LIMITED COMPETITIVE CONTINUATION FOR AHRQ CENTERS FOR EDUCATION AND RESEARCH 
ON THERAPEUTICS PROGRAM

RELEASE DATE:  May 8, 2003

RFA:  HS-03-002

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

CFDA:  Number 93.226

LETTER OF INTENT RECEIPT DATE:  June 16, 2003

APPLICATION RECEIPT DATE:  July 15, 2003

THIS RFA CONTAINS THE FOLLOWING INFORMATION:

o   Purpose of this Limited Competing Continuation
o   Research Objectives
o   Mechanism of Support
o   Funds Available 
o   Eligible Institutions
o   Special Requirements
o   Where to Send Inquiries
o   Submitting an Application
o   Peer Review Process
o   Review Criteria
o   Receipt and Review Schedule
o   Award Criteria
o   Required Federal Citations  

PURPOSE OF THIS LIMITED COMPETING CONTINUATION RFA

The Agency for Healthcare Research and Quality (AHRQ) announces the 
availability of limited competitive continuation funds for awards to existing 
Centers for Education and Research on Therapeutics (CERTs) whose initial 
funding commenced in 2000.  The purpose of these awards is to allow these 
grantees to build on their current work in progress and to expand the work 
to: (a) develop and implement educational strategies focused on translating 
the most promising findings of current work into everyday practice; (b) 
address existing gaps within the overall CERTs program including 
pharmacoeconomics, cost effectiveness analyses, and education; (c) enhance 
the work of the CERTs, consistent with the AHRQ patient safety agenda; and 
(d) develop additional projects within each center's overarching center theme 
that was previously determined to be complementary to AHRQ research 
priorities and responsive to the needs and goals of programs of the 
Department of Health and Human Services (DHHS), as discussed below.  This 
program began with the release of RFA: HS-99-004 on January 27, 1999, and the 
subsequent award of grants pursuant to the Food and Drug Administration 
Modernization Act of 1997 which authorized the AHCPR (now AHRQ), in 
coordination with FDA, to carry out a demonstration program to conduct 
research and provide objective information on drugs, biologics, and devices.  
AHRQ continues to manage this program under the Agency's reauthorizing 
legislation, P.L. 106-129, enacted in December 1999.

The program's legislative mandate is to "conduct state-of-the-art research to 
increase awareness of:  (1) new uses of drugs, biological products, and 
devices; (2) ways to improve the effective use of drugs, biological products, 
and devices; and (3) risks of new uses and risks of combinations of drugs and 
biological products."  Further, the legislation directs "CERTs to provide 
objective clinical information to the following individuals and entities:  
(1) health care practitioners and other providers of health care goods or 
services; (2) pharmacists, pharmacy benefit managers and purchasers; (3) 
health maintenance organizations and other managed health care organizations; 
(4) health care insurers and governmental agencies; and (5) patients and 
consumers."  Additionally the centers are to "investigate various ways to 
improve the quality of health care while reducing the cost of health care 
through an increase in the appropriate use of drugs, biological products, and 
devices and the prevention of adverse effects of drugs, biological products, 
and devices and the consequences of such effects, such as unnecessary 
hospitalizations."  Finally, the CERTs will "conduct research on the 
comparative effectiveness, cost-effectiveness, and safety of drugs, 
biological products, and devices."

CERTs is an ongoing multi-year program that supports research demonstration 
centers. The CERTs program is mandated by Congress.  Because the existing 
CERTs recipients possess the infrastructure, leadership, organization, and 
multidisciplinary research objectives to enable them to build on the existing 
work to address existing gaps and to develop additional projects, and because 
continuity in the research is necessary, this will be a limited competition.  
In addition, ongoing evaluation of the CERTs demonstration activities require 
that a longer period of funding be in place for the current awardees in order 
to determine the appropriate structure for the permanent Agency program.  
Detailed information on the program can be obtained at 
http://www.ahrq.gov/clinic/certsovr.htm.

RESEARCH OBJECTIVES

Background

The Centers for Education and Research on Therapeutics (CERTs) program is a 
national initiative to increase awareness of the benefits and risks of new, 
existing, or combined uses of therapeutics (defined as drugs, biologics and 
medical devices) through education and research. The CERTs concept grew out 
of recognition that physicians need more information about the therapies they 
prescribe.  Although information is available through the private industry 
sponsored programs, continuing medical education programs, professional 
organizations, and peer-reviewed literature, comparative information about 
the risks and benefits of new and older agents, and about drug interactions 
is limited. 

The mission of the CERTs program is to provide objective, scientific 
information on the safe and effective use of therapeutics.  The CERTs 
research centers (RC), Coordinating Center (CC), and Steering Committee (SC) 
work together to achieve these goals.

The vision of the CERTs program is to become a trusted national resource for 
people seeking information about medical products.  This is being 
accomplished through research and education by first developing knowledge and 
then sharing it with people who can use it to manage risk, improve practice, 
and inform policies.  CERTs centers have participated in 100 projects to 
date, extending along broad spectra of research and educational efforts.

Along the research spectrum, CERT center projects have included purely 
descriptive research, interventional research, and applied research.  This 
represents a logical progression.  Similarly, educational efforts have 
reflected a spectrum of efforts, including development of teaching modules, 
seminar presentations, fellowship programs, Internet-based materials, and 
one-on-one consultations for caregivers, policy-makers, regulators, and 
patients.

The major objective of each center is to develop priorities for education and 
educational research in therapeutics, within its own "theme", a broadly 
defined therapeutics research area, such as therapeutics used within a 
particular type of health care setting or population.  Guidance in developing 
these priorities, within the context of the missions of AHRQ and FDA, are 
listed below under the section on Special Review Criteria.  The center will 
develop demonstration or pilot educational programs that meet these criteria 
and explain how these projects fit within a comprehensive plan to improve the 
use of therapeutics.  Each center should develop objective, measurable, 
educational goals within its therapeutic theme.  Each center should address 
its field as a whole and identify current and future goals.

Each center should also address the critical issues of medical errors and 
patient safety.  The Institute of Medicine (IOM) in November, 1999, released 
a report estimating that as many as 98,000 patients die as the result of 
medical errors in hospitals each year.  Many of these adverse events are 
associated with the use of therapeutics, and are potentially preventable. The 
IOM estimates the number of lives lost to preventable medication errors alone 
represents over 7,000 deaths annually - more than the number of Americans 
injured in the workplace each year. According to this same report, one study 
found that approximately two in 100 hospitalized patients experienced a 
preventable adverse drug event, resulting in an average increase of $4,700 
per admission.

This report inspired a number of responses within the Federal Government.   
The Federal Quality Interagency Committee (QuIC), developed an action plan 
based on the IOM report.  AHRQ sponsored a National Summit on Medical Errors 
and Patient Safety Research on September 11, 2000, and findings from the 
summit define the Agency's patient safety research funding priorities.  A 
summary of the summit is available on the Agency's web page 
http://www.ahrq.gov/. 

The ultimate goal of the CERTs program is to provide access to therapeutics 
research and education programs, as described in the authorizing legislation, 
for all who need such access, throughout the spectrum of health care.  The 
goal of the CERTs demonstration is to test various methods and develop pilot 
programs that will provide direction as to how the program's research and 
education goals can be achieved.

In order to assist this program in achieving its goals, AHRQ commissioned an 
evaluation of the program.  During the upcoming year, the Steering Committee 
will review this evaluation and develop a response so that the centers are 
able to maintain responsiveness to the CERTs authorizing legislation.  
Centers should review the evaluation.  Proposals should address how the 
center will address the recommendations in the evaluation.

MECHANISM OF SUPPORT

The administrative and funding instrument to be used for this program will be 
a cooperative agreement (U18), an "assistance" mechanism in which substantial 
AHRQ and other government scientific and/or programmatic involvement with the 
awardee is anticipated during performance of the activity.  This is a 
cooperative demonstration program.  The dominant role and prime 
responsibility for all CERTS research resides with the awardee(s) for the 
project as a whole, although specific tasks and activities in carrying out 
the studies will be shared among the awardees, the coordinating center, the 
steering committee and the AHRQ Program Officials(s).  Details of the 
responsibilities, relationships and governance of the study to be funded 
under cooperative agreement(s) are discussed later in this document under the 
section "Terms and Conditions of Award."  

The total project period for applications submitted in response to the 
present request for competing continuation applications may not exceed four 
years.  The projects may undergo program peer review to determine whether 
appropriate progress has been made at the end of year two of the award.

FUNDS AVAILABLE

The AHRQ expects to award up to $800,000 in total costs in fiscal year 2003 
to each successful applicant.  At least $200,000 total costs of the proposed 
budget should be allocated for projects consistent with the patient safety 
agenda developed by the individual center and consistent with the AHRQ 
patient safety agenda.  A separate budget and budget justification must be 
submitted for each proposed project including those related to patient 
safety.  Additional projects (e.g., patient safety or educational research) 
will be considered for funding pending availability of funds.  These 
additional projects may not exceed a total cost budget of $200,000 per 
center.  Thus, the proposed project budget should not exceed $1 million total 
cost per year.  The total project period may not exceed 4 years.
The anticipated award date is September 30, 2003.  This program is provided 
for in the financial plans of AHRQ, but awards are contingent upon 
availability of funds. AHRQ has not determined whether or how this 
solicitation will be continued beyond the present RFA.

ELIGIBLE INSTITUTIONS

AHRQ will accept competing continuation applications from the three existing 
CERTs Centers with Cooperative Agreement Awards ending during FY2003. 
 
For-profit organizations are eligible to apply for cooperative agreement 
awards.  They may also participate in the grant projects as members of 
consortia or as subcontractors.  Organizations described in section 501(c)4 
of the Internal Revenue Code that engage in lobbying are not eligible.

Competitive funding for new research centers will be deferred until AHRQ 
staff are able to determine appropriate new or modified program priorities 
and structure for the ongoing Agency program. 

SPECIAL REQUIREMENTS

General

The overall focus of each research center will continue to be a broad 
therapeutic area, such as a particular setting or population, rather than any 
single disease or condition.  A center, for the purpose of this application, 
should maintain its initial focus.  Minor modifications in focus, such as 
expansion into related areas, are acceptable.  The chosen area must maintain 
both a strong research and educational component.

o  These centers should continue to evaluate, develop therapeutic options, 
research methods, and conduct state-of-the-art, clinical, laboratory and 
health services research in accordance with the research and education 
program objectives to increase awareness of the benefits, risks and 
effectiveness of new, existing, or combinations of therapeutics to improve 
practice.

  A fundamental program goal continues to be the development of freestanding 
continuing centers of therapeutics expertise that conduct research and 
educate health care providers, other health care decision makers, care 
givers, and patients, within their particular overarching focus.

o  It is expected that centers will continue to expand ultimately support 
larger research initiatives by combining CERTs funds with funding from other 
sources (e.g., government, private sector, foundation and corporate). 

Guidance on specific project choices

Centers will focus on the overarching theme of developing, disseminating and 
implementing educational programs based on findings from previously funded 
CERTs research and other priority areas listed below. 

o   The mission of the CERTs is consistent with the AHRQ patient safety 
agenda.  Each center should explicitly develop patient safety projects 
consistent with its own theme.  Applicants are encouraged to consult 
descriptions of the issues and definitions contained in "To Err is Human: 
Building a Safer Health System" and the report from the Quality Interagency 
Committee (QuIC).  All are available at 
http://www.ahrq.gov/qual/errorsix.htm.  In developing projects, the 
grantees may utilize the definition of medical errors provided by the QuIC 
report.

o   The 1999 AHRQ reauthorization specifically adds cost-effectiveness 
research to the list of responsibilities for the CERTs.  Each CERTs center 
should incorporate measures of cost effectiveness into Core (defined as those 
funded completely or in part through AHRQ funding) projects where feasible.  
Applicants are encouraged to discuss issues related to cost-effectiveness 
with Joanna Siegel, Sc.D., Director, Research Initiative in Clinical 
Economics, jsiegel@ahrq.gov, 301-594-1485.

o   Each center should support career development of junior faculty and 
investigators through efforts to increase in-house expertise in the varied 
area of therapeutics. A program should encourage commitment to the future of 
therapeutics research.  Partnerships that establish capacity for 
multidisciplinary career development programs involving multiple 
organizations, both public and private, are strongly encouraged.   

o   Other useful basic guidance that may be helpful for choosing topics 
includes: (1) high incidence or prevalence in the general population or 
subpopulations, including racial and ethnic minorities, women and children; 
(2) significance to the Medicare, Medicaid and other Federal health programs;  
(3) high costs associated with a condition, procedure, treatment, or 
technology, whether due to the number of people needing care, high unit cost 
of care, or high indirect costs; (4) controversy or uncertainty about the 
effectiveness or relative effectiveness of available clinical strategies or 
technologies; (5) potential to inform and improve patient or provider 
decision making; (6) potential to reduce clinically significant variations in 
the prevention, diagnosis, treatment, or clinical management of a disease or 
condition, or in the use of a procedure or technology, or in the health 
outcomes achieved; (7) availability of scientific data to support the study 
or analysis of the topic; and (8) potential opportunities for rapid 
implementation.

o   Further guidance on potential areas of research of interest to AHRQ may 
be found at in the program announcements listed at 
http://www.ahrq.gov/fund/grantix.htm.

o   In addition to AHRQ's needs, FDA's needs relate to research into areas of 
more effective education of and  communication with the clinical community.  
In particular, there is a crucial need for research to help understand the 
keys to recognition of adverse events and use error problems with medical 
products and to sensitize the clinical community toward this recognition.  In 
addition, more research needs to be conducted on the most effective means of 
communicating product information (whether on labeling changes or in public 
health advisories) that would be incorporated quickly into clinical practice.  

o   The chosen studies should have strong justification as to why this 
research and education will result in public health impact.  The applicant 
will define how to best approach the issues of improving treatment in that 
particular area.  In choosing projects, consideration should be given to the 
legislative mandate, as noted in the section on research objectives.  In the 
justification, it should be noted how the project meets the goals of the 
legislation, and to quantitatively impact on public health.

o   Newly proposed projects should be multidisciplinary and may address 
various health care providers, settings, and geographic areas.  
Multidisciplinary research may involve scientists in medicine, pharmacology, 
epidemiology, engineering, pharmacy, nursing, human behavior, statistics, 
economics, organizational behavior and related fields.

o   Each proposed project should identify desired outcomes, identify method 
for measuring progress toward the goal and be linked to a plan for 
implementation.

Administrative

o   Evidence should be presented of a continuing infrastructure capable of 
maintaining the CERTs center.  Past or planned changes in the center and its 
team should be described in detail and a discussion of the impact of these 
changes should be included.

o   Each proposed project should identify desired outcomes, identify method 
for measuring progress toward the goal and be linked to a plan for 
implementation. Each center should submit well-developed, relevant new study 
protocols. However, it is expected that further research will continue to be 
developed for the duration of the project that will build on current 
research.

o   The applicant should summarize plans in the application for additional 
funding through private partnerships or additional government funding to 
assist in completing larger projects.  For those projects where a non-
governmental partner has been identified, the applicant should include in the 
application a description of the steps that have been taken to assure 
adherence to the principles set forth in the CERTs Principles for Public-
private Partnerships. These principles can be viewed at the following web 
address http://www.certs.hhs.gov/partners/principles.html.

o  Programs developed for this application should show plans for how the 
research will be translated into specific, measurable outcomes.  It should 
include a plan that describes the steps required to progress from 
developmental pilot programs to national programs that measurably affect 
outcomes.  Results from these small pilot and developmental projects will 
ultimately be used by the centers, the CERTs program, DHHS, and other 
partners, to translate this developmental work into educational programs.  A 
high priority should be given to translational activity that results in 
education and measurably improves health care, as measured by commonly 
accepted indicators, such as mortality, hospitalization rates, quality of 
life, or reduced resource utilization and quality of life criteria.  A 
specific plan that identifies how this goal will be achieved should be 
developed.

o   In developing a research plan for the continuation-funding period, the 
center may consider gaps in research and education within its area of focus, 
such as laboratory research and its application to clinical medicine, 
research on the utilization of medical devices or new therapeutic methods or 
treatments and studies of cost-effectiveness. 

o   A document that provides the priorities and criteria for the choice of 
projects within the theme of the CERTs center should be included in the 
application.  Each center's application should outline how it expects to help 
AHRQ meet the overall goals of the program.  In addition, each center should 
articulate the outcomes it expects to achieve as a result of the program of 
work being undertaken.

o   The AHRQ funds are intended to provide basic support for each center and 
to allow it to function effectively.  This core funding will be provided for 
administrative and staff support to undertake the design, development and 
implementation of one or more educational studies and a dissemination 
program.

o   Detailed research plans which allow for the review of a discrete budget 
for each proposed major Core project should be presented within the 
application.   

o   It is expected that core funding, as a component of the CERTs budget, 
will be expended in such a way as to allow more active participation on the 
part of the center teams in Steering Committee and AHRQ activities (e.g., 
seminars or workshops).  In addition to budgeting for quarterly meetings, 
each center should budget for one trip to Rockville for two people from the 
center per year.  At the discretion of AHRQ program staff; this trip may be 
used to fund investigator travel to another location.  Additionally, a 
limited budget should be set aside, not to exceed 1% of the annual proposed 
total cost budget, for other collaborative activities.  These activities may 
require rapid responses on the part of the investigator teams.  Some examples 
of potential collaborative activities include assisting program staff in 
responding to questions related to a Medicare drug benefit, or participation 
in a workshop related to CERTs. 

o   When proposed core projects (defined as projects funded by AHRQ) involve 
surveys that are not research center initiated or collection of  survey data 
from individuals is required by AHRQ, plans should consider the applicability 
of the Paperwork Reduction Act 44 USC 3501ff and related regulations, 5 CFR 
1320 [1320.3(h)(5) exempts collections of data from patients e.g., in 
clinical trials] and seek technical assistance from the agency, as needed, 
(e.g., as to the impact of these requirements on timing of these projects).

o   Should a center desire to embark on larger projects, not contained within 
the original application during the grant period, it would need to seek 
alternative funding sources or apply and compete for AHRQ funding.   

o   Each center should provide a thorough evaluation of the accomplishments 
of its program.  An appendix describing partnerships (both governmental and 
private) with products should be attached. Evidence should be presented that 
the center is serving the needs and meeting the objectives of the CERTs 
program such as support of the steering committee for its projects and the 
program as a whole.  Have the activities of this center provided evidence to 
support the safe and effective use of therapeutics?

o   Accomplishments should be placed in the appropriate section of the 
proposal. Accomplishments should focus on peer-reviewed publications, 
presentations, and abstracts that support the goals of CERTs.  Of particular 
importance is the determination of impact and importance of the publications.  
Has the research undertaken been high-impact with a high probability of 
translation into policy  or clinical practice?  Publications, to date, should 
be placed in an appendix, with a complete bibliography.

o   The application must present evidence that the institution continues to 
have a broad base of skills with demonstrated experience in multidisciplinary 
research, including clinical epidemiology, clinical pharmacology, health 
services research and analyses of large databases.  Additional strengths 
would include schools of public health, medicine, nursing and pharmacy; a 
bioengineering program; a clinical pharmacology program, or a 
pharmacoeconomics program, from which to draw appropriate personnel.

o   CERTs should develop new and support existing public-private 
partnerships.  These partnerships may be developed in conjunction with the 
CERTs Steering Committee, FDA and AHRQ.  Applicants should show evidence of 
the ability to obtain additional funding in both the research plan and in the 
center accomplishments.  The documentation of such collaborative arrangements 
will be a part of the review.  Collaborators may include arrangements with 
partners such as other governmental agencies, professional groups, consumer 
groups, foundations, and pharmaceutical companies. Contributions of outside 
entities may include significant donation of investigator time, free access 
to computerized databases or computer time and personnel, free 
pharmaceuticals or other therapeutics or others as appropriate.

o   Peer review may be convened to review subsequent non-competing 
continuation applications. Reviewers will assist AHRQ program staff in doing 
midcourse reviews of these projects after two years.  These reviews may be 
site visits or may simply consist of paper reviews.  These reviewers will 
evaluate progress in fulfilling  the requirements of this RFA. 

o   The application must demonstrate the availability of personnel with the 
necessary expertise to study a wide range of topical areas in after-market 
medical product research and have experience in the areas of dissemination 
and evaluation of such.  Applicants should show evidence of a continued 
appropriate administrative structure in place that enables it to complete 
projects in a timely fashion, with full accountability for funds.

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 announcement should 
address attention to these priority populations and outline potential 
benefits of proposed projects for any of them.

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 Office of Health Care Information (OHCI) through the AHRQ program 
officer, when articles from their studies are accepted for publication in the 
professional literature.  Grantees should also discuss their ideas 
about other dissemination and marketing efforts with OHCI staff.  The goal is 
to ensure that efforts to disseminate research findings are coordinated with 
other Agency activities to maximize awareness and application of the research 
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 will take place in close 
coordination with OHCI and the press offices of the grantee's institutions.  
In cases when products are created (such as annual or final reports, Web-
based tools, CD-ROMs), grantees will be asked to submit to OHCI a brief plan 
describing how the product will be publicized.  An OHCI staff person will be 
assigned to each product and will coordinate the implementation of the plan, 
especially issues related to printing and electronic dissemination, and 
outreach to the media. Office of Health Care Information Contact Number: 
301594-1360.

TERMS AND CONDITIONS OF AWARDS

These special Terms of Award are in addition to and not in lieu 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 and 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.

This cooperative agreement (U18), is an "assistance" mechanism, in which 
substantial AHRQ scientific and/or programmatic involvement with the awardee 
is anticipated during the 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 the individual CERTs 
activities through data sharing, data access and through improved 
communication.

All cooperative activities that potentially include significant government 
involvement will require prior approval by the AHRQ program official who is 
expected to consult with the SC.

Awardee Rights and Responsibilities

o   The centers are expected to work with AHRQ, the FDA and other Federal 
Agencies, as appropriate, on analyses and studies.  Such joint activities may 
involve syntheses of research findings, data analyses, or the preparation of 
background information on various topics related to therapeutics.

o   The Principal Investigator will work with the coordinating center, as 
appropriate, to disseminate study findings, including, but not limited to, 
publication in peer review journals. 

o   Each Principal Investigator will attend the quarterly steering committee 
meetings, and the monthly conference calls chaired by the coordinating 
center.  One co-investigator from the center will be designated in the 
application to act and make decisions related to Steering Committee business, 
in the absence of the Principal Investigator.

o   The Principal Investigator will provide access to the various center data 
sources to the coordinating center and to AHRQ as appropriate to the 
individual studies, consistent with statutorily based promises of 
confidentiality.

o   Publications and other pertinent information, such as educational 
modules, should be submitted to the coordinating center as soon as they are 
available via both direct transmittal and hard copy.

o   Submission of a semi-annual report of progress to the responsible AHRQ 
program official.

Federal Agency Responsibilities

o   AHRQ and FDA representatives will participate as permanent members of the 
steering committee.  Other government agencies may also be invited by the 
Steering Committee Chair to become members of that committee.

o   AHRQ with assistance from FDA, the CC, and the research centers will 
identify a chair for the steering committee, should the current chair resign.  

o   The AHRQ Program Official(s) will work in conjunction with FDA, the 
centers' principal investigators, the coordinating center and the Steering 
Committee to assure that issues for further study receive adequate review.  
Government representatives will also meet periodically to provide input and 
advice to the Steering Committee.

o   The Federal agencies will on occasion have substantive involvement in the 
planning and conduct of research, technical assistance, dissemination, and 
career development carried out by each center.  Such involvement will require 
the approval of the AHRQ Program Official and such research may require 
further approval by OMB.

o   The Federal agencies involved will provide information on appropriate 
government resources, such as additional funding and data sources.

o   The Federal agencies involved will work with the center staff to 
facilitate dissemination of results.

o   As additional data and sources of funding are identified, the Federal 
agencies will work with centers, through the Public Private Partnership 
working group to establish appropriate agreements to optimize use and sharing 
of these resources.

o   AHRQ reserves the right to terminate or curtail any study or an entire 
award in the event of substantial lack of progress or lack of participation 
in CERT-related activities.

WHERE TO SEND INQUIRIES   
 
AHRQ encourages inquiries concerning this limited competing continuation and 
welcomes the opportunity to answer questions from applicants.  Inquiries may 
fall into three areas:  scientific/research, peer review, and financial or 
grants management issues:

o   Direct your inquiries about scientific/research issues to:

Lynn Bosco, MD, MPH
6010 Executive Blvd., Suite 300
Rockville, MD 20852
Phone: 301 594 2416
E-mail: Lbosco@ahrq.gov

o   Direct your questions about peer review issues to:

Veronica M. Friel, Ph.D.
2101 East Jefferson Street, Suite 400W
Rockville, MD 20852
Phone: 301 594 6225
E-mail: vfriel@ahcq.gov

o   Direct your question about financial or grants management matters to:

Michelle Burr
2101 East Jefferson Street, Suite 601
Rockville, MD 20852
E-mail: mburr@ahrq.gov
301-594-1840

SUBMITTING AN APPLICATION  

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (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.

SUPPLEMENTAL INSTRUCTIONS

Because of the complexity of the issues required in this application, 
applicants are allowed an additional five pages beyond the usual twenty-five 
maximum for the research plan.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: 

AHRQ is not using the Modular Grant Application and Award Process.  
Applicants for funding from AHRQ should ignore application instructions 
concerning the Modular Grant Application and Award Process, and prepare 
applications according to instructions provided in form PHS 398.  
Applications submitted in the Modular format will be returned without review.

SENDING AN APPLICATION TO THE NIH AND AHRQ
  
Submit a signed, typewritten original of the application, including the 
checklist, and five 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)

APPLICATION PROCESSING

Applications must be received by the receipt date listed in the heading of 
this Limited Competing Continuation.  If an application is received after 
that date, it will be returned to the applicant without review.  

Although there is no immediate acknowledgement of the receipt of an 
application, applicants are generally notified of the review and funding 
assignment within 8 weeks.
 
The Center for Scientific Review (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.  However, when a previously unfunded application, originally 
submitted as an investigator-initiated application, is to be submitted in 
response to an RFA, it is to be prepared as a NEW application.  That is the 
application for the RFA must not include an Introduction describing the 
changes and improvements made, and the text must not be marked to indicate the 
changes.  While the investigator may still benefit from the previous review, 
the RFA application is not to state explicitly how.

Applicants are encouraged to read all PHS Forms 398 instructions prior to 
preparing an application in response to this announcement.  The PHS 398 type 
size requirements will be enforced rigorously and non-compliant applications 
will be returned.

Institutional Review Board (IRB) approval of human subjects' protection is 
not required but is recommended prior to peer review of an AHRQ application.  
The "AHRQ Revised Policy for IRB Review of Human Subjects Protocols in Grant 
Applications" was published in the NIH Guide on September 27, 2000.  
(http://grants.nih.gov/grants/guide/notice-files/not-hs-00-003.html). 

This announcement is available on AHRQ's Web site, http://www.AHRQ.gov, (see 
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 this 
announcement number).  This announcement 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.

Application Preparation (for using CMS Data)

For applications that propose to use Medicare or Medicaid data that are 
individually identifiable, applicants should state explicitly in the 
"Research Design and Methods" section of the Research Plan (form 398) the 
specific files, time periods, and cohorts proposed for the research.  In 
consultation with Center for Medicare and Medicaid Services (CMS), previously 
called Health Care Financing Administration (HCFA), AHRQ will use this 
information to develop a cost estimate for obtaining the data.  This estimate 
will be included in the estimated total cost of the grant at the time funding 
decisions are made. 

Applicants should be aware that for individually identifiable Medicare and 
Medicaid data, Principal Investigators and their grantee institutions will be 
required to enter into a Data Use Agreement (DUA) with CMS to protect the 
confidentiality of data in accordance with AHRQ's confidentiality statue, 42 
USC 299c3(c), the Privacy rules at 45 CFR Part 164, if applicable, and 
standards set out in OMB Circular A-130, Appendix III-Security of Federal 
Automated Information Systems.  The use of the data will be restricted to the 
purposes and time period specified in the DUA.  At the end of this time 
period, the grantee will be required to return the data to CMS or certify 
that the data have been destroyed.  

Unless AHRQ is able to negotiate exceptional arrangements, for the sole 
purpose of assuring that data confidentiality is maintained, included in the 
DUA is the requirement that the User agrees to submit to CMS, a copy of all 
findings within 30 days of making such findings.  The user further agrees not 
to submit these findings to any third party (including but not limited to 
any manuscript to be submitted for publication) until receiving CMS's 
approval to do so.

In developing research plans, applicants should allow time for refining, 
approving, and processing any CMS data requests.  Requests may take 6 months 
from the time they are submitted to complete.  Applications proposing to 
contact beneficiaries or their providers require the approval of the CMS 
Director and may require meeting(s) with CMS staff.  CMS data are provided on 
IBM mainframe tapes using the record and data formats commonly employed on 
these computers.  Applicants should either have the capability to process 
these tapes and formats or plan to make arrangements to securely convert them 
to other media and formats.

Questions regarding CMS data should be directed to the AHRQ program official 
listed under INQUIRIES.

In carrying out its stewardship of research programs, the AHRQ, at some point 
in the future, may begin requesting information essential to an assessment of 
the effectiveness of Agency research programs.  Accordingly, grant recipients 
are hereby notified that they may be contacted after the completion of awards 
for periodic updates on publications resulting from AHRQ grant awards, and 
other information helpful in evaluating the impact of AHRQ-sponsored 
research.  

AHRQ expects grant recipients to keep the Agency informed of publications as 
well as the known uses and impact of their Agency-sponsored research.  
Applicants are to agree to notify the AHRQ Program Officer immediately when a 
manuscript based on research 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 research 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).

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.  An appropriate peer review 
group convened in accordance with standard AHRQ Special Emphasis Panel (SEP) 
peer review procedures will evaluate applications that are complete and 
responsive to the RFA for scientific and technical merit.  As part of the 
merit review, all applications will:

o   Receive a written critique
o   Undergo a preliminary screening process in which only those applications 
deemed to have the highest scientific merit will be discussed and assigned a 
priority score. 

REVIEW CRITERIA

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 research will have a substantial impact on the pursuit of these 
goals:

o    Significance
o    Approach
o    Innovation
o    Investigator
o    Environment
o    Budget 

The scientific 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 scientific impact and thus 
deserve a high priority score.  For example, you may propose to carry out 
important work that by its nature is not innovative but is essential to move 
a field forward.

(1)   SIGNIFICANCE:  Does your study assist AHRQ in meeting the goals of the 
overall CERTs program?  How does the project you are proposing address the 
current gaps in knowledge about the important problem identified in your 
original application?  What are the specific outcomes which will be achieved 
if the aims of your application are realized? 

(2)   APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics?

(3)   INNOVATION:  Does your project employ novel concepts, approaches or 
methods?  Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4)   INVESTIGATOR: Are you appropriately trained and well suited to carry 
out this work?  Is the work proposed appropriate to your experience level as 
the principal investigator and to that of other researchers (if any)?

(5)   ENVIRONMENT:  Does the scientific environment in which your work will 
be done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific environment 
or employ useful collaborative arrangements?  Is there evidence of 
institutional support? 

(6)   BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.

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

(1)   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.

(2)   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.  

(3)   Adequacy of attention to other populations of special priority to AHRQ, 
as discussed in SPECIAL REQUIREMENTS, above.  (See also Inclusion Criteria 
included in the section on Federal Citations, below.) 

(4)   RELEVANCE TO LEGISLATIVE MANDATE:  Reviewers will also consider the 
extent to which  the projects outlined in your proposal will assist AHRQ in 
achieving the overall goals of the CERTS: potential of the proposed activity 
to foster and sustain innovation in the long-term; the degree to which the 
proposed activity will stimulate new innovation opportunities for the partner 
organizations; the degree to which the participation of the institutions that 
serve groups currently underrepresented in the scientific workforce are 
involved in the proposed activity.

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-study that identifies 
an individual or entity must be treated as confidential in accordance with 
any explicit or implicit promises made or implied regarding the possible uses 
and disclosures of such data.  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.  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/handbook.pdf.  
The application of these confidentiality and security standards to 
subcontractors and vendors, if any, should be addressed.

Rights in Data

AHRQ grantees may copyright 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 research 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. Important legal rights and requirements applicable to 
AHRQ grantees are set out or referenced in the AHRQ's grant 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).

SPECIAL REVIEW CRITERIA

Special Review Criteria for these applications will be the fulfillment of 
items listed in the Special Requirements section of this RFA.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:  June 16, 2003
Application Receipt Date:  July 15, 2003
Peer Review Date:  August 2003
Earliest Anticipated Award Date:  September 29, 2003

AWARD CRITERIA

Applications will compete for available funds with all other applications 
under this RFA. The intent of this RFA is to continue funding technically and 
scientifically meritorious centers unless there is reason to question the 
applicant's ability to participate in the program's cooperative activities. 
The following will be considered in making funding decisions: 1) quality of 
the proposed project as determined by peer review; 2) program balance; 3) 
availability of funds; and, 4) potential impact of proposed research.  AHRQ 
reserves the right to fund all or part of any application.

REQUIRED FEDERAL CITATIONS

INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY 
POPULATIONS:  It is the policy of AHRQ that women and members of minority 
groups be included in all AHRQ-supported research 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 research.  

All investigators proposing research 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.  

Investigators 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.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.  It is 
not likely that data gathered under projects supported through this 
initiative will be used as a basis for federal regulation or action having 
the force and effect of law. However, should applicants wish to 
place data collected under this PA 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-3c) 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.

STANDARDS FOR PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION:  The 
Department of Health and Human Services (DHHS) issued final modification to 
the "Standards for Privacy of Individually Identifiable Health Information", 
the "Privacy Rule," on August 14, 2002.  The Privacy Rule is a federal 
regulation under the Health Insurance Portability and Accountability Act 
(HIPAA) of 1996 that governs the protection of individually identifiable 
health information, and is administered and enforced by the DHHS Office for 
Civil Rights (OCR). Those who must comply with the Privacy Rule (classified 
under the Rule as "covered entities") must do so by April 14, 2003  (with the 
exception of small health plans which have an extra year to comply).  

Decisions about applicability and implementation of the Privacy Rule reside 
with the researcher and his/her institution. The OCR website 
(http://www.hhs.gov/ocr/) provides information on the Privacy Rule, including 
a complete Regulation Text and a set of decision tools on "Am I a covered 
entity?"  Information on the impact of the HIPAA Privacy Rule on NIH 
processes involving the review, funding, and progress monitoring of grants, 
cooperative agreements, and research contracts can be found at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-03-025.html.

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.

Weekly TOC for this Announcement
NIH Funding Opportunities and Notices

	Office of Extramural Research (OER)			National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892			Department of Health and Human Services (HHS)
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