior selected members. This special 
arbitration procedure in no way affects the awardee's right to appeal an 
adverse action that is otherwise appealable in accordance with the PHS 
regulations at 42 CFR Part 50, Subpart D and HHS regulation at 45 CFR Part 
16.

Priority Populations

The Agency's authorizing legislation (refer to http://www.ahrq.gov/hrqa99a.htm) 
directs special attention in Agency programs to populations of inner-city areas 
and rural areas (including frontier areas); low income groups; minority groups;
women; children; the elderly; and individuals with special health care needs, 
including individuals with disabilities and individuals who need chronic care 
or end-of-life health care.  Applications under this RFA should address
attention to and potential benefits for these priority populations. 

Publication Transmittal: General AHRQ Requirements

In keeping with the Agency's efforts to translate the results of AHRQ-funded 
research into practice and policy, grantees and/or contractors are to inform 
the AHRQ Office of Health Care Information (OHCI) when articles from their 
studies are accepted for publication in the professional literature.  
Grantees and contractors should also discuss other dissemination and 
marketing efforts with staff of the Agency's Office of Health Care 
Information.  The intent is by no means to discourage or delay such efforts, 
but to facilitate their coordination with other Agency activities.   The 
Agency wishes  to maximize awareness and application of the results by 
potential users, including clinicians, patients, health care systems and 
purchasers and policymakers.  This is critical when outreach to the general 
and trade press is involved.  Contact with the media should take place in 
close coordination with OHCI and the press offices of the grantee's or 
contractor's institutions.  In cases when products are created (such as Web-
based tools, CD-ROMs, "best practices," or "lessons learned"), grantees and 
contractors may be asked to submit to OHCI a brief plan describing how the 
product will be publicized.  Agency staff may elect to have a cooperative 
role in furthering and coordinating these plans.

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this RFA and welcome the opportunity 
to answer questions from potential applicants.  Inquiries may fall into four 
areas: programmatic, programmatic involving bioterrorism readiness, peer 
review, and financial or grants management issues:

o   Direct your questions regarding programmatic issues, including 
information on the inclusion of women, minorities, and children in study 
populations to:
 
Mary Cummings
Center for Outcomes and Effectiveness Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Room 300
Rockville, MD 20852
Telephone: 301, 594-2417
Fax: 301, 594-3211
email: mcumming@ahrq.gov

OR

Margaret Coopey
Center for Practice and Technology Assessment
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Room 300
Rockville, MD  20852
Telephone:  (301) 594-4022
FAX: (301) 594-4027
Email: mcoopey@ahrq.gov

OR

Marge Keyes
Center for Quality Improvement and Patient Safety
6011 Executive Boulevard, Room 200
Rockville, MD 20852
Telephone: (301) 594-1824
FAX: (301) 594-2155
Email: mkeyes@ahrq.gov 

(Alternate for Marge Keyes: Elinor Walker, CquIPS, telephone: (301) 594-2049, 
Fax: (301) 594-2155, Email: ewalker@ahrq.gov)

o Direct your questions about programmatic issues having to do with 
bioterrorism readiness to:

Sally Phillips, RN, PhD
Center for Primary Care Research
Agency for Healthcare Research and Quality
6010 Executive Boulevard, Room 200
Rockville, MD 20852
Telephone: (301) 594-6491
FAX: (301) 594-3721
Email: sphillip@ahrq.gov 

o Direct your questions about programmatic issues having to do with 
incentives to:

Michael Hagan, PhD
Center for Organization and Delivery Services
Agency for Healthcare Research and Quality
2101 E. Jefferson St.
Rockville, MD 20852
Telephone: (301) 594-6818
FAX: 301, 594-2314  
Email: mhagan@ahrq.gov 

o   Direct your questions about peer review issues to:

Joan Hurley, MHS, JD
Office of Research Review, Education and Policy
Agency for Healthcare Research and Quality
Suite 400
Rockville, MD  20852
Telephone:  (301) 594-6075
FAX: (301) 594-0154
Email: jhurley@AHRQ.gov

o   Direct your questions about financial or grant management matters to:

Al Deal
Grants Management Specialist
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Suite 601
Rockville, MD  20852
Telephone: (301) 594-1843
FAX: (301) 594-3210
Email: adeal@AHRQ.gov

LETTER OF INTENT

Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o   Descriptive title of the proposed research
o   Name, address, and telephone number of the Principal Investigator       
o   Names of other key personnel
o   Participating institutions
o   Number and title of this RFA

Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows Agency staff to estimate the potential review workload and 
plan the review.

The letter of intent is to be sent by the date listed at the beginning of 
this document.  The letter of intent should be sent to:

Pat Thompson, PhD
Director, Division of Scientific Review
Agency for Healthcare Research and Quality
2101 East Jefferson Street, Room 400
Rockville, MD  20852
Telephone:  (301) 594-1404
FAX: (301) 594-0154
Email: pthompso@AHRQ.gov

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and form (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone 301-435-0714, 
Email: GrantsInfo@nih.gov.

State and local government entities applying as members of consortia with 
other organizations, are entitled to use PHS 5161-1, Application for Federal 
Assistance (rev. 5/96), and follow those requirements for copy submission.  
To ensure equity among applicants, however, applicants using this form must 
observe page number and font size requirements specified in the Form PHS 398.  
AHRQ encourages use of Form PHS 398 in preference to Form 5161-1.  

USING THE RFA LABEL: The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  Failure to use this label 
could result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA title 
and number must be typed on line 2 of the face page of the application form 
and the YES box must be marked.  The RFA label is also available at:
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.

SUPPLEMENTAL INSTRUCTIONS:  Applicants are encouraged to make use of AHRQ'S 
Healthcare Cost and Utilization Program.  The HCUP includes databases 
covering 1988-1997, with 1998 and 1999 data available in 2001. These all-
payer databases were created through a Federal- State-industry partnership to 
build a multistate healthcare data system. The main HCUP databases contain 
discharge-level information for inpatient hospital stays in a uniform format 
with privacy protections. The Nationwide Inpatient Sample (NIS) is a 
nationwide probability sample for about 1000 hospitals. The State Inpatient 
Databases (SID) contain inpatient records for all community hospitals in 22 
states. Other HCUP databases contain ambulatory surgery data from nine 
states. These databases can be directly linked to county-level data from the 
Health Resources and Services Administration's Area Resource File and to 
hospital-level data from the Annual Survey of the American Hospital 
Association. 

Format of the Application Narrative.  Standard instructions for Form PHS 398, 
which refer to a "research plan," should be disregarded.    The sections of 
an application narrative for these projects are as follows: (1) Background, 
Significance and Rationale, addressing the problem or target to be addressed, 
its importance, and the logic of the proposal, with reference to scientific 
evidence as appropriate, a brief statement of the methods to be used to bring 
about improvement, and evidence supporting selection of these methods, with 
use of diagrams if appropriate; (2) Specific Aims, in which the aims, 
approach, and rationale are presented; (3) Methods and Timeline, expanding on 
the Specific Aims, indicating what will be done and in what sequence, 
barriers anticipated and plans for overcoming them, a timetable for the 
project indicating activities to take place in Phase I and subsequent 
phase(s) and results anticipated, keyed to reporting intervals; (4) Project 
Organization, indicating the qualifications of the organizations, discussion 
of past or ongoing quality improvement initiatives, future plans for 
creating, strengthening, or expanding partnerships, the way in which 
participants (organizations and individuals) will interact, and how decisions 
will be made; (5) Inclusion of Minority, Female, and Other AHRQ Priority 
Populations, as discussed in Special Requirements, above;  (6) Human 
Subjects, addressing the protections that will be instituted to preserve 
privacy of patients and confidentiality of their medical information, to 
disclose to patients any deviation from standard care that may confer risk,  
and to guard patients from consequent injury or harm.
 
SENDING AN APPLICATION TO NIH & AHRQ:  Submit a signed original of the 
application, including the checklist, and three signed photocopies in one 
package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040 - MSC 7710
Bethesda, MD  20892-7710
(20817 for express/courier service)
 
At the time of submission, two additional copies of the application, labeled 
"Advance Copy" must also be sent to:

Marge Keyes
Center for Quality Improvement and Patient Safety
6011 Executive Boulevard, Room 200
Rockville, MD 20852
Telephone: (301) 594-1824
FAX: (301) 594-2155
Email: mkeyes@ahrq.gov 

APPLICATION PROCESSING:   Applications must be received by the receipt dates 
listed in the heading of this RFA.  If an application is received after that 
date, it will be returned to the applicant without review.  The CSR and AHRQ 
will not accept any application in response to this RFA that is essentially 
the same as one currently pending initial review unless the applicant 
withdraws the pending application.  The CSR and AHRQ will not accept any 
application that is essentially the same as one already reviewed.  This does 
not preclude the submission of substantial revisions of applications already 
reviewed, but such applications must include an Introduction addressing the 
previous critique.

Applicants are encouraged to read all PHS Forms 398 instructions prior to 
preparing an application in response to this RFA.  The PHS 398 type size 
requirements (p.6) will be enforced rigorously and non-compliant applications 
will be returned.  State and local government applicants may use PHS 5161-1, 
Application for Federal Assistance (rev. 5/96), and follow those requirements 
for copy submission.  It is very important to note that limitations on number 
of pages and size of font must be observed; applications violating these 
requirements will be returned without review.

Beginning with applications for AHRQ submitted for the February 1, 2001 
receipt date, Institutional Review Board (IRB) approval of human subjects is 
not required prior to peer review of an application unless otherwise 
indicated by the Agency 
(http://grants.nih.gov/grants/guide/notice-files/NOT-HS-00-003.html.)
However, given the nature of this project and the speed with 
which successful applicants will need to begin work, IRB approval prior to 
review will facilitate subsequent processing of awards to successful projects 
and avoid delays in beginning project activities.  All applicants should pay 
particular attention to the instructions in the form PHS 398 regarding human 
subject involvement.

The RFA is also available on AHRQ's Web site, http://www.AHRQ.gov, (under 
Funding Opportunities) and through AHRQ InstantFAX at (301) 594-2800.  To use 
InstantFAX, you must call from a facsimile (FAX) machine with a telephone 
handset.  Follow the voice prompt to obtain a copy of the table of contents, 
which has the document order number (not the same as the RFA number).  The 
RFA will be sent at the end of the ordering process.  AHRQ InstantFAX 
operates 24 hours a day, 7 days a week.  For comments or problems concerning 
AHRQ InstantFax, please call (301) 594-6344.

In carrying out its stewardship of funded programs, the AHRQ may request 
information essential to an assessment of the effectiveness of Agency 
programs.  Accordingly, grant recipients are hereby notified that they will 
be asked for periodic updates on publications resulting from AHRQ grant 
awards, and other information AHRQ requires in order to evaluate the impact 
of AHRQ-
sponsored projects.

AHRQ expects grant recipients to keep the Agency informed of publications as 
well as the known uses and impact of their Agency-sponsored work.  Applicants 
are to agree to notify AHRQ immediately when a manuscript based on work 
supported by the grant is accepted for publication, and to provide the 
expected date of publication as soon as it is known, regardless of whether or 
not the grant award is still active. 

To receive an award, applicants must agree to submit an original and 2 copies 
of an abstract, executive summary, and full report of the results in the 
format prescribed by AHRQ no later than 90 days after the end of the project 
period.  The executive summary should be sent at the same time on a computer 
disk which specifies on the label the format used (WP5.1 or WP6.0 is 
preferable).

CMS Data
 
Projects will ordinarily not use CMS (Medicare or Medicaid) data involving 
individual identifiers.   Purchase of CMS public-use data, if required, 
should be discussed in the application narrative and included in the budget.

PEER REVIEW PROCESS

Upon receipt, applications will be reviewed for completeness and  
responsiveness to the RFA.  Incomplete and/or non-responsive applications or 
applications not following instructions given in this RFA will be returned to 
the applicant without further consideration.  Applications that fail to 
observe instructions in Form PHS 398 as to numbers of pages and font size 
will be returned in this way.  Applications that are complete and responsive 
to the RFA will be evaluated for scientific and technical merit by an 
appropriate peer review group convened in accordance with standard AHRQ peer 
review procedures.    

As part of the merit review, all applications will:

o   Receive a written critique
o   Undergo a process in which only those applications deemed to have the 
highest technical merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score. 

REVIEW CRITERIA

The goals of this RFA are to improve quality of care for large numbers of 
people in a measurable, broad, and lasting way, and to establish and assess 
models for achieving further improvements.  In the written comments, 
reviewers will be asked to discuss the following aspects of your application 
in order to judge the likelihood that the proposed project will have a 
substantial impact on the pursuit of these goals:

o   Significance
o   Approach
o   Organizational Strength and Commitment
o   Project Leadership and Staff
o   Environment 
o   Budget

The technical review group will address and consider each of these criteria 
in assigning your application's overall score, weighting them as appropriate 
for each application.  Your application does not need to be strong in all 
categories to be judged likely to have a major impact and thus to deserve a 
high priority score. 
 
(1) SIGNIFICANCE: Does the application target an important problem?  If the 
aims of the application are achieved, do they have the potential to effect 
improvement in quality of care?  What will be the effect of this work on 
other aspects of quality of care for other diseases, conditions, settings, or 
populations?  To what extent will this work result in improved outcomes for 
important diseases or conditions and/or improved safety, quality, security 
and health status for a large proportion of the U.S. population?  In terms of 
the AHRQ aim for this program of affecting health care for hundreds of 
millions of people, will this project as one of ten funded contribute a 
reasonable share to that aggregate number.  For supplemental bioterrorism 
projects, is the proposed work likely to result in enhanced preparedness for 
a significant sector of the health care system?

(2) APPROACH:  Are targeted conditions/populations well defined and selected?  
Are the rationale, preliminary plans, interventions, evaluation, and 
dissemination plans or preliminary plans adequately described, suitably 
evidence-based, technically sound, well integrated, and appropriate to the 
aims of the project?  Does the application acknowledge potential problem 
areas and consider alternative tactics?   Do the interventions make sense 
from the perspective of the interests and motivations of stakeholders?  Are 
incentives (monetary or nonmonetary) appropriately aligned to achieve the 
aims?

(3) ORGANIZATIONAL STRENGTH AND COMMITMENT:   Does the application provide 
evidence that the applicant has sufficient influence, experience, and 
resources to carry out the proposed interventions? Is there thorough and 
convincing documentation of the commitment of Partnership members to perform 
the roles indicated in the application? Are the resources proposed for 
investment in the effort by the applicant organization sufficient to show 
serious commitment?   If multiple organizations or groups are involved, is 
there a history of similar collaborative activities among these 
organizations, or between these organizations and others?  If development of 
partnerships with other organizations is among the aims of the project, are 
realistic plans described to accomplish this intent?  Is this effort part of 
an ongoing effort to improve health care quality, or is there other evidence 
that the organization or consortium has a history of successful efforts in 
quality improvement? Are there adequate provisions and capabilities to 
involve all stakeholder groups in planning, implementation, and evaluation of 
these efforts?   Are adequate mechanisms in place or proposed to conduct 
studies of costs and benefits that will affect sustainability and 
institutionalization of the effort?  For supplemental bioterrorism projects, 
can the organization(s) demonstrate a prior commitment to improving 
bioterrorism preparedness?  How will the organizations use their 
organizational strength and commitment to improve preparedness for 
bioterrorism?

(4) PROJECT LEADERSHIP AND STAFF:  Are the Principal Investigator and other 
designated staff appropriately trained and experienced and well suited to 
carry out the proposed work?  Is the Principal Investigator in a strong 
position to influence the policies and activities of the applicant 
organization?  Is an appropriate array of skills represented for all the aims 
and for evaluation and dissemination?  Are time commitments sufficient to 
accomplish the aims?  Are roles clearly delineated and complementary?  

(5) ENVIRONMENT:  Will  the health care  environment in which the proposed 
work will be done contribute to the probability of success? Do the proposed 
interventions take advantage of unique features of the health care and 
medical practice environment or employ useful collaborative arrangements?  Is 
there evidence of institutional support?  Are participant organizations 
investing their own resources sufficiently to show commitment and the 
likelihood of sustained improvement?  Are stakeholders, including 
institutions, clinicians, patients, and the wider community, adequately 
involved in planning, carrying out, and evaluating the quality improvement 
activities proposed?  For supplemental bioterrorism projects, the partners 
should demonstrate how their work will complement ongoing state and federal 
initiatives to improve preparedness.

(6) BUDGET: Is the budget appropriate to the work proposed?  Are suitable 
amounts included for travel to attend two Rockville meetings per year (and to 
host one meeting in one year)?  Are data collection activities apportioned 
according to instructions, with the grant to support only planning, 
development, and analysis?  Are dedicated grantee resources sufficient to 
ensure commitment on the part of key participants?  For supplemental 
bioterrorism projects, can the partners justify the additional use of 
resources for a focused activity related to bioterrorism preparedness that is 
distinct from other core partnership activities?

ADDITIONAL REVIEW CRITERIA:  In addition to the above criteria, the 
application will also be reviewed with respect to the following:

o   PROTECTIONS:  The adequacy of the proposed protection for humans, in 
terms of protecting privacy, disclosing risk, obtaining informed consent, and 
guarding against harm or injury.  If applicable, the adequacy of protection 
for the environment, to the extent it may be adversely affected by the 
project proposed in the application.

o   INCLUSION:  The adequacy of plans to address the needs of both genders, 
all racial and ethnic groups (and subgroups), and children as appropriate for 
the aims of the project.  Adequacy of attention to other populations of 
special priority to AHRQ (see discussion on Priority Populations in the 
sec6tion on Special Requirements, above, and Inclusion Criteria included in 
the section on Agency policies and Requirements, below.) 

DATA SHARING

Data Confidentiality

Pursuant to section 924(c) of the Public Health Service Act (42 USC 299c-
3(c)), information obtained in the course of any AHRQ supported-study that 
identifies an individual or entity must be treated as confidential in 
accordance with any explicit or implicit promises made regarding the possible 
uses and disclosures of such data.  There are now civil monetary penalties 
for violation of this confidentiality statute. [42 U.S.C.299c-3(d))  In the 
Human Subjects section of the application, applicants must describe 
procedures for ensuring the confidentiality of the identifying information to 
be collected.  The description of the procedures should include a discussion 
of who will be permitted access to the information, both raw data and machine 
readable files, and how personal identifiers and other identifying or 
identifiable data will be restricted and safeguarded. 

Identifiable patient health information collected by grantees under this RFA 
will also be managed in accordance with 42 CFR Parts 160 and 164, federal 
regulations pertaining to the privacy of patient-related health information.  
These privacy regulations, developed by the Department of Health and Human 
Services pursuant to the Health Insurance Portability and Accountability Act 
of 1996 (HIPAA), are scheduled to be effective and enforceable in April 2003.  
These regulations serve to limit the disclosure of personally identifiable 
patient information and define when and how such information can be 
disclosed.  Thus, for example, health care plans and providers will require 
either patient authorization of disclosures of identifiable information to be 
made to researchers who are not their health care providers or waivers of 
such authorizations obtained from an IRB or Privacy Board (defined in the 
regulations) upon being satisfied that any identifiable health information 
will be appropriately safeguarded by the investigators.  Additional 
information about the regulations and their implementation can be obtained 
from: http://www.aspe.hhs.gov/admnsimp/

The awardee should ensure that computer systems containing confidential data 
have a level and scope of security that equals or exceeds those established 
by the Office of Management and Budget (OMB) in OMB Circular No. A-130, 
Appendix III - Security of Federal Automated Information Systems.  The 
National Institute of Standards and Technology (NIST) has published several 
implementation guides for this circular.  They are: An Introduction to 
Computer Security: The NIST Handbook; Generally Accepted Principals and 
Practices for Securing Information Technology Systems; and Guide for 
Developing Security Plans for Information Technology Systems.  The circular 
and guides are available on the web at
http://csrc.nist.gov/publications/nistpubs/800-12/.  The applicability and 
intended means of applying these confidentiality and security standards to 
subcontractors and vendors, if any, should be addressed in the application.

Rights in Data

AHRQ grantees may copyright unless otherwise provided in grant awards, or 
seek patents, as appropriate, for final and interim products and materials 
including, but not limited to, methodological tools, measures, software with 
documentation, literature searches, and analyses, which are developed in 
whole or in part with AHRQ funds.  Such copyrights and patents are subject to 
a worldwide irrevocable Federal government license to use and permit others 
to use these products and materials for government purposes.  In accordance 
with its legislative dissemination mandate, AHRQ purposes may include, 
subject to statutory confidentiality protections, making project materials, 
data bases, results, and algorithms available for verification or replication 
by other researchers; and subject to AHRQ budget constraints, final products 
may be made available to the health care community and the public by AHRQ or 
its agents, if such distribution would significantly increase access to a 
product and thereby produce public health benefits.  Ordinarily, to 
accomplish distribution, AHRQ publicizes research findings but relies on 
grantees to publish research results in peer-reviewed journals and to market 
grant-supported products.  AHRQ's Office of Health Care Information wishes to 
be consulted in advance of publication in order to coordinate these issuances 
with other AHRQ dissemination activities.

Important legal rights and requirements applicable to AHRQ grantees are set 
out or referenced in the AHRQ's grants regulation at 42 CFR Part 67, Subpart 
A (Available in libraries and from the GPO's website 
http://www.access.gpo.gov/nara/cfr/index.html).

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date: June 20, 2002
Application Receipt Date: July 17, 2002
Peer Review Date: September 2002
Earliest Anticipated Start Date: September 30, 2002

AWARD CRITERIA

In making decisions about awards, AHRQ will take into account funds 
available; technical merit as determined by scientific peer review; potential 
impact (numbers of patients or size of population, disease burden reduced, 
breadth of geographic area); geographic balance; and balance in targets, 
types of approaches, or change agents.

REQUIRED FEDERAL CITATIONS

INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN STUDY POPULATIONS:   It is 
the policy of AHRQ that women and members of minority groups be included in 
all AHRQ-
supported projects involving human subjects, unless a clear and compelling 
rationale and justification are provided that inclusion is inappropriate with 
respect to the health of the subjects or the purpose of the project.

All applicants proposing projects involving human subjects should read the 
updated "NIH Guidelines on the Inclusion of Women and Minorities as Subjects 
in Clinical Research," published in the NIH Guide for Grants and Contracts on 
August 2, 2000 (http://grants.nih.gov/grants/guide/notice-files/not-od-00-048.html).
A complete copy of the updated Guidelines is available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_update.htm.  To the 
extent possible, AHRQ requires adherence to these NIH Guidelines.

Applicants  may obtain copies from the above sources or from the AHRQ 
Publications Clearinghouse, listed under INQUIRIES, or from the NIH Guide Web 
site http://grants.nih.gov/grants/guide/index.html.  AHRQ Program staff may 
also provide additional information concerning these policies (see 
INQUIRIES).

AHRQ also encourages investigators to consider including children in study 
populations, as appropriate.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT:  The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  If no Federal act is taken, having the force and effect of 
law, in reliance upon an AHRQ supported research project, the underlying data 
is not subject to this disclosure requirement and under FOIA, 5 USC 552(b), 
disclosure of identifiable data from such study is exempted from disclosure 
under "the (b)(3) exemption."  It is important for applicants to understand 
the scope of this requirement and its limited potential impact on data 
collected with AHRQ support. Proprietary data might also be exempted from 
FOIA disclosure requirements under "the (b)(4) exemption", for example, if it 
constituted trade secrets or commercial information. However, courts have 
generally not regarded a researcher's interest in "his" data as proprietary.  
NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.  Should 
applicants wish to place data collected under this RFA in a public archive, 
which can provide protections for the data (e.g., as required by the 
confidentiality statute applicable to AHRQ supported projects, 42 U.S.C. 
299c-3(c)) and manage the distribution of non-identifiable data for an 
indefinite period of time, they may.  The application should include a 
description of any archiving plan in the study design and include information 
about this in the budget justification section of the application.  In 
addition, applicants should think about how to structure informed consent 
statements and other human subjects procedures given the potential for wider 
use of data collected under this award.  

HEALTHY PEOPLE 2010:  The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of "Healthy 
People 2010," a PHS-led national activity for setting health improvement 
priorities for the United States.  AHRQ encourages applicants to submit grant 
applications with relevance to the specific objectives of this initiative.  
Potential applicants may obtain a copy of "Healthy People 2010" at 
http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of 
Federal Domestic Assistance, Number 93.226.  Awards are made under Title IX 
of the Public Health Service Act (42 USC 299-299c-7) as amended by P.L. 106-
129 (1999).  Awards are administered under the PHS Grants Policy Statement 
and Federal Regulations 42 CFR 67, Subpart A, and 45 CFR Parts 74 or 92.  
This program is not subject to the intergovernmental review requirements of 
Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a 
smoke-free workplace and promote the non-use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care or early childhood 
development services are provided to children.  This is consistent with the PHS 
mission to protect and advance the physical and mental health of the American 
people.

REFERENCES
1.   Institute of Medicine, 2000.  Crossing the Quality Chasm: A New Health 
System for the 21st Century.  Washington, DC: National Academy of Sciences.

2.   Davis DA, Thomson MA, Oxman AD, Haynes RB (1995, Sep 6). Changing 
physician performance. A systematic review of the effect of continuing 
medical education strategies.  JAMA. 274(9):700-5. 

3.   Eisenberg JM (2001). The Agency for Healthcare Research and Quality and 
the U.S. Preventive Services Task Force. Public support for translating 
evidence into prevention practice and policy. American Journal of Preventive 
Medicine, 20 (3S): 1-2.

4.   Thomas MA, Oxman AD, Davis DA, Haynes RB (1998).  Audit and feedback to 
improve health professional practice and health care outcomes (Parts I and 
II): The Cochrane Library. 

5.   Soumerai SB, McLaughlin TJ, Gurwitz JH, and others (1998).  Effect of 
local medical opinion leaders on quality of care for acute myocardial 
infarction: a randomized controlled trial.  JAMA 179 17:1358-63.

6.   Institute of Medicine (2001).  Envisioning the National Health Care 
Quality Report.   Washington, D.C.: National Academy of Sciences, pages 58 
and 61).

7.   U.S. Preventive Services Task Force (1996).  Guide to Clinical 
Preventive Services, Second Edition.   Washington, D.C.: U.S. Department of 
Health and Human Services, available on the Web at 
http://www.ahrq.gov/clinic/uspstfix.htm#review). 

8.   Grol R (2001).  Improving the Quality of Medical Care: Building Bridges 
Among Professional Pride, Payer Profit, and Patient Satisfaction, 2001 
November, JAMA 286(20): 2578-2691. 

9.   Rogers, EM (1983).  Diffusion of Innovations, New York, The Free Press.

10.  IOM, Crossing the Quality Chasm, Chapter 8, pp. 193-219.

11.  Allison J, Kiefe CI, Weissman NW (1999, Jan.).   Can data-driven 
benchmarks be used to set the goals of Healthy People 2010?  Am J Public 
Health, 89(1):61-5.  See also, on the Website for Healthy People 2010, the 
ABC toolkit: http://www.health.gov/healthypeople/state/toolkit. 

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