Grants for Health Services Research from the Agency for Healthcare Research and Quality AHRQ

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Grants for Health Services Research from the
Agency for Healthcare Research and Quality (AHRQ)
Ryan Mutter, Ph.D. Agency for Healthcare
Research and Quality April 19, 2006 UMBC Office
of Sponsored Programs
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AHRQ

• Federal agency

• Component of DHHS

• 318 million budget

• Approximately 80 percent of AHRQ's budget is
  invested in grants and contracts focused on
  improving healthcare.

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Two Types of Research

• New Knowledge
• Translation and Implementation

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Mission
To improve the quality, safety, efficiency, and
effectiveness of healthcare for all Americans
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Mission

• AHRQ achieves its mission through programs
  designed to
• Improve clinical practice
• Improve the healthcare system's ability to
  provide access to and deliver high quality,
  high-value healthcare
• Provide policymakers with the ability to assess
  the impact of system changes on outcomes,
  quality, access to, cost, and use of healthcare
  services.

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Areas of Emphasis

• System capacity and bioterrorism
• Data development
• Care management
• Cost, organization, and socio-economics
• Health information technology
• Quality/safety of patient care
• Long-term care
• Pharmaceutical outcomes
• Training
• Prevention

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Growing Focus on Results

• Research promoting AHRQ goals
• Actionable research results
• Shorter research turnaround
• More demonstrations, planning, evaluation
  projects (often done through contracts)
• Leveraging funds for broad impact
• Priority populations policy

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Grant Example (1) Impact of Specialty Hospitals
on Procedure Utilization

• RO1, PI B. Nallamothu
• Background concern that specialty hospitals
  siphon off most profitable procedures from
  general hospitals and create supplier induced
  demand for these procedures.
• Policy implications relevant to debate in
  Congress over whether to declare moratorium on
  specialty hospital construction
• Aim 1 Impact of opening of specialty hospitals
  on volumes for 4 procedures (e.g., coronary
  artery bypass total knee anthroplasty) at
  competing general hospitals
• Aim 2 Impact on population rates for 4
  procedures
• Design longitudinal analysis of population level
  data by regions
• Data Medicare 1994-2000

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Grant Example (2)Public Reporting (PR) and
P4PImpact on Safety Net Hospitals (SNHs)

• R03, PI Adams Dudley
• Background Much activity and interest but little
  research on impact of PR and P4P on SNHs
• Questions (1) What are SNH executives concerns
  about PR and P4P and their suggestions for future
  programs? (2) How feasible and acceptable are
  their suggestions in view of regulators, payers,
  and non SNH executives?
• Method Documentary analysis of regulations and
  practices in Californina, qualitative in-depth
  interviews with 2 types of hospital executives
  and other stakeholders.
• Analysis iterative using qualitative software

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Funding Announcements

• Requests for Applications (RFAs)
• stimulate activity in AHRQ programmatic research
  priority areas
• single application receipt date is specified
• amount of funds earmarked for the initiative and
  the number of awards likely to be funded
  announced
• Program Announcements (PAs)
• continuing, new, or expanded program interests
  for which grant or cooperative agreement
  applications are invited

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RFAHS-06-030

• Improving Patient Safety through Simulation
  Research

• 8 to 10 grants of 2,400,000

• Use simulation to mirror, anticipate, or amplify
  real situations with guided experiences in a
  fully interactive way (e.g., mannequins are used
  for teaching CPR)

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PA-00-111

• AHRQ Health Services Research

• Primarily R01s
• R01 is a large research grant
• Large means over 100,000

• Special Emphasis Note describes current Agency
  priorities

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Special Emphasis Note FY 2006

• Redesign and Evaluation of Patient Centered Care
  for Chronically Ill
• Coordination of care across settings
• Health education and patient self-management
• Strategies to reduce disparities
• Organizing care
• Implications for professional education and
  training
• Impact of strategies, structures, and practices
  on access and clinical outcomes
• Financial implications of care coordination
• Cost-effective health system improvements
• Pay for performance

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PA-00-111

• AHRQ always encourages
• partnerships with private and public
  organizations to facilitate development and
  sharing of scientific knowledge and resources
• cost-sharing mechanisms
• projects that will produce results within 2-3
  years
• results that can be integrated rapidly in
  practice and policy.

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PAR-01-040

• AHRQ Small Research Grant Program

• Primarily R03s
• R03 is a small research grant
• Small means under 100,000

• Ideal for new investigators

• Special Emphasis Note applies

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PA-03-117

• AHRQ Grant Program for Large Conference Support

• R13 mechanism
• direct costs of more than 50,000 per year OR
• project period of longer than 1 year, but not
  exceeding 5 years

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PA-03-117

• Intended to complement and promote AHRQ's core
  research by providing a mechanism
• to develop health services research agendas and
  identify strategies for studying them
• to discuss and develop consensus around
  methodological and technical issues
• to disseminate health services research
  information and facilitate adoption of research
  findings
• to develop partnerships with stakeholder
  organizations and build their capacity to
  participate in research activities and use the
  results of health services research.

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PA-06-074

• Small Grant Program for Conference Support

• Small conference grants are those with direct
  costs of 50,000 or less over the project period.

• Applicants may request full or partial support
  for conferences. (Requests for partial support
  are encouraged.)

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PAR-06-118

• AHRQ Grants for Health Services Research
  Dissertation

• R36 mechanism

• Total direct costs awarded must not exceed
  35,000 for the entire project period, which
  should be a minimum of nine months and not to
  exceed 17 months in duration

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PA-00-069

• Predoctoral Fellowship Awards for Minority
  Students

• Up to five years of support for research training
  leading to the Ph.D. or equivalent research degree

• New announcement due May 1, 2006

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Other PAs

• PA-00-010
• Mentored Clinical Scientist Development Award
• K08 mechanism

• See website for co-sponsored PAs
• Often co-funded with NIH
• Typically use R01, R03, etc. mechanisms

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FY 2007 -- Patient Safety

• FY 2007 Planning Level 84 million
• 35.2 million Ambulatory Patient Safety Program
  (29.4 M HIT funds and 5.8 M in general PS
  funds)
• Patient Safety Quality Improvement Act

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Ambulatory Patient Safety Program

• Current public and private sector patient safety
  programs have focused largely on care for
  hospitalized patients
• This investment will focus on ambulatory
  settings.
• Primary focus will be improving the safety and
  safe use of medications.
• Will use health information technology

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FY 2007Non-Patient Safety Research

• 17.1 million in new research grants
• These grants will continue research in our 10
  portfolios of work with an increased focus on
  knowledge translation.

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Applying for a Grant

• Submit the application

• Application reviewed by study section

• Revise and resubmit application

• Application with low technical merit score (lower
  is better) go to funding meeting where decision
  to fund is made based on programmatic concerns.

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Submission Dates

• Mechanism Cycle 1 Cycle 2 Cycle 3
• R01, R13, Feb 1 June 1 Oct 1
• K08
• R03 Mar 24 July 24 Nov 24
• R36 Apr 10 Aug 10 Dec 10

See website for updates and further details.
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Study Sections

• Applications are scored
• 1.0-1.5   Outstanding1.5-2.0   Excellent2.0-2.5 
    Very Good2.5-3.5   Good3.5-5.0   Acceptable

• Applications are ranked
• Shows the relative position of each application's
  score among all scores assigned by a study
  section at its last three meetings.

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Your Successful Application

• Leads to important research
• Fits well with AHRQs priorities
• Meets requirements of specific program
  announcement
• Rates high on scientific merit
• Will produce research that matters

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Application Fundamentals

• Plan Choose problem. Develop hypotheses, design,
  project plan
• Write concept paper
• Consult colleagues agency program staff
• Build a strong team Cover methods, topics, sites
• Present well Write a clear convincing
  application
• Revise and resubmit

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1. Planning

• Scientific plan
• Literature, background
• Hypotheses
• Design aims (stages) and procedures for each
  aim
• Instrument development and pilots
• Research implementation plan including
  contingency plans
• Project plan
• Budget
• Access to sites and data
• Human subjects informed consent, protocols
• IRB approvals
• Institutional arrangements and approvals

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1. Planning (Contd)

• Finding a research mechanism
• How much has already been done to address your
  research question?
• Do you have pilot data?
• What is the necessary timeframe?
• What are the needed resources?

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2. Writing Concept Paper

• Main hypothesis or research questions
• State of the field
• Design
• Sample
• Design (e.g. cross-sectional, prospective, RCT,
  case study)
• Data gathering methods
• Statistical methods
• Fit with Agency/ support mechanism
• Distinctive competencies of investigator team
• Questions

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3. Consulting Others

• Senior investigators and mentors -- at your
  institution and elsewhere
• Campus research office
• Peers
• Program officers
• Website and printed resources
• Potential co-funders
• Stakeholders, user groups
• Workshops

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4. Team Building

• Grants experience
• Subject expertise
• Methodological expertise
• Professional expertise
• Links to research sites
• Team dynamics time commitments, leadership,
  coordination
• Stakeholder and user involvement
• Letters of cooperation
• Access to sites
• Dissemination plan

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5. Presenting the Application

• State the distinctive contribution and relevance
  to program announcement
• Provide a tight scientific plan
• Be concrete define terms, give examples
• Use graphics for complex relations
• Provide measurement tools and findings from
  pilots
• Anticipate questions about design and methods
• Spell out project implementation, including
• Cooperating sites, researchers
• Data access
• Team members, contributions, coordination
• Timetable
• Products

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5. Presenting (Contd)

• Writing tip
• Study section members and agency staff are busy
  people, so
• Make it easy for them to understand why your
  application should be given a high score and be
  generously funded!

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6. Revise and Resubmit

• Expect criticism
• Respond to comments systematically and
  non-defensively
• Specify how you dealt with comments
• Be prepared to resubmit elsewhere or try another
  idea at same agency

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6. Revising (Contd)Responding to Comments

• Before... While the hypothesis is original, the
  significance and ultimate impact in the health
  care field are questionable. ..The application
  is a useful academic exercise with limited
  practical applications. .. There is a lack of
  clinicians in the study..The need for proposed
  methods development is not well justified. Why
  would the setting studied be different from
  other well-researched settings?
• After This is a well-designed study to adapt
  body of theory and methods to the field. The
  investigators were extremely responsive to
  initial review. In general, this is an
  outstanding study from a strong, experienced team
  of investigators, which includes knowledgeable
  clinicians. The study fills an important
  knowledge gap It is likely to produce important,
  policy-relevant findingsThere is a need for a
  series of examples of how the tool will be used.
  The committee needs a clear sense of what the
  researchers are doing and where they are going.

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AHRQ is Transitioning to Electronic Submission of
Applications

• The current PHS 398 application will be replaced
  by the Standard Form (SF) 424 Research and
  Related (RR) application.

• Details are available on the website

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Help is Available

• Program Officers, such as myself, want to provide
  you with assistance

• Staff contacts are listed on the website

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Help is Available
Materials providing further information developed
by Michael Harrison, Ph.D. and colleagues
available at http//www.esi-bethesda.com/grantsm
anship/presentations.htm
My contact information Ryan Mutter 301-427-1415
rmutter_at_ahrq.gov rmutte1_at_umbc.edu