Disseminating patient centered outcomes research to improve healthcare delivery

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Research Network faithful take note - AHRQ is out with a great funding opportunity to "disseminate and implement existing evidence for improving the quality of health care delivery. Applicants are required to demonstrate the ability and commitment to leverage the capacities of existing broad-based networks of providers and other key stakeholders in their dissemination and implementation activities."

Read the announcement online and apply here.

Full Text of Announcement

Section I. Funding Opportunity Description

Purpose:
The purpose of the FOA is to leverage the capacities of existing broad-based networks of providers and other key stakeholders to disseminate and implement existing evidence for improving the quality of care delivery.

Background: 
Since the 2009 Recovery Act (ARRA), the scope of Comparative Effectiveness Research (CER) has expanded from its earlier focus on identifying improvements in clinical treatments to include improvements in care delivery.  Past AHRQ-supported delivery system improvement activities have revealed unique challenges associated with actual implementation of evidence in this domain. Spread of evidence to support change in care delivery requires coordination, buy-in and active participation by diverse providers across multiple settings of care, collaboration with other key stakeholders (including payers and consumers) who are instrumental in shaping care delivery, and adaptation of interventions to local conditions. In recognition of these well-documented challenges and needs, this FOA requires that applicants represent existing networks of providers and other stakeholders that have the knowledge, on-going relationships, expertise, infrastructures, past experience and understanding of local needs and constraints to maximize buy-in, collaboration, and appropriate adaptation to local conditions.

Method:
Applicants must:

Utilize the resources and capabilities of an existing network (as defined below under definitions and eligibility requirements) to support spread activities.

Applicants may propose either to

OR

All applicants are expected to:

Each successful applicant will represent an already established network with:

Each of these capacities should be described in detail in the grant application and the specific contribution of these elements to the proposed project must be discussed.  (For additional Applicant Eligibility Requirements, see section III below)

To achieve maximum impact, applicants are expected to design initiatives that:

Initiatives (coordinated, multi-stakeholder projects) that would fall within the scope of this FOA may aim to accomplish objectives such as (but not limited to) the following:

Applications which propose to implement findings within and across safety net institutions or priority populations are particularly encouraged.

Definitions of Key Terms -- For the purpose of this FOA, the following definitions apply:

Evidence-based interventions, practices, findings, care delivery improvements  (henceforth "interventions") --  For the purposes of this FOA, evidence and research findings about practices or interventions for improving clinical outcomes, care delivery, or the performance of delivery systems cover both broad improvement strategies and specific interventions or techniques. These strategies and interventions may aim for outcomes at the individual, group (a.k.a. team), organizational, population, delivery system, local community, or regional level. The objectives can focus on clinical, behavioral, or organizational change. The objectives may be broadly defined or narrowly focused. The evidence base for these strategies and interventions is empirical documentation of sufficient strength, clarity, and technical merit to produce strong expectations as to the likelihood of success in achieving improvement goals. Evidence about non-clinical interventions often derives from the social, behavioral, and management sciences. Evidence should be generated by comparing two or more methods designed to achieve the same goal. One of these methods may be current practice.

Initiative -- a comprehensive approach or set of approaches for spread (dissemination and implementation) undertaken in a coordinated fashion across multiple sites and among groups of stakeholders.

Intervention -- a specific activity, action, or technique that can be utilized individually or in combination in support of a broader strategy.

Strategy -- a set of practices, techniques or interventions with an underlying logic for improving the quality of clinical care or care delivery (e.g., introducing decision-support systems; fostering patient self-management; developing cross-disciplinary care teams).

Approach -- an explicit set of techniques or activities for achieving spread (dissemination and implementation) of interventions or strategies.

Delivery settings or sites -- any location where health care services are delivered or received including, but not limited to, hospitals, long term care facilities, doctors’ offices, primary care clinics, pharmacies, school or community health clinics, and home care.

Provider -- any individual or organization that provides care to patients (including, but not limited to, physicians, nurses, other healthcare practitioners, group practices, hospitals, ambulatory care centers, integrated delivery systems).

Stakeholder group -- any group, entity, or organization involved in providing, receiving or paying for health care; any group that represents or advocates on behalf of those who provide, receive, or pay for care.

Network – An established, broad-based association, coalition, or partnership of clinical practitioners, provider practices or organizations, or other groups, entities or organizations playing an influential role in health care delivery, with a  history of collaborative relationships directed at improving health care quality. Relationships among these linked actors can be formal or informal; capacities must include at a minimum: established channels for communication and data sharing and an infrastructure that has proven to be capable of supporting joint actions to improve care and collaborations for improvement and/or shared learning.

Dissemination -- purposeful distribution of information and guides to improvement interventions and strategies to specific audiences.

Implementation -- adoption and actual uptake or use of proposed interventions and strategies by individuals, sites, and organizations.

Spread (or scale-up) – the process of achieving uptake of one or more interventions that have been successfully tested in pilots or experimental sites to additional sites.  This process involves disseminating information about preferred practices, procedures, and organizational arrangements and actively supporting the implementation of the changes needed to put the interventions and strategies into practice.

Section II. Award Information

Funding Instrument

Grant

Application Types Allowed

New

The OER Glossary and the SF424 (R&R) Application Guide provide details on these application types.

Funds Available and Anticipated Number of Awards

The number of awards is contingent upon AHRQ appropriations and the submission of a sufficient number of meritorious applications.

Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. The total amount awarded and the number of awards will depend upon the number, quality, duration, and costs of the applications received.

AHRQ intends to fund 4-8 awards, at a total of $4 million total costs per year for the four year duration of this initiative.

Award Budget

Total costs (including both direct and indirect costs) will ordinarily be around $500,000 in any given year of the project period.  No single award may exceed $1 million total costs in any given year.  Applications will ordinarily not exceed $2 million total costs for the entire project period. In special cases AHRQ may consider submissions that exceed this amount due to project complexity and scope.

No single award shall exceed $1million total costs per year.              

Projects requesting in excess of $500,000 total costs in any given year will only be considered if they involve spread in multiple states, large geographic areas or areas across multiple delivery systems.  

Requests for awards totaling more than $2 million total costs over the four year project period must be justified in terms of the complexity of the proposed project aims and the initiative's potential to provide solutions to particularly challenging problems in care delivery, to affect the lives of large sectors of the population, and/or to demonstrate ways to better care for critical subgroups.  These larger projects should therefore be likely to provide models of spread initiatives of great importance to healthcare delivery system leaders and policy makers.  

Award Project Period

The project period for these applications must be from 2 to 4 years. 

These projects are being funded pursuant to 42 U.S.C. 299a, which provides that AHRQ shall conduct and support research, support demonstration projects, and disseminate information on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness, and value of health care services.

All applications submitted and AHRQ grants made in response to this FOA are subject to AHRQ's grant regulations at 42 CFR Part 67, Subpart A, the HHS Grants Policy Statement (see http://dhhs.gov/asfr/ogapa/aboutog/grantsnet.html and  http://dhhs.gov/asfr/ogapa/grantinformation/hhsgps107.pdf), and the terms and conditions set forth in the Notice of Award.

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