Full Text AA-97-001 HEALTH SERVICES RESEARCH ON ALCOHOL-RELATED PROBLEMS NIH GUIDE, Volume 25, Number 41, November 29, 1996 RFA: AA-97-001 P.T. 34 Keywords: Alcohol/Alcoholism Health Services Delivery National Institute on Alcohol Abuse and Alcoholism Letter of Intent Receipt Date: March 21, 1997 Application Receipt Date: April 24, 1997 PURPOSE The National Institute on Alcohol Abuse and Alcoholism (NIAAA) seeks health services research grant applications that are aimed at developing a knowledge base to improve the delivery of services for alcohol-related problems. Such a knowledge base includes both treatment and preventive interventions. This Request for Applications (RFA) invites research grant applications related to improving the availability, accessibility, delivery, quality, effectiveness, cost-effectiveness, and outcomes of alcohol-related treatment and prevention services. The research objectives include, but are not limited to, five major areas: (1) determining the effects of financing and reimbursement mechanisms on alcohol-related health care program availability, accessibility, delivery, organization, content, quality, and outcomes; (2) assessing sources of variation in access and utilization of treatment services and prevention interventions for alcohol-related problems; (3) identifying and assessing the effectiveness and outcomes of alcohol-related treatment and preventive services; and (4) evaluating the cost, cost-effectiveness, cost-benefit, and cost-utility of alcohol-related treatment and prevention services; and (5) identifying organizational and managerial factors that influence the delivery of treatment and prevention services for alcohol-related problems across regions, populations, and settings. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of "Healthy People 2000," a PHS-led national activity for setting priority areas. This RFA, Health Services Research On Alcohol-Related Problems, is related to the priority areas of alcohol abuse reduction and alcoholism treatment. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary Report: Stock No.017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (Telephone 202-512-1800). ELIGIBILITY Applications may be submitted by domestic and foreign, for-profit and non-profit, public and private organizations, such as universities, colleges, hospitals, laboratories, units of State and local governments, and eligible agencies of the Federal government. Racial/ethnic minority individuals, women, and persons with disabilities are encouraged to apply as Principal Investigators. Foreign institutions are not eligible for First Independent Research Support and Transition (FIRST) Awards (R29). Regular research project grant applications (R01) from foreign institutions are limited to three years. MECHANISM OF SUPPORT Research support may be obtained through applications for a regular research project grant (R01) or FIRST (R29) Award. Applications are also encouraged for exploratory/developmental grants (R21), which are limited to up to two years for up to $70,000 per year for direct costs. Applicants may also submit Investigator-Initiated Interactive Research Project Grants (IRPG) under this RFA. Interactive Research Project Grants require the coordinated submission of related regular research project grant applications and, to a limited extent, FIRST Award applications from investigators who wish to collaborate on research, but do not require extensive shared physical resources. Program Project Grant applications (P01) will not be accepted under this RFA. Potential applicants for FIRST (R29) Awards, or exploratory/developmental (R21) grants may obtain copies of the specific announcements from the NIAAA Home Page at HTTP://WWW.NIAAA.NIH.GOV or from the Office of Scientific Affairs, NIAAA, Willco Building, Suite 409, 6000 Executive Boulevard MSC 7003, Bethesda, MD 20892-7003, telephone: 301-443-4375 or FAX 301-443-6077. Further information on grant mechanisms and areas of research interest may be obtained from the program staff listed under INQUIRIES. FUNDS AVAILABLE It is estimated that up to $4 million will be available for approximately 16 grant awards under this RFA in FY 1997. This level of support is dependent on the receipt of a sufficient number of applications of high scientific merit. The NIAAA estimates that the average grant size will be approximately $250,000 in total costs for the first year. Although the financial plans of the NIAAA provide for the support of this program, the award of grants pursuant to this RFA is contingent upon the availability of funds for this purpose. RESEARCH OBJECTIVES Health services research is defined as "research endeavors that study the impact of the organization, financing and management of health services on the quality, cost, access to and outcomes of care" (PL 101-321, Section 409). Health services research also is concerned with assessing the effectiveness of health services in everyday practice. For the purposes of this RFA, health services research includes: (a) the assessment of the impact of health services and the effects of organizational and financing arrangements in "real world" clinical settings on the quality and outcomes of care provided to patients with alcohol abuse and alcoholism or with medical problems consequent to alcoholism and (b) the assessment of the effectiveness of prevention services as well as their financing, organization, management, implementation, cost, and utilization. As directed by subsequent legislation (P.L. 103-43), for the purposes of this RFA health services research does not include studies of the efficacy of specific preventive, diagnostic, and treatment modalities. Applications whose main objective is to establish and support treatment or prevention service programs are not eligible for funding under this RFA. Support for research-related treatment, rehabilitation, or prevention services and programs may be requested only for those particular costs related to the implementation of the research project and for that period of time required by the research project. These costs must be justified in terms of research objectives, methods, and designs that promise to yield important generalizable knowledge and/or to make a significant contribution to theoretical concepts. Applicants should adopt the most rigorous research designs feasible in conducting their alcohol-related treatment and prevention services research studies (see Lettieri 1992; Sechrest, Persin, and Bunker 1990; Cook and Campbell 1979). As elaborated in the "Review Criteria" section of this RFA, applications will be judged on the basis of the scientific and technical merit of the proposed research as well as on the adequacy and appropriateness of the proposed methodology. Applicants may wish to consult generic publications in health services research as well as alcohol-specific examples of prevention and treatment research. The following list of research topics is for illustrative purposes. Topics not mentioned below that fall within the research objectives of this RFA will also be accepted. The NIAAA is particularly interested in applications that address the effects of managed care on access, utilization, cost, cost-effectiveness, and outcomes of alcohol services. Financing and Reimbursement of Services o Investigating the effects of financing and reimbursement approaches on the quality, cost effectiveness, and supply of alcohol treatment and/or prevention services as well as demand for and barriers to those services. o Assessing how alternative managed care systems affect availability, quality, cost, and outcomes of treatment and prevention services. o Developing uniform ways to measure insurance benefits and payments for treatment and prevention of alcohol-related problems in order to compare performance of alternative health plans. o Identifying the impact of changes in compensation incentives on 1) the behavior of consumers, clinicians, and institutions; 2) treatment appropriateness; 3) treatment outcomes; and 4) the nature and extent of prevention services within the health care system. o Modeling and assessing the impact of health care reform legislation and other policy changes on the organization, management, financing, availability, appropriateness, and cost of alternative alcohol-related health policies and treatment/prevention services. Access and Utilization of Services o Identifying health service factors and individual characteristics influencing access to, or compliance with, treatment or preventive interventions for alcohol-related problems, particularly among underserved, uninsured, and HIV-infected populations. o Assessing how alternative managed care systems affect access and utilization of treatment and prevention services. o Identifying care-seeking behavior of people with alcohol problems, including utilization of informal resources (e.g., self-help groups) and alternative (e.g., acupuncture) health resources as well as general medical and specialty alcohol services. o Developing standardized criteria for identifying episodes of alcohol treatment to apply in longitudinal analyses of utilization data. o Determining whether prevention programs have significant effects on the utilization of treatment services. Effectiveness and Outcomes of Services o Developing and assessing criteria to classify and measure objectives, components, and processes involved in delivering major types of treatment services or prevention interventions for alcohol-related problems; examining linkages between treatment content, quality of care, and functional as well as alcohol-specific outcomes; and examining linkages (e.g., process evaluations) between prevention content, its method of delivery, and alcohol outcomes. o Examining alternative managed care systems to assess the effect of these arrangements on the effectiveness and outcomes of alcohol-related treatment and prevention interventions. o Assessing the effectiveness of brief interventions to treat or prevent problem drinking and its medical and social consequences. Health services treatment research may assess brief interventions in inpatient or outpatient acute and specialty as well as primary care settings. o Assessing adequacy and appropriateness of treatment and prevention services to meet needs and demands of different groups such as women, youth, minorities, rural residents, and the elderly. o Determining the impact of organization, financing, and management on the effectiveness of research-based treatment and prevention interventions when they are delivered to heterogeneous populations in natural rather than experimental settings. o Developing classification or measurement systems for use by clinicians to better assign patients to treatment modalities or to improve outcomes, particularly prevention and management of post-treatment relapse. o Assessing the effects of participation in Alcoholics Anonymous on treatment utilization, outcome, and cost. Cost Analyses of Services o Determining the extent to which costs of treatment or prevention services are offset by subsequent reductions in health care costs. For example, evaluating characteristics of individuals, programs, service systems, and insurance benefits associated with greater cost offsets and cost effectiveness. o Applying cost effectiveness, cost-benefit and cost-utility analyses to alcohol-related health services (including treatment and prevention) from the perspective of consumers or their families as well as from the perspectives of payers, providers, or employers. o Applying cost effectiveness, cost-benefit and cost-utility analyses to alcohol-related health services within managed health care systems. o Effects of managed care on costs of alcohol-related health services. Service System Delivery, Organization, and Management o Examining organization and management of alcohol treatment and prevention services, including social, economic, demographic, geographic, legal or health policy, and other factors that may facilitate or impede effective and efficient linkage and delivery of those services. o Evaluating the effect of different organizational models of managed care on the availability, quality, cost, and outcomes of treatment and prevention services. o Determining the impact of system-level, service integration initiatives on the coordination, comprehensiveness, and continuity of alcohol treatment and prevention services. o Identifying different organizational models needed for delivery of alcohol treatment and prevention services to different subpopulations such as the elderly, youth, women, minorities, rural residents, or HIV-positive individuals. o Developing and testing innovative management approaches to improve productivity and efficiency in implementing treatment and prevention services. Examining organizational, provider, and consumer responses to changes in the following areas: (a) financing and reimbursement policies, (b) structural aspects of managed care systems, insurance coverage characteristics of populations in the service area, (d) number and characteristics of other organizations and providers in the area, and (e) demographic factors such as population density, and/or other factors that may lead to changes in organizational and provider behavior with ultimate consequences for access to and outcomes of treatment and prevention services. Investigating factors that influence how preventive interventions or treatment services reach the appropriate target populations; are distributed to be accessible to those populations; are utilized in an effective manner; are adopted with sufficient commitment from policy makers to make them viable; and are implemented with adequate resources. INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the NIH that women and members of minority groups and their subpopulations must be included in all NIH supported biomedical and behavioral research projects involving human subjects, unless a clear and compelling rationale and justification is provided that inclusion is inappropriate with respect to the health of the subjects or the purpose of the research. This new policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) and supersedes and strengthens the previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations), which have been in effect since 1990. The new policy contains some provisions that are substantially different from the 1990 policies. All investigators proposing research involving human subjects should read the "NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 20, 1994 (FR 59 14508-14513) and reprinted in the NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18, 1994. Investigators also may obtain copies of the policy from the program staff listed under INQUIRIES. Program staff may also provide additional relevant information concerning the policy. LETTER OF INTENT Prospective applicants are asked to submit, by March 21, 1997, a letter ofc intent that includes a descriptive title of the proposed research, the name,c address, and telephone number of the Principal Investigator, the identities ofc other key personnel and participating institutions, and the number and title of the RFA in response to which the application may be submitted. Although a letter of intent is not required, is not binding, and does not enter into the review of a subsequent application, the information that it contains allows NIAAA staff to estimate the potential review workload and to avoid conflict of interest in the review. The letter of intent is to be sent to: RFA-AA-97-001 Office of Scientific Affairs National Institute on Alcohol Abuse and Alcoholism Willco Building, Room 409 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-4375 FAX: (301) 443-6077 APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 5/95) is to be used in applying for these grants. Applications kits are available at most institutional offices of sponsored research and may be obtained from the Grants Information Office, Office of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email: ASKNIH@odrockm1.od.nih.gov. The RFA label available in the PHS 398 (rev. 5/95) application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for review. In addition, the RFA title and number must be typed on line 2 of the face page of the application form and the YES box must be marked. Applications for support mechanisms other than R01 (i.e., an R29) must cite the relevant program announcement on line 2 in addition to listing the current RFA. Applications for FIRST awards (R29) must include at least three sealed letters of reference attached to the face page of the original application. FIRST award (R29) applications submitted without the required number of reference letters will be considered incomplete and will be returned without review. Page limits and limits on size of type are strictly enforced. Non-conforming applications will be returned without being reviewed. Applicants from institutions that have a General Clinical Research Center (GCRC), funded by the NIH National Center for Research Resources, may wish to identify the Center as a resource for conducting the proposed research. If so, a letter of agreement from either the GCRC program director or principal investigator should be included in the application material. Submit a signed, typewritten original of the application, including the checklist and three signed photocopies in one package to: DIVISION OF RESEARCH GRANTS NATIONAL INSTITUTES OF HEALTH 6701 ROCKLEDGE DRIVE, ROOM 1040-MSC 7710 BETHESDA, MD 20892-7710 BETHESDA, MD 20817-7710 (for express/courier service) At the time of submission, two additional copies of the application must also be sent to: RFA-AA-97-001 Office of Scientific Affairs National Institute on Alcohol Abuse and Alcoholism Willco Building, Room 409 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Rockville, MD 20852-7003 (for express/courier service) Applications must be received by April 24, 1997. If an application is received after that date, it will be returned to the applicant without review. The Division of Research Grants (DRG) will not accept any application in response to this RFA that is essentially the same as one currently pending initial review, unless the applicant withdraws the pending application. The DRG 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 and must be prepared in the format of a revised application. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness by DRG and for responsiveness by the NIAAA. Incomplete applications will be returned to the applicant without further consideration. If the application is not responsive to the RFA, DRG staff may contact the applicant to determine whether to return the application to the applicant or submit it for review in competition with unsolicited applications at the next review cycle. Applications that are complete and responsive to the RFA will be evaluated for scientific and technical merit by an appropriate peer review group convened by the NIAAA in accordance with the review criteria stated below. As part of the initial merit review, a review process may be used by the initial review group in which applications may or may not be discussed based on their scientific merit relative to other applications received in response to the RFA. Applications that are fully discussed will be assigned a priority score. Applications that are not discussed will be withdrawn from further considerations and the Principal Investigator and the official signing for the applicant organization will be notified. The second level of review will be provided by the National Advisory Council on Alcohol Abuse and Alcoholism. Review Criteria Criteria to be used in the scientific and technical merit review of alcohol-related health services research grant applications will include the following: 1. The scientific, technical, health or medical significance, and originality of the proposed research in the context of alcohol-related health services and relevance to the goals of this RFA. 2. The appropriateness and adequacy of the research design and methodology proposed to carry out the research. 3. The adequacy of the qualifications (including level of education and training) and relevant research experience of the principal investigator and key research personnel. 4. The feasibility of implementing the project (including recruitment of subjects, implementation of the intervention or innovation, cooperation of relevant organizations, and/or availability and quality of necessary data). 5. The availability of adequate facilities, general environment for the conduct of the proposed research, other resources, and collaborative arrangements necessary for the research. 6. The appropriateness of budget estimates and duration in relation to the proposed research. 7. Adequacy of plans to include both genders and minorities and their subgroups as appropriate for the scientific goals of the research. Plans for the recruitment and retention of these subjects will also be evaluated. The initial review group will also examine the provisions for the protection of human subjects and the safety of the research environment. The review criteria for FIRST Awards (R29) and Exploratory/Developmental Grants (R21) are contained in their program announcements. AWARD CRITERIA Applications recommended for approval by the National Advisory Council on Alcohol Abuse and Alcoholism will be considered for funding on the basis of the overall scientific and technical merit of the proposal as determined by peer review, NIAAA programmatic needs and balance, and the availability of funds. NIAAA is particularly interested in managed care and alcohol-related health services. Special consideration will be given to applications that focus on the effects of managed care arrangements on access, utilization, cost, cost-effectiveness, and outcomes of alcohol services. INQUIRIES Inquiries concerning this RFA are encouraged. The opportunity to clarify any issues or questions from potential applicants is welcome. Direct inquiries regarding applications under this RFA to: Robert B. Huebner, Ph.D. Division of Clinical and Prevention Research National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-0786 FAX: (301) 443-8774 Email: bhuebner@willco.niaaa.nih.gov Direct inquiries regarding fiscal matters to: Linda Hilley Grants Management Branch National Institute on Alcohol Abuse and Alcoholism 6000 Executive Boulevard MSC 7003 Bethesda, MD 20892-7003 Telephone: (301) 443-0915 FAX: (3010 443-3891 Email: lhilley@willco.niaaa.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance, No. 93.273. Awards are made under the authorization of the Public Health Service Act, Sections 301 and 464H, and administered under the PHS policies and Federal Regulations at Title 42 CFR Part 52 and 45 CFR Part 74. 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 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 Cook, T.D. and Campbell, D.T. Quasi-Experimentation: Design and Analysis Issues for Field Settings. Boston: Houghton Mifflin, 1979. Lettieri, D.J. A Primer of Research Strategies in Alcoholism Treatment Assessment. DHHS Pub. No. (ADM) 92-1882. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1992. Sechrest, L.; Persin, E.; and Bunker, J., eds. Research Methodology: Strengthening Causal Interpretations of Nonexperimental Data. DHHS Pub. No. (PHS) 90-3454. Rockville, MD: Agency for Health Care Policy and Research, 1990. .
Return to NIH Guide Main Index
Office of Extramural Research (OER) |
National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland 20892 |
Department of Health and Human Services (HHS) |
||||||||
Note: For help accessing PDF, RTF, MS Word, Excel, PowerPoint, Audio or Video files, see Help Downloading Files. |