BUILDING THE EVIDENCE TO PROMOTE BIOTERRORISM AND OTHER PUBLIC HEALTH 
EMERGENCY PREPAREDNESS IN HEALTH CARE SYSTEMS

RELEASE DATE:  May 30, 2003

PA NUMBER:  PAR-03-130 (see Notice of Deactivation NOT-HS-04-008)

CFDA NUMBER:  93.226

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

APPLICATION RECEIPT DATES:  July 17, 2003, January 14, 2004, January 14, 2005, 
and January 17, 2006

This Program Announcement expires on August 27, 2004 per Notice of 
Deactivation NOT-HS-04-008.

THIS PA CONTAINS THE FOLLOWING INFORMATION:

o   Purpose of the PA
o   Research Objectives
o   Mechanism(s) of Support
o   Eligible Institutions
o   Individuals Eligible to Become Principal Investigators
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 
o   References

PURPOSE OF THE PA

The Agency for Healthcare Research and Quality (AHRQ) announces the 
availability of 1-2 year (maximum 2 years) research grants that will 
examine and promote the health care system's readiness for a 
bioterrorist event and other public health emergencies through the 
development of new evidence, tools and models.  In light of recent 
events in the U.S., there is considerable urgency to develop a public 
health infrastructure that is prepared to respond to acts of 
bioterrorism and other public health emergencies. AHRQ recognizes that 
community clinicians, hospitals, and health care systems have essential 
roles to play in this infrastructure. To inform and assist these groups 
in meeting the health care needs of the U.S. population in the face of 
bioterrorist threats and other public health emergencies, AHRQ intends 
to support research that emphasizes the following research objectives: 
(1) Emergency preparedness of hospitals and health care systems for 
bioterrorism and other public health emergencies; (2) Enhanced capacity 
needs of ambulatory care, home and long term care, care of psycho-
social consequences, and other related services during and after a 
bioterrorist event and other public health emergencies; (3) Information 
technology linkages and emerging communication networks to improve the 
linkages between the personal health care system, emergency response 
networks and public health agencies; (4) Novel uses of health care 
system training strategies that can  prepare community clinicians to 
recognize and manage a bioterrorist event and other public health 
emergencies.

RESEARCH OBJECTIVES
 
The mission of the Agency for Healthcare Research and Quality (AHRQ) is 
to support and conduct research that improves the outcomes, quality, 
access to, and cost and utilization of health care services.  AHRQ 
achieves this mission through health services research designed to: (1) 
improve clinical practice, (2) improve the health care system's ability 
to provide access to and deliver high quality, high-value health care, 
(3) provide policymakers with the ability to assess the impact of 
payment and organizational changes on outcomes, quality, access, cost 
and use of health care services. In doing so, AHRQ seeks to identify 
and respond to the information needs of consumers, patients, 
clinicians, and other providers, institutions, plans, purchasers, and 
Federal and State policy-makers, and to provide them the information 
they need to make evidence-based decisions.

AHRQ's investment in bioterrorism and other public health emergencies 
preparedness research recognizes that community clinicians, hospitals, 
and health care systems have essential roles in the public health 
infrastructure. These research investments are intended to complement 
the department's investments through the CDC and HRSA programs. The 
application of health services research and health system research to 
the area of bioterrorism and other public health emergency preparedness 
is a relatively new area of inquiry.  AHRQ's particular interest in 
bioterrorism and other public health emergency preparedness research 
focuses on the role of the health care system in preparing for and 
responding to bioterrorism other public health emergencies.  
Specifically, these projects will highlight issues of health care 
system preparedness and coordination between public health and health 
care systems. This is an emerging field in need of researchers with 
health services research skills that can be applied to bioterrorism 
other public health emergency preparedness research. For example, while 
health services research has examined hospital capacity and throughput, 
there has been limited application of these techniques to surge 
capacity as it relates to bioterrorism and other public health 
emergency preparedness.

Although the grants will focus broadly upon the emergency preparedness 
of health care systems, AHRQ encourages particular attention to the 
preparedness of these systems with regard to specific priority 
populations.  These populations include children, residents of inner-
city areas and rural areas (including frontier areas); low income 
groups; minority groups; women; 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.  For many 
of these groups, there is limited information about potential 
differences in the detection and treatment of bioterrorism-related 
illnesses.

AHRQ also recognizes the difficulty in conducting research on actual 
bioterrorist events.  As a result, many of the proposed projects will 
involve theoretical and systemic modeling.  However, special emphasis 
should also be placed upon the real-world application of these models 
through exercises and demonstrations. These research grants will 
address pressing national concerns about the health care system's 
preparedness for bioterrorism and other public health emergencies.  For 
that reason, 1-2 year grants will be supported with the expectation of 
rapid turnaround and the timely dissemination of results. Insert 
language from partnerships grants re: coop agreements and 
dissemination?  Therefore, the total project period for an application 
submitted in response to this PA may not exceed two years.  Grants 
funded in response to this program announcement will be funded in one 
year budget periods.

Background

The anthrax incidents of October 2001 and SARS 2003 quickly illuminated 
the challenges that faced our public health and hospital systems and 
highlighted the need for a rapid response in building up the public 
health infrastructure. Additionally, the need for comprehensive plans 
for hospital preparedness, better coordination of communication 
systems, and real time information networks between front line 
providers and local health departments were apparent and urgent.

Recent studies have demonstrated that the preparedness and 
infrastructure of hospitals and the public health system are inadequate 
to deal with a bioterrorist attack (Inglesby, Khan, Garrett, Wetter).  
One study found that the majority of primary care providers do not feel 
prepared to diagnose and manage a bioterrorist event (Chen).

As a result, there has been heightened awareness and responsiveness of 
many groups over the recent months. AHRQ has been working with the 
Department of Health and Human Services' Office of Public Health and 
Emergency Preparedness on activities that capitalize on the unique 
expertise and abilities of health services researchers to identify and 
evaluate strategies for enhancing the intersection of health care 
system needs and resources with public health infrastructure.

AHRQ Evidence-Based Practice Center (EPC) researchers at Johns Hopkins 
University have reviewed and reported on the most effective means for 
training physicians for bioterrorism and other public health emergency 
preparedness.  An Integrated Delivery System Research Network partner 
at Weill Medical Center designed a model for distributing medications 
in response to bioterrorist events that was put into place in New York 
City shortly after the anthrax incidents. AHRQ hopes to build upon the 
success of these projects by bringing health services research 
expertise to the problems of bioterrorism other public health emergency 
preparedness, and public health infrastructure. 

At the same time, emphasis is being placed upon 'dual use' 
technologies.  'Dual use' refers to systems of care, tools, or 
technologies that, while offering proven benefit in bioterrorism and 
other public health emergency preparedness, are also utilized in the 
everyday delivery of health care.  Examples include the use of a pre-
existing asthma surveillance system to help detect bioterrorist events, 
or the enhancement of current natural disaster warning systems to 
improve communication between clinicians and the public health system.

Objectives and Scope of Activity:

AHRQ seeks bioterrorism and other public health emergency preparedness 
projects that address these specific priority research areas: (1) 
Emergency preparedness of hospitals and health care systems for 
bioterrorism and other public health emergencies; (2) Enhanced capacity 
needs of ambulatory care, home and long term care, care of psycho-
social consequences, and other related services during and after a 
bioterrorist event and other public health emergencies; (3) Information 
technology linkages and emerging communication networks to improve the 
linkages between the personal health care system, emergency response 
networks and public health agencies; (4) Novel uses of health care 
system training strategies that can  prepare community clinicians to 
recognize and manage a bioterrorist event and other public health 
emergencies.

(1)   Emergency preparedness of hospitals and health care systems for 
bioterrorist events and other public health emergencies.

The national health care system's ability to mobilize resources for 
surge capacity has become increasingly important since the anthrax 
cases in fall of 2001 and the recent advent of SARS. Readiness to 
respond to mass casualties expected from a large-scale bioterrorist 
attack and other public health emergencies is unique in its 
intersection of public health, clinical medicine and emergency 
management planning.  It is critical that we examine the outcomes and 
cost of models of hospitals, hospital emergency departments, and health 
system readiness, including any proposed models of regional care. The 
lack of surge capacity in our current health care system is the primary 
issue for any locale dealing with casualties from a bioterrorist attack 
and other public health emergencies.  In selected areas, the 
availability of nurses, pharmacists and other members of the health 
care team have been described in crisis, leaving some systems of care 
with little to no capacity to respond to bioterrorist events and other 
public health emergencies.  Currently, little evidenced-based guidance 
has been available to assist metropolitan and non-metropolitan areas in 
planning for the provision of such expanded capacity.  Given the 
current financial constraints confronting health care institutions and 
the current shortage of health care personnel, there is an enormous 
need for creative model development to address these looming problems. 

Surge capacity has three major aspects: facilities, equipment, and most 
importantly personnel. As issues of capacity are examined, there is a 
need to study the collaborative role of current systems not typically 
connected to networks of care such as the DoD and VA facilities and in 
some regions for-profit and not-for-profit institutions.  Studies are 
needed to examine the impact of market forces on capacity and its 
effects on regional models of health care system preparedness. Staffing 
issues of surge capacity also need to be examined for various health 
care settings including hospital inpatient systems, emergency 
departments, primary care practices, alternative care sites, home care 
and long term care.

In addition to the issues around surge capacity, adequate risk 
communication is vital for an effective response to bioterrorism and 
other public health emergencies.  Risk communication is a science-based 
approach for communicating effectively in high-concern situations.  
There is a need for studies and models of good risk communication that 
are designed to meet the needs of diverse audiences in the event of a 
bioterrorist attack and other public health emergencies. For example, 
the health care workforce and first responders involved in a 
bioterrorist event and other public health emergencies need customized, 
well-organized information.  Similarly, effective communication between 
designated spokespersons and the general public must be studied and 
implemented.

Illustrative questions of interest under this priority area include:

o   What are the effects and costs of system readiness efforts on 
hospitals, hospital emergency departments and health systems?
o   Which indicators in regional care models are suggestive of 
preparedness?
o   How have regional care models improved public health preparedness 
and at what cost?
o   What staffing and personnel models can be employed to meet the 
requirements of surge capacity in the event of a bioterrorist event and 
other public health emergencies?
o   How can models of mass prophylaxis and vaccination be adapted for 
special populations such as children, elderly, and the homebound, 
homeless, disabled?
o   How does the health care system communicate risk to providers and 
the public?  How can the effectiveness of that communication be 
measured?
o   What are the best means for risk communication? How will these 
models differ for the general public and health care provider 
communities?
o   How can current public health emergency communication systems be 
utilized for bioterrorism response?
o  What kind of intelligence would be most helpful pre , during and 
post event? and for what audience?
o  How would providers use that information?o What is the best vehicle 
for communication and with what groups are the various models most 
effective?

(2)   Enhanced capacity needs of a broad range of health care settings, 
including hospitals, emergency departments, ambulatory care, home and 
long term care, care of psycho-social consequences, and other related 
services during and after a bioterrorist event and other public health 
emergencies.

Most preparedness activities to date have focused on the immediate 
needs for mass casualty events within emergency departments and 
hospitals. However, surge capacity issues impact all health care 
settings, including ambulatory care, home and long term care. In 
addition, many of the settings most in need of study are already 
affected by shortages and financial constraints.  For example, 
ambulatory care settings may experience increased volume during the be 
involved initially in the mass casualty event, as well as a significant 
n increases in post event visits for both medical and psycho social 
evaluationssurge capacity. The problem of increased volume of 
individuals that must be accommodated when current capacity is exceeded 
at the emergent level is compounded by the post event care needs of 
those victims that will stress an overburdened segments of the system.  
Similarly, home care and long term care settings, which are already 
under strain, may be called upon to provide extended medical and psycho 
social care to persons affected by bioterrorism and other public health 
emergencies.  Staffing issues and personnel demands, as well as cost 
implications, including reimbursement, need to be critically examined 
in variouswill be vital to these settings as enhanced capacity is 
requiredneeded.

In the event of a bioterrorist attack and other public health 
emergencies, health care workers will be taxed to stretch their time 
and expertise and will most likely assume a heightened level of risk 
for themselves and their families.  The psycho-social consequences of a 
bioterrorist event and other public health emergencies upon mental 
health care resources, health care utilization, and cost modeling, have 
not been studied.  The redeployment of adequately trained mental health 
personnel in the case of a bioterrorist event or other public health 
emergencies will be vital, in addition to the role of cross trained 
personnel who are prepared to substitute and augment services for 
limited qualified mental health personnel.  Examination and development 
of models for training, mobilization and management of individuals 
experiencing bioterrorism-related, or other public health emergencies 
will be critical.

Illustrative questions of interest under this priority area include:

o  What is the role of various elements of the health care system in 
meeting the surge capacity demands in a regional model of care?
o  What are the barriers and demands for surge capacity on home care 
and long term care in a post event scenario of mass casualties?
o  What are the economic  implications to rural health care systems in 
finances, personnel, and equipment in a bioterrorist event with mass 
casualties and other public health emergencies?
o  What models for cooperation are effective in regional models that 
may include school, hotels,  and community health centers as alternate 
sites to care for victims of a bioterrorist event?
o  What is the capacity of existing special care systems to be enhanced 
and redesigned for use in the case of a bioterrorist event and other 
public health emergencies, such as poison control and, burn teams?, 
neonatal networks etc.
o  What models can be developed to deploy adequately trained mental 
health professionals to areas of need in the event of a bioterrorist or 
mass casualty event?
o  What are the financial and regulatory incentives for efficient 
models of regionalized health care services for care following a 
bioterrorist event and other public health emergencies?

(3)   Information technology linkages and emerging communication 
networks to improve the linkages between the personal health care 
system, emergency response networks and public health agencies.

A key issue in the Nation's capacity to respond to the threat of 
bioterrorism and other public health emergencies will depend on the 
ability of clinicians, health care facilities, and public health 
officials to collect, analyze, manage, and communicate information 
rapidly, accurately, and effectively. Information and communication 
technologies (IT) can play a vital role in assisting clinicians and 
public health officials to detect and respond effectively to 
bioterrorism threats and other public health emergencies. These 
investments in IT are ultimately intended to assure a vital public 
health information network or to assure that such a network includes 
effective linkages with clinicians and health care settings. 
Unfortunately, the lack of a national interconnected health information 
infrastructure presents a significant barrier to realizing many of the 
potential benefits offered by IT.

There are a number of IT systems currently in use in the clinical and 
public health sector in the United States.  However, the majority of 
them were not designed for detecting or managing bioterrorism events or 
other emerging public health emergencies. In the recent study by the 
University of California San Francisco-Stanford Evidence-Based Practice 
Center (EPC), the investigators identified 217 IT systems of potential 
use by clinicians and public health officials in the event of a 
bioterrorist attack. They included 90 surveillance systems, 55 
detection systems, 26 communication systems, 23 diagnostic systems, 18 
management systems, and 7 systems that integrate surveillance, 
communication, and command and control functions. The investigators 
found that most of these systems were not designed specifically for 
bioterrorism, but instead were created for detecting and managing 
naturally occurring illnesses such as influenza.  In addition, many of 
the systems had not been evaluated rigorously for their effectiveness 
in dealing with bioterrorism. In fact, many had not even been evaluated 
for their originally intended purpose.  Most of the evaluations that 
did exist were limited in scope - they looked at the usefulness of the 
systems for their intended purpose, but they did not provide 
information about their effects on important outcomes. Despite these 
limitations, many of the systems were thought to be potentially useful 
for responding to bioterrorism threats, especially if they provided 
"dual use" functionality - i.e. they were designed to serve clinical or 
public health purposes, but they could also be adapted to respond to 
bioterrorism threats.

IT can play a central role in the development of communication systems 
for providing bidirectional information flow in real-time between 
front-line clinicians and local, state, regional and national public 
health departments. The ability to collect, analyze and communicate 
this information is crucial for early detection of possible 
bioterrorist threats and other public health emergencies and can help 
facilitate the rapid mobilization of appropriate personnel and 
resources in response to such a bioterrorist event and other public 
health emergencies. The use of clinical decision support systems can 
also help clinicians, public health officials, and the public respond 
to perceived or actual threats by improving their knowledge, decision-
making, and management abilities.

Although IT offers immense potential as a key component of the Nation's 
armamentarium for dealing with the threat of bioterrorism and other 
public health emergencies, large gaps exist in current technologies and 
the application of these technologies to maximize the benefits of IT to 
improve public health preparedness. As demonstrated by the EPC report, 
further research is needed to learn the most effective and efficient 
ways to use IT to improve our Nation's capacity to respond to the 
threat of bioterrorism. IT applications that are designed to assist in 
the detection, diagnosis, reporting, treatment, communication, and 
overall management of potential and real bioterrorism events and other 
public health emergencies must be developed and evaluated with respect 
to their impact on important outcomes.

Areas for further research include: evaluation of current systems to 
determine the best ways to leverage existing technology for 
bioterrorism and other public health emergency preparedness; 
development and evaluation of systems to improve surveillance and 
detection of possible threats; development and evaluation of diagnostic 
and treatment decision support systems to assist front-line clinicians, 
health care facilities, and public health officials, including 
innovative ways to provide fast and dependable communication links 
between local, state, regional, and national entities; use of automated 
systems that can gather important information from existing information 
sources; use of handheld devices to assist clinicians and public health 
officials respond to bioterrorism and other public health emergences; 
and the use of smart IT systems with analytical capabilities that are 
integrated into the clinical workflow and do not require redundant data 
input.
 
Illustrative questions of interest under this priority area include:

o   How can existing IT systems such as hospital bed and emergency 
department  monitoring systems  be enhanced to and identify surge 
capacity and regional assets in the event of a bioterrorist attack and 
other public health emergencies?
o   What are the most effective models of communication networks that 
enhance the health care teams ability to be involved in early 
recognition, diagnosis and treatment of victims of a bioterrorist event 
and other public health emergencies.
o   What models can be designed that are effective at linking providers 
across the healthcare system with public health and the private health 
care system?

4)   Novel uses of health care system training strategies that can  
prepare community clinicians to recognize and manage a bioterrorist 
event and other public health emergencies.

Healthcare providers primary care clinicians in the community are a 
vital part of the health care system's response to bioterrorism and 
other public health emergencies.  In particular, primary care and other 
community clinicians are important elements in the front-line response 
to those types of events. While there are data that suggest that 
primary care providers do not feel adequately prepared to deal with 
bioterrorist events, there is little information about effective 
training strategies that can prepare clinicians for such events. There 
is also limited information about other training issues relate to 
effective models of cross training of specialty physicians and 
specialty trained nurses for care of mass casualties in a bioterrorist 
event and other public health emergencies. There is a need for research 
on effective models of training and data systems to track the trained 
workforce are needed.  In addition, further research is needed on how 
to and address issues of mobilizeing this healthcare workforce in the 
event of an attack.  AHRQ is not seeking specific educational curricula 
but rather novel models and demonstrated strategies for training that 
can be implemented by health care systems.

Illustrative questions of interest under this priority area include:

o   What training models are most effective in preparing healthcare 
personnel to care for rare public health events and bioterrorist 
agents?
o   What models of workforce tracking and mobilizations can be employed 
within a region or state level?
o   What are the lessons learned from disaster drills, table top 
exercises, formal classes, simulated events, that inform our effective 
planning for essential health care personnel and first responders?  Are 
these exercises cost-effective?
o   Are computer simulations a cost-effective method for bioterrorism 
and other public health preparedness?
o What information technologies and decision support tools are 
effective in training and enhancing the knowledge and skills of health 
care providers and first responders?

MECHANISM OF SUPPORT
 
This PA will use the cooperative agreement (U01) award mechanism, with 
this assistance mechanism, substantial AHRQ programmatic involvement 
with the awardees is anticipated during performance of the activity.  
The dominant role and prime responsibility for the activity resides 
with awardee(s) for the project as a whole, although specific tasks and 
activities in carrying out the studies will be shared among the 
awardees and the AHRQ Program Official(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 describing awardee and AHRQ rights and 
responsibilities.  The anticipated award date is September 2003. 

AHRQ does not use the Modular Grant Application and Award Process. 

ELIGIBLE INSTITUTIONS

You may submit (an) application (s) if your institution has any of the 
following characteristics:

o   For Profit or Non-profit organizations
o   Domestic and foreign
o   Public and private non-profit institutions, such as universities, 
clinics, colleges, hospitals, and professional associations
o   Units of State and local governments
o   Faith-based and community-based organizations
o   Tribes and Tribal Organizations

Practice-based networks, such as Integrated Delivery System Research 
Networks or PBRN, are encouraged to apply.

Organizations described in section 501(c) 4 of the Internal Revenue 
Code that engage in lobbying are not eligible.

Important Note: Under recent enacted reauthorization legislation, AHRQ 
is authorized to enter into cooperative agreements with for-profit 
organizations as well as with public and not- for profit entities. 
Thus, for-profit organizations are eligible to respond to this notice 
with applications for cooperative agreements. Such applications will be 
administered in accordance with Subpart E of 45 CFR Part 74 and 42 CFR 
part 67 Subpart A. This latter regulation has not yet been amended to 
reflect these changes in Agency name and authority. (See December 6, 
1999, AHRQ reauthorization at http://www.ahrq.gov.

Applicants are required to seek approval from AHRQ staff at least 3 
weeks prior to the anticipated submission of any application requesting 
$500,000 or more in direct costs for any year.  If staff is contacted 
less than 3 weeks before submission, there may be insufficient time to 
make a determination about assignment prior to the intended submission 
date. Applicants proposing grants for $500,000 or more for any year 
should read the "Advanced Approval of Unsolicited Applications That 
Request More Than $500,000 Direct Costs in Any One Year," published in 
the NIH Guide for Grants and Contracts on August 22,1997 
http://www.ahrq.gov (under Funding Opportunities).

INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS

Any individual with the skills, knowledge, and resources necessary to 
carry out the proposed research is invited to work with their 
institution or organization to develop an application for support.  
Individuals from under represented racial and ethnic groups as well as 
individuals with disabilities are always encouraged to apply for AHRQ 
programs. 

SPECIAL REQUIREMENTS

Studies under this PA are expected to produce evidence, tools, and 
models that can be integrated into preparedness initiatives at the 
national, state, and local level.  Applicants should be concrete in 
describing 1) decision making audiences most interested in the proposed 
research and 2) how applicants anticipate their results being used and 
by what audiences. The Agency recognizes that rural communities, which 
historically have had limited public health infrastructure, small 
numbers of providers and volunteer emergency medical services ( EMS), 
are considered most vulnerable and least able to respond. The ability 
of local first responders, public health agencies and providers to 
respond to an event is critical. Therefore, AHRQ recognizes the unique 
burden preparedness activities and expectations place on rural 
communities and will strongly encourage researchers to address rural 
considerations in all proposal as appropriate.  Dissemination and 
implementation strategies should not be limited to publication in peer- 
reviewed journals, but should address mechanisms and vehicles to 
disseminate, implement, and communicate evidence, tools and models with 
appropriate national, state, and local entities, professional 
associations and other parties engaged in bioterrorism preparedness 
activities.

TERMS AND CONDITIONS OF AWARD  

These special Terms of Award are in addition to and not in lieu of 
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, 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.   [Part 
92 applies when State and local governments are eligible to apply as a 
"domestic organization."]
 
Consistent with the U01 concept defined under Mechanism of Support, the 
dominant role and prime responsibility for the activity 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 and the AHRQ Program Official(s).
 
Awardee Rights and Responsibilities

Awardees have primary authorities and responsibilities to define 
objectives and approaches, and to plan, conduct, analyze, and publish 
results, interpretations, and conclusions of their studies.
  
Awardees will retain custody of and have primary rights to the data 
developed under these awards, subject to Government rights of access 
consistent with current HHS, PHS, and AHRQ policies.

AHRQ Staff Responsibilities

The AHRQ Program Official(s) will have substantial scientific 
programmatic involvement in directing the grant activities to address 
priority issues of AHRQ and the U.S. Department of Health and Human 
Services regarding bioterrorism and other public health emergency 
preparedness initiatives. AHRQ staff will coordinate grantee activities 
with the Health Resources Services Administration Hospital Preparedness 
Program staff and other relevant DHHS agencies and provide technical 
assistance to the grantees on identifying key mechanisms, vehicles, and 
partners to disseminate, implement, and communicate the evidence, tools 
and models from these projects.  The dominant role and prime 
responsibility for the activity 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 and the AHRQ Program 
Official(s). AHRQ program official(s) will also facilitate the 
acquisition of appropriate data sets as needed.  AHRQ reserves the 
right to terminate or curtail the study (or an individual award) in the 
event of any major delays or failure to adhere to the overall study 
design that may result in the failure to successfully produce the 
models, tools, or reports intended, or any human subject ethical issues 
that may dictate a premature termination.
 
Collaborative Responsibilities

When appropriate, AHRQ expects award recipients to work with each other 
to identify collaborative activities that contribute toward enhanced 
preparedness initiatives.

Arbitration

Any disagreement that may arise on scientific/programmatic matters 
(within the scope of the award), between award recipients and AHRQ may 
be brought to arbitration.  An arbitration panel will be composed of 
three members one selected by the individual awardee in the event of an 
individual disagreement, a second member selected by AHRQ, and the 
third member selected by the two prior selected members.  This special 
arbitration procedure in no way affects the awardee's right to appeal 
an adverse action that is otherwise appealable in accordance with the 
PHS regulations at 42 CFR Part 50, Subpart D and HHS regulation at 45 
CFR Part 16.

o   Priority Populations

The Agency's authorizing legislation (refer to http://www.ahrq.gov 
(Under Funding Opportunties) 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 RFA should address 
attention to and potential benefits for these priority populations.  

o   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) when 
articles from their studies are accepted for publication in the 
professional literature.  Grantees and contractors should also discuss 
any 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 or 
contractor's institutions.  In cases when products are created (such as 
annual or final reports, Web-based tools, CD-ROMs), grantees and 
contractors 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.

WHERE TO SEND INQUIRIES

We encourage your inquiries concerning this PA and welcome the 
opportunity to answer questions from potential applicants.  Inquiries 
may fall into three areas: scientific/research, peer review, and 
financial or grants management issues:

o   Direct your questions regarding programmatic issues, including 
information on the inclusion of women, minorities, and children in 
study populations to:

Sally Phillips, RN, PhD
Center for Primary Care Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Telephone: 301-427-1571
FAX: 301-427-1595
Email: sphillip@ahrq.gov

o   Direct your questions about peer review issues to:

Carl Ohata, PhD
Office of Research Review, Education, and Policy
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD  20850
Telephone:  (301) 427-1549
FAX: (301) 427-1561
Email: cohata@AHRQ.gov

Direct your questions about financial or grant management matters to:
 
George Gardner
Grants Management Specialist
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD  20850
Telephone: (301) 427-1453
FAX: (301) 427-1464
Email: ggardner@ahrq.gov

SUBMITTING AN APPLICATION

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

The PA title and number must be typed on line 2 of the face page of the 
application form and the YES box must be marked. 

APPLICATION RECEIPT DATES:  Applications submitted in response to this 
program announcement will be accepted at the following application 
deadlines:  July 17, 2003, January 14, 2004, January 14, 2005, and 
January 17, 2006. 

This Program Announcement expires on July 17, 2007 unless reissued.

SUPPLEMENTAL INSTRUCTIONS:

Applicants are encouraged to make use of AHRQ'S Healthcare Cost and 
Utilization Program (HCUP).  The HCUP includes databases covering 1988-
1997, with 1998 and 1999 data available in 2001. These all-payer 
databases were created through a Federal-State-industry partnership to 
build a multistate healthcare data system. The main HCUP databases 
contain discharge-level information for inpatient hospital stays in a 
uniform format with privacy protections. The Nationwide Inpatient 
Sample (NIS) is a nationwide probability sample of about 1000 
hospitals. The State Inpatient Databases (SID) contain inpatient 
records for all community hospitals in 22 states. Other HCUP databases 
contain ambulatory surgery data from nine states. These databases can 
be directly linked to county-level data form the Health Resources and 
Services Administration's Area Resource File and to hospital-level data 
from the Annual Survey of the American Hospital Association. 

This does not preclude the use of secondary data sources or primary 
data collection.

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 three 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)
 
At the time of submission, two additional copies of the application, 
labeled "Advanced Copy (s)" must also be sent to:

Sally Phillips, RN, PhD
Center for Primary Care Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Telephone: 301-427-1571
FAX: 301-427-1595
Email: sphillip@ahrq.gov

SPECIAL APPLICATION REQUIREMENTS:

Application Preparations:

1)   Biographical Sketches: In addition to general biographical 
information, applicants should describe the relevant experience and 
activity of the researchers to this specific research area of study.

2)   Research Plan: In addition to the overall elements of the research 
plan, applicants should address:

o   how the researcher/s have direct experience in the field of study 
described in this project or how their previous experience will 
transfer to this new area of research?
o   the decision making audiences most interested in the proposed 
research.
o   how applicants anticipate their results being used and by what 
audience?
o   a detailed plan for the mechanisms and vehicles to disseminate, 
implement,  and communicate evidence, models, and tools with 
appropriate national, State, and local entities, professional 
associations, and other parties engaged in bioterrorism and other 
public health  preparedness activities.

APPLICATION PROCESSING:   Applications must be received by the receipt 
dates listed in the heading of this PA.  If an application is received 
after that date, it will be returned to the applicant without review.  
The CSR and AHRQ will not accept any application in response to this PA 
that is essentially the same as one currently pending initial review 
unless the applicant withdraws the pending application.  The CSR and 
AHRQ will not accept any application that is essentially the same as 
one already reviewed.  This does not preclude the submission of 
substantial revisions of applications already reviewed, but such 
applications must include an Introduction addressing the previous 
critique.

Although there is no immediate acknowledgment of the receipt of an 
application, applicants are generally notified of the review and 
funding assignment within 8 weeks.

Applicants are encourage to read all PHS Forms 398 instructions prior 
to preparing an application in response to this PA.  The PHS 398 type 
size requirements (p.6) will be enforced rigorously and non-compliant 
applications will be returned.  It is very important to note that 
limitations on number of pages and size of font must be observed; 
applications violating these requirements will be returned without 
review.

Institutional Review Board (IRB) approval of human subjects is not 
required 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)
 
The PA is also 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 the PA number).  The PA 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.

TECHNICAL ASSISTANCE:

AHRQ encourages applicants to take advantage of a technical assistance 
conference call sponsored by AHRQ program staff.  This conference call 
will be held on July 2, 2003, 1-3 p.m.  Please contact Kelly Morgan 
kmorgan@ahrq.gov or 301-427-1570, 2 working days prior to the 
conference call. 

Projects will ordinarily not use CMS (Medicare or Medicaid) data 
involving individual identifiers.  Purchase of CMS public-use data, if 
required, should be discussed in the application narrative and included 
in the budget. 

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 AHRQ 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 by the Agency Referral Officer, program staff, and 
grants management staff.  Incomplete and/or non-responsive applications 
or applications not following instructions given in this PA will be 
returned to the applicant by the Agency Referral Officer without 
further consideration.  Applications that are complete and responsive 
to the PA will be evaluated for scientific and technical merit by an 
appropriate peer review group convened in accordance with standard AHRQ 
peer review procedures.  

As part of the merit review, all applications will:

o   Receive a written critique
o   Undergo a 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   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. 
 
(1)   SIGNIFICANCE:  Does your study address an important problem? If 
the aims of your application are achieved, is the proposed work likely 
to result in enhanced preparedness for a significant sector of the 
health care system? Will this project provide federal, state and local 
policy makers, and others participating in the formulation of plans and 
policies for bioterrorism and other public health emergency 
preparedness, with the evidence, models, and tools that will enhance 
preparedness activities?  

(2)   APPROACH:  Are the rationale, preliminary plans, interventions, 
model or tool development methodologies, testing, evaluation and 
disseminations or preliminary plans adequately described, suitably 
evidence-based, technically sound, well integrated, and appropriate to 
the aims of the project?  Does the application acknowledge potential 
problem areas and consider alternative tactics? Will the proposed 
evidence, tools and/or models be relevant to bioterrorism and other 
public health emergency preparedness activities at the national, state, 
and local level?

(3)   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? Does the proposed study team reflect an appropriate array 
of skills for the aims and evaluation and dissemination?  Are the time 
commitment sufficient to accomplish the aims? Are roles clearly 
delineated and complementary?

(4)   ENVIRONMENT:  Does the scientific environment in which your work 
will be done contribute to the probability of success?  Is there 
evidence of institutional support? Is there any affiliation or a plan 
for affiliation of the organization or research team members with  
national, State, or local bioterrorism and other public health 
emergency preparedness partners that can enhance the likelihood of 
successful dissemination of the evidence, models, or tools developed?

(6)   BUDGET:  The proposed project budget and the requested period of 
support in relation to the proposed research questions:?

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

o   PROTECTIONS:  The adequacy of the proposed protection for humans or 
the environment, to the extent they may be adversely affected by the 
project proposed in the application.

o   INCLUSION:  The adequacy of plans to address the need of both 
genders, all racial and ethnic groups (and subgroups), and children as 
appropriate for the aims of the project.  Adequacy of attention to 
other populations of special priority to AHRQ (see discussion on 
Priority Populations in the section on Special Requirements, above, and 
Inclusion Criteria included in the section on Agency policies and 
Requirements, below.)

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 supported-
study that identifies an individual or entity must be treated as 
confidential in accordance with any explicit or implicit promises made 
regarding the possible uses and disclosures of such data. There are now 
civil monetary penalties for violation of this confidentiality statute. 
[42 U.S.C.299c-3(d)] 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. Identifiable patient health information 
collected by grantees under this PA will also be managed in accordance 
with 42 CFR Parts 160 and 164, federal regulations pertaining to the 
privacy of patient-related health information. These privacy 
regulations, developed by the Department of Health and Human Services 
pursuant to the Health Insurance Portability and Accountability Act of 
1996 (HIPAA), are scheduled to be effective and enforceable in April 
2003. These regulations serve to limit the disclosure of personally 
identifiable patient information and define when and how such 
information can be disclosed. Thus, for example, health care plans and 
providers will require either patient authorization of disclosures of 
identifiable information to be made to researchers who are not their 
health care providers or waivers of such authorizations obtained from 
an IRB or Privacy Board (defined in the regulations) upon being 
satisfied that any identifiable health information will be 
appropriately safeguarded by the investigators.  

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/.  The 
applicability and intended means of applying these confidentiality and 
security standards to subcontractors and vendors, if any, should be 
addressed in the application. 

Rights in Data 

AHRQ grantees may copyright unless otherwise provided in grant awards, 
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 project 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. 

AHRQ's Office of Health Care Information wishes to be consulted in 
advance of publication in order to coordinate these issuances with 
other AHRQ dissemination activities. Important legal rights and 
requirements applicable to AHRQ grantees are set out or referenced in 
the AHRQ's grants 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). 

RECEIPT AND REVIEW SCHEDULE

Technical Assistance Conference Call:  July 2, 2003
Application Receipt Dates:  July 17, 2003
                            January 14, 2004
                            January 14, 2005
                            January 17, 2006 
(This Program Announcement expires on July 17, 2007 unless reissued.)
Peer Review Date:  August 2003
Earliest Anticipated Start Date:  September 2003

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o   Scientific merit (as determined by peer review)
o   Availability of funds
o   Programmatic priorities

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 (FAIA) 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 FAIA. If no Federal act is taken, 
having the force and effect of law, in reliance upon an AHRQ supported 
research project, the underlying data is not subject to this disclosure 
requirement and under FAIA, 5 USC 552(b), disclosure of identifiable 
data from such study is exempted from disclosure under "the (b)(3) 
exemption." It is important for applicants to understand the scope of 
this requirement and its limited potential impact on data collected 
with AHRQ support. Proprietary data might also be exempted from FAIA 
disclosure requirements under "the (b)(4) exemption", for example, if 
it constituted trade secrets or commercial information. However, courts 
have generally not regarded a researcher's interest in "his" data as 
proprietary. NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm. 

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-3(c)) 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.

REFERENCES  

1.   Bravata DM, McDonald K, Owens DK. Bioterrorism: use of information 
technologies and decision support system. AHRQ Clearinghouse. 2001.

2.   Catlett C, Perl T, Jenckes MW, Robinson KA, Mitchell D, Hage J, 
Fuererstein CJ, Chuang S, Bass E. Evidence report on training 
clinicians for public health events relevant to bioterrorism 
preparedness. AHRQ Clearinghouse. 2001.

3.   Chen FM, Hickner J, Fink KS, Galliher JM, Burstin, H. On the front 
lines: family physician's preparedness for bioterrorism. J. Fam Pract 
2002;51:745-50.

4.   Garrett LC,. Magruder C, Molgard CA. Taking the terror out of 
bioterrorism: planning for a bioterrorist event from a local 
perspective. J Public Health Manag Pract. 2000;6(4):1-7.

5.   Khan AS, Morse S, Lillibridge S. Public-health preparedness for 
biological terrorism in the USA. Lancet. 2000;356(9236):1179-1182.

6.   Khan AS, Ashford DA. Ready or not–preparedness for bioterrorism. N 
Engl J Med. 2001; 345(4):287-289.

7.   Wetter DC, Daniell WE, Tesser DC. Hospital preparedness for 
victims of chemical and biological terrorism.  Am J Public Health. 
2001;91(5):710-716.


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