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Health Services Research Matrix

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Outcomes Research Awards RFA

A Component of the Health Services Research Matrix
Grant Application Instructions, 2009

Deadlines:

  • Letter of Intent: Friday, October 30, 2009
  • Final applications: Friday, January 8, 2010
  • Notification: March, 2010
  • Funds available: July 1, 2010

You can download a copy of the Outcomes Research Award RFA and the Outcomes Research Award Application.

For questions regarding these instructions please contact April Mack-Williams (april.mack-williams@cchmc.org) or Evie Alessandrini (evaline.alessandrini@cchmc.org).

  1. Background and Purpose
    The goal of the Outcomes Research Awards is to stimulate the development of health services and quality improvement research at Cincinnati Children's Hospital Medical Center and 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 Cincinnati Children's. 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, Cincinnati Children's is most likely to achieve its mission of ensuring the best medical and quality of life outcomes, patient and family experiences and value locally, regionally and nationally.
  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 receive 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 Cincinnati Children's internal grant award mechanisms. Applicants can confer with the leaders 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 (led by Dr. Timothy Cripe) is to stimulate research that bridges from basic science discovery to clinical trials. The Trustee Awards (led by Dr. Chris Karp) 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.
  4. Research Areas of Interest
    Themes are driven by the Cincinnati Children's mission and can be linked to specific diseases or larger systems of care delivery. We have established four new priority areas for funding:
    • New Priority Areas
      1. Safety: e.g., determining whether a change in health care practices reduces wound infections; examining the effect of altered patient handoff procedures on medical errors
      2. Chronic disease management: e.g., studying clinical outcomes improvement from implementation of the chronic disease management guideline
      3. EPIC implementation: e.g., assess the impact of an electronic medical record on disease specific quality of care or outcome indicators
      4. Operational improvements: e.g., testing whether caregiver entry of key medical information (e.g., asthma symptom checklists) improves patient care and flow
    • Medical and Quality of Life Outcomes
      1. Evidence based medicine: e.g., examining the effect of a new disease management guideline on disease outcomes
      2. Quality improvement methods: e.g., evaluating whether a change in care processes reduces variation in disease guideline implementation
      3. 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
      4. Coordination across systems: e.g., evaluating new patient discharge processes to improve information transfer to primary care pediatricians
      5. Clinical informatics: e.g., examining how to help clinicians integrate complex medical information using alternative interfaces on the computer; determining the test characteristics (sensitivity, specificity, negative and positive predictive value) of several different ways of ascertaining medical information in EPIC
      6. Implementation of new technology: e.g., determining how to incorporate new tests (e.g., biomarkers of exposure or disease) into care to improve outcomes
      7. Population impact: e.g., evaluating synergistic community-based and clinical approaches to care for prevalent conditions with complex etiologies (e.g., obesity, asthma)
      8. Prevention: e.g., testing whether stratifying children in well child care leads to a better match between needs and services and improved outcomes
    • Patient and Family Experience
      1. Family centered care: e.g., examining how method of physician rounding affects families’ satisfaction with care
      2. Shared decision making: e.g., evaluating how jointly determined medical decision making affects adherence to the management plan
      3. Enhanced patient access to medical information: e.g., testing different models of access and exchange of information (e.g., email, disease portals) and the impact those models have on patient experience and disease outcomes
    • Value
      1. Decision and cost-effectiveness analysis: e.g., evaluating the cost-effectiveness of a pharmacogenetic approach to drug selection and dosing
      2. Return on investment: e.g., examining whether an enhanced disease management protocol reduces admissions and associated health care costs and who benefits from the return on investment
    • Types of Grants Available
      1. Research Proposals: Grants can be requested for up to 2 years of support, with the second year contingent on a review of research progress. Funding will begin July 1, 2009. The maximum allowable budget is $60,000 per annum. Funds cannot carry over between Year 1 and 2 of the Award. The number of awardees will be determined by the quality of the proposals, the total amount of the requested budgets of sufficiently meritorious proposals and available funds. It is anticipated that up to 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. The maximum Principal Investigator support is 10% of salary per year. 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 Cincinnati Children's 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 e-mailed to robert.kahn@cchmc.org.
  5. 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 Cincinnati Children's. 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 will include participation in “work in progress” seminars outside the applicant’s usual research meetings, participation in jointly sponsored seminars, attendance at events (including visiting professor lectures and grand rounds) sponsored by the HSR matrix and additional network building activities. These awards and the related activities have subsequent NIH or foundation funding and publications as their anticipated outcomes.
  6. Eligibility
    Applications will be accepted from all faculty of Cincinnati Children’s, 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.
  7. Process
    The initial application for research proposals 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 LOI’s will be screened by established outcomes researchers at Cincinnati Children's. Following the initial screening, selected investigators will be invited to submit the full application.
  8. Letter of Intent (Research Proposals)
    The LOI consists of the application face page and 2 pages consisting of the specific aims and hypotheses and a brief overview of the research design and methods. Please address the Letter of Intent to the Outcomes Research Awards Committee.

    All LOI applications must be submitted electronically 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 Friday October 10, 2008.
  9. Signatures
    The signature of the primary investigator is sufficient in the Letter of Intent initial application. The signatures of the lead investigators and their respective division chiefs or department chairs are required for the full application.
  10. 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. Please address letters of support to the Outcomes Research Awards Committee.
  11. Composition of Research Proposal
    Full applications must be submitted electronically. Send a pdf file of the assembled proposal to amy.flanary@cchmc.org. Application forms (modified from PHS 398) are provided and are available online. 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. If you are submitting a revised proposal that was previously submitted, please include a cover letter explaining revisions in response to the prior reviews. Research proposal applications will be due by 5 pm on December 12, 2008.

    Invited research proposals should include:
    • Face Page (check if IRB approved or indicate pending if submitted)
    • Abstract
    • Tables of Contents
    • Detailed Budget (use PHS 398 form provided). Separate budget pages must be done for each fiscal year. Fringe benefits may be included in Direct Costs. Funds will be available July 1, 2009. FUNDS CANNOT CARRY OVER.
    • Budget Justification
    • Biosketch(es) (include PI and co-investigators; use PHS 398 form)
    • Other Support (PHS 398 form)
    • Resources (PHS 398 form)
    • Specific Aims and Hypotheses
    • Background and Significance
    • Preliminary Results, or Progress Report if 2nd year renewal
    • Research Design and Methods
    • 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 Cincinnati Children's and the Health Services Matrix in a timely and efficient way. Include a statement of commitment to participating in HSR matrix sponsored events.
    • Project Timeline and Specific Expected Deliverables (manuscripts, actual changes in clinical care, future grant plans)
    • Statement Regarding Human Subjects
    • Literature Cites
    • Consortium/Contractual Arrangements (if applicable)
    • Letter of Support from division chief or department chair
  12. Composition of Retreat Proposal
    Applications for support of a retreat should include:
    • Face page
    • Purpose and relationship to health services and quality improvement research
    • Anticipated outcomes of retreat
    • Budget (PHS 398 form provided)
    • Anticipated attendees (categories of people, and expertise)
    • Format of meeting
    • Proposed major speakers (including those external to institution)
    • Location
    • Duration and timing of proposed retreat
    • Source of matching funds
    • Letter documenting source of matching funds (may be included in #9)
    • Letter of Support from division chief or department chair
  13. Proposal Evaluation Criteria
    Outcomes researchers from Cincinnati Children's, 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 addressing one of the four priority areas are strongly desired. Projects should be clearly linked to improvements in disease specific outcomes. 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.