Health Services Research Matrix

1.      Background and Purpose: The goal of the Outcomes Research Awards is to stimulate the development of health services and quality improvement research at CCHMC to ensure optimal implementation of clinical and operational innovations in the care delivery system. The path from basic science discovery to successful clinical trial must end with successful incorporation into practice and measurable transformation of health care within and beyond CCHMC so that advances reach all children.  Outcomes research includes research that results in innovative approaches to health care delivery, optimizes the effectiveness and implementation of clinical interventions, examines whether outcomes meaningful to patients and families have changed, and assesses the value of new clinical practices. Through this research, CCHMC's mission of ensuring the best medical and quality of life outcomes, patient and family experiences and value locally, regionally, nationally is most likely to be achieved.

2.      Definitions: Outcomes research is the effort to understand the end results of particular health care practices. End results include effects that people experience and care about, such as change in the ability to function, as well as disease specific indicators and mortality. By carefully linking the health care people get to the outcomes they experience, outcomes research has also become an important driver in the effort to monitor and improve health care quality. 

The central interest of this Award mechanism is to foster research that links health care practices and specific disease outcomes and to use such linkages to drive health care quality improvement.  Linking health care practices to disease outcomes typically involves the field of health services research. Health services research is the multidisciplinary field of scientific investigation that studies how social factors, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations.

Health care quality improvement is defined as a systematic pattern of actions that seeks to constantly optimize productivity, communication, and value within a health care organization.  Research in this area involves the design, development and evaluation of interventions to produce new, generalizable knowledge that creates and sustains improvement in health care delivery in real world settings.

3.      Complementary award mechanisms. There are several CCHMC internal grant award mechanisms. Applicants can confer with the administrators of each mechanism if the appropriate one for the applicant's project is not clear.  For reference, the goal of the Translational Research Initiative awards is to stimulate research that bridges from basic science discovery to clinical trials.  The Trustee awards support both laboratory-based and clinical research projects. The Trustee awards are primarily used to provide start-up funds for new faculty or for support of established faculty who are substantially altering the direction of their research programs.  The application process for the outcomes research awards has been modeled on these successful programs.   

4.      Outcomes research awards: Potential themes of inquiry can be linked to specific diseases or larger systems of care delivery.  Examples include:

a.      Medical and quality of life outcomes

i.        Evidence based medicine: e.g., examining the effect of a new disease management guideline on disease outcomes;

ii.      Quality improvement methods: e.g., evaluating whether a change in care processes reduces variation in disease guideline implementation;

iii.    Risk stratification: e.g., evaluating whether segmenting patients with a given disease by biological, behavioral or social risk to tailor their care improves quality of life outcomes;

iv.     Coordination across systems: e.g., evaluating new patient discharge processes to improve information transfer to primary care pediatricians,

v.       Clinical informatics: e.g., examining how to help clinicians integrate complex medical information using alternative interfaces on the computer; or characterizing the test characteristics (sensitivity, specificity, negative and positive predictive value) of several ways of ascertaining medical information in EPIC;

vi.     Implementation of new technology: e.g., determining how to incorporate new tests (e.g., biomarkers of exposure or disease) into care to improve outcomes;

vii.   Population impact: e.g., evaluating synergistic community-based and clinical approaches to care for prevalent conditions with complex etiologies (e.g., obesity, asthma);

viii. Prevention: e.g., testing whether stratifying patients in well child care better reduces threats to optimal child development;

ix.     Safety: e.g., determining whether a change in health care processes is associated with reduced medical errors in care transitions;

x.       Self management of chronic health conditions: e.g., testing new technologies to improve adherence to medication; or evaluating the effect of motivational interviewing on patient behavior change.

b.      Patient and family experience:

i.        Family centered care: e.g., examining how method of physician rounding affects families' satisfaction with care;

ii.      Shared decision making: e.g., evaluating how jointly determined medical decision making affects adherence to the management plan;

iii.    Operational improvements, including flow, access and scheduling: e.g., testing whether caregiver entry of medical information (e.g., asthma symptom checklists, behavior scales) while still in the waiting room improves patient care or evaluating the impact of automated test result notification (e.g., laboratory or radiology results) on timely patient discharge;

iv.     Enhanced patient access to medical information: e.g., testing different models of access and exchange of information (e.g., email, disease portals) and their impact on patient experience and disease outcomes.

c.      Value

i.        Decision and cost-effectiveness analysis: e.g., evaluating the cost-effectiveness of a pharmacogenetic approach to drug selection and dosing.

5.      Types of Grants Available:

1. New research proposals: Grants can be requested for up to 2 years of support, with the second year contingent on a review of research progress. For this initial round, grant funds can begin either January 1, 2008 (or in selected cases July 1, 2008). In subsequent years, grant funds will begin with a July 1 start date (e.g., July 2009).  The maximum allowable budget (direct costs) is $60,000 per annum. The number of awardees will be determined by the quality of the proposals, the total amounts of the requested budgets of sufficiently meritorious proposals, and available funds. It is anticipated that approximately 8 awards will be made each round.  Funding can be requested for faculty salary support, support staff, supplies, and travel to a single domestic scientific meeting.  Faculty at all levels of appointment are eligible, and balance among the program awardees will be sought.

    

2. Retreats: Support is available for multidisciplinary retreats (at CCHMC or off-campus) for up to $3,000/retreat. Retreats should have a goal of developing or accelerating an outcomes research agenda within or between Divisions or Departments. Proposals should include a health services and/or quality improvement research focus and include participants with outside expertise or experience in these areas if needed.  Funds are contingent upon matching funds (1:1) derived from other resources (clinical or research divisions). Applications for retreats are accepted at any time and should be emailed to robert.kahn@cchmc.org.

    

6.      Outcomes Research Awardee Activities: An overarching goal of the grants mechanism is to foster a community of researchers focused on cutting edge outcomes research at CCHMC. Researchers should focus on specific disease outcomes wherever possible.  Such a research community will have ties that cut across the Divisions and programs that currently conduct outcomes related research.  To this end, awardees will be required to attend an annual symposium within the institution in which research in progress and completed research will be presented in poster or platform format.  Additional activities may include participation in "work in progress" seminars outside the applicant's usual research meetings, participation in jointly sponsored seminars, and additional network building activities.   These awards and the related activities have subsequent NIH or foundation funding and publications as their anticipated outcomes.

7.      Eligibility: Applications will be accepted from all faculty of Cincinnati Children's Hospital Medical Center, including patient services, health outcomes and other health care faculty with advanced degrees (M.D., Ph.D., M.D.-Ph.D., or equivalent). Clusters of investigators spanning disciplines and programs made up of basic and clinical faculty are strongly encouraged.

8.      Process: The initial application will consist of a 2 page Letter of Intent (LOI). The LOI will be screened to examine if the proposed research project supports the goals of the Health Services Matrix. The screening process will be performed by a multidisciplinary group representing established outcomes researchers at CCHMC. Following the initial screening, an invitation will be sent to investigators to submit the full application.

9.      Letter of intent: For research proposals, the LOI consists of the application face page and 1-2 pages of the hypothesis and specific aims page. It should also include a brief description of the research design and methods. For a proposed retreat, the LOI should include the face page and 1-2 pages describing the purpose and anticipated outcomes of the retreat, likely attendees (categories of people, expertise), proposed major speakers, and meeting format and location (CCHMC or off-site).  All LOI applications must be submitted by email to amy.flanary@cchmc.org. An email confirmation of receipt will be returned to the applicant.  Research proposal LOI's must be received by 5 pm on October 1, 2007.  Retreat LOI's can be submitted at any time.

10. Signatures: The signature of each primary investigator is sufficient in the Letter of Intent initial application. The signatures of all investigators and their respective division chiefs or department chairs are required for the full application.

11. Letter of Support: Full applications must include a letter of support from the primary applicant's Division chief or chairperson. Included in the letter of support must be a statement regarding the priority of the research proposal for the division, particularly as it relates to Divisional focus and resources.   

Required format: Applications must also be submitted electronically (except letter of support, unless it is also available electronically). Send a pdf file of assembled proposal to amy.flanary@cchmc.org. Application forms (modified from PHS 398) are attached.  Proposals must be submitted in single spaced text, one-half inch margins, and no smaller than an 11-point font. Arial or Helvetica typeface is preferred. The primary applicant's name must appear in the upper right hand corner of each page. Proposal text must be limited to five pages (items 9-13 below, including figures but excluding references). Standard PHS 398 forms for budget, biosketch, other support, and resources may be used and may be submitted as separate files.  Research proposal applications will be due by 5 p.m. on November 19^th, 2007.

12. Research proposal instructions:

1. Face page

    

2. Abstract

    

3. Tables of contents

    

4. Detailed Budget (use PHS 398 form provided).  Separate budget pages must be done for each fiscal year as FUNDS CANNOT CARRYOVER. The proposed project  can begin January 1, 2008 or July 1, 2008.  Those projects beginning in January 2008 will cross over three fiscal years over the 24 month period (FY08-FY10).  A separate budget page must be done for each fiscal year.  (Of note, renewal for a second year – and release of those funds - will be based on progress after the first 12 months.)

    

5. Budget justification

    

6. Biosketch(es) (include PI and key co-investigators; use PHS 398 form)

    

7. Other grant support for PI (PHS 398 form)

    

8. Resources (PHS 398 form)

    

9. Hypothesis and Specific Aims

    

10. Background and Significance

     

11. Preliminary Results or, if 2^nd year renewal, Progress Report

     

12. Research Design and Methods

     

13. Clear statement of how the project will lead to a direct impact on child/family outcomes, experiences, or value, and any next steps required to ensure or amplify that impact. The project goals must clearly advance the missions of CCHMC (http://www.cincinnatichildrens.org/about/corporate/mission.htm )  and the Health Services Matrix (http://www.cincinnatichildrens.org/research/project/hsr/) in a timely and efficient way.

     

14. Project Timeline and Anticipated Deliverables

     

15. Statement regarding human subjects

     

16. Literature cited

     

17. Consortium/Contractual Arrangements (if applicable)

     

18. Letter of support from division chief or department chair

     

19. Letters of support from key collaborators or consultants

     

13. Composition of retreat proposal. Applications for support of a retreat should include:

1. Face page

    

2. Purpose and relationship to health services and quality improvement research

    

3. Anticipated outcomes of retreat

    

4. Budget (PHS 398 form provided)

    

5. Anticipated attendees (categories of people, and expertise)

    

6. Format of meeting

    

7. Proposed major speakers (including those external to institution)

    

8. Location

    

9. Duration and timing of proposed retreat

    

10. Source of matching funds

     

11. Letter documenting source of matching funds (may be included in #9)

     

12. Letter of support from division chairperson

     

14. Proposal evaluation criteria

Outcomes researchers from CCHMC, the University of Cincinnati and/or external organizations will conduct a review of each full grant proposal. Proposals will be evaluated along dimensions similar to those of other CCHMC internal awards and NIH awards.  These include the proposal's significance, innovation, approach, generalizability, investigator, mentoring/research environment, human subjects issues, and budget.  Projects with a high likelihood of addressing outcomes of targeted diseases/conditions are desired and such a project must be clearly linked to improvements in disease specific outcomes.  Projects involving diseases likely to receive expanded attention in EPIC will also be a priority.  Projects addressing larger systems of health care delivery will be judged by similar criteria.  In all cases, an early impact on health care quality and/or health outcomes will be viewed very positively..