MAKING QUALITY COUNT FOR CONSUMERS AND PATIENTS Release Date: January 5, 2000 RFA: HS-00-002 Agency for Healthcare Research and Quality (formerly AHCPR) National Cancer Institute Letter of Intent Receipt Date: February 11, 2000 Application Receipt Date: March 24, 2000 PURPOSE The Agency for Healthcare Research and Quality (AHRQ), formerly known as the Agency for Health Care Policy and Research (AHCPR), and the National Cancer Institute (NCI) at the National Institutes of Health invite applications for demonstrations that facilitate consumer and patient use of information about quality. We are seeking demonstrations that: (1) develop and test methods and models for developing information on quality for consumer and patient use in health care decisions; and (2) evaluate the impact of strategies to provide information about quality to consumers and patients. AHRQ and NCI are especially interested in projects that focus on vulnerable populations as defined by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (Quality Commission). The final report of the Quality Commission recognizes individuals made vulnerable by ".... their financial circumstances or place of residence; health, age or functional developmental status; or ability to communicate effectively (and) ..... personal characteristics such as race, ethnicity, and sex" (Quality First, 1998). 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 health improvement priorities for the United States. AHRQ and NCI encourage applicants to submit grant applications with relevance to the specific objectives of this initiative. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No.017-001-00474-0) or "Healthy People 2000" (Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, D.C. 20402-9325 (telephone 202-512-1800). ELIGIBILITY REQUIREMENTS Applications may be submitted by domestic or foreign, public or private nonprofit organizations, including universities, clinics, units of State and local governments, and eligible agencies of the Federal government. AHRQ by statute, can make grants only to nonprofit organizations; however, for-profit organizations may participate in grant projects as members of consortia or as subcontractors. NCI can make grants to for-profit organizations. Organizations described in section 501(c)4 of the Internal Revenue Code that engage in lobbying are not eligible. AHRQ and NCI encourage investigators who are women, members of minority groups and persons with disabilities to apply as Principal Investigators. MECHANISM OF SUPPORT This RFA will use the research demonstration and dissemination projects (R18) grant mechanism. Responsibility for the planning, direction, and execution of the proposed project will be solely that of the applicant. The focus of the R18 applications should be on evaluation. It is not the intent of this RFA to support extensive development of databases, or computerized information systems, but rather to demonstrate and evaluate the application of strategies to assist consumers and patients to use information about quality. We are interested in funding 2-3 year projects, but will consider projects of up to 5 years. The anticipated award date is September 29, 2000. This RFA is a one-time solicitation. There are no plans to reissue this RFA at any future time. FUNDS AVAILABLE AHRQ expects to award up to $1.0 million and NCI expects to award up to $ 0.5 million in fiscal year 2000 to support the first year total costs of approximately 3 to 4 projects under this RFA. The actual number of applications funded is dependent on the number of high quality applications and their individual budget requirements; it is not our intent that the awards be equal in size. Funding beyond the initial budget period will depend upon annual progress reviews by AHRQ and NCI as well as the availability of funds. RESEARCH OBJECTIVES Background Changes in health care delivery have stimulated unprecedented interest in the importance of the individual's role in health decisions. This interest reflects the convergence of several currents in health care. Changes in health care purchasing have shifted the focus of health care delivery from an individual or visit-based model to a population model that seeks to maximize health for a defined group. This population focus blurs the distinction between "consumers" and "patients." It also creates new incentives to understand and anticipate factors that affect individual and family decisions to seek care and to select health insurance plans, facilities, and clinicians. Without reliable, usable information regarding the issues most relevant to them, consumers and patients cannot make meaningful choices. Expanded tools for disseminating health information, and interest among Americans to participate in their care, offer the potential for individuals to assume a more active role in their health decisions. The content and availability of consumer information are also changing. Comparative reports of hospitals, health insurance plans, and medical groups are expanding public access to information that compares quality, while technological advances such as the world wide web and web TV have the potential for making information easier to find and interpret. Moreover, there is increasing evidence that decision aids and other tools may decrease overuse and overcome underuse of health services. An effective health care market for individuals requires information about price and quality of care. Asymmetries of information among individuals, providers and purchasers hinder genuine competition. Increasing demands of purchasers for evidence of value, combined with the recent focus on using quality assessments that include the patient's perspective, mandate the collection of information that may help individuals and families choose. Several specific groups within the U. S. population have been shown to be affected disproportionately by these changes. These individuals are vulnerable to health care quality problems due to demographic factors (health, age, race or ethnicity), financial circumstances or place of residence. They may be hindered from receiving and using health care information by language or cultural differences, level of education or development, or physical or mental disabilities. Finally, characteristics of the evolving health system such as eroding safety nets can interact with personal characteristics to contribute to vulnerability. This RFA is based on research gaps identified by several initiatives. In particular, The Quality Commission recommended further research to "enhance understanding of how information on quality is and can be used by the public in purchasing decisions; how people value and use different types of quality information; differences in values among populations, (e.g., with different educational, cultural, socioeconomic and health status); and effective dissemination strategies for consumer information" (Quality First, 1998). The Quality Commission was particularly interested in research that evaluates information for consumers and patients and assistance programs for vulnerable individuals (those with low literacy, complex chronic conditions, language or cultural barriers). In addition to these gaps, we are also interested in research that will improve our understanding of ways in which the public uses quality information to make decisions about their use of health care services from disease detection through treatment. In February 1998, in response to the Quality Commission's recommendations, the President ordered all Federal Agencies with responsibilities for health care to coordinate activities to measure and improve quality. One of the five action areas of this group of agencies involved in health care, called the Quality Interagency Coordination Task Force (QuIC), is "Providing Patient and Consumers Information about Quality." To further the agenda in this area, the QuIC sponsored a national conference on consumer health information, "Making Quality Count. Helping Consumers Make Better Health Care Choices" in December 1998. This RFA has been informed by that conference and by its cosponsors, the Health Care Financing Administration (HCFA) and the Office of Personnel Management (OPM). (To obtain copies of related publications see INQUIRIES). This RFA also requests applications responsive to elements of the mission of AHRQ. This includes research which identifies: strategies for enhancing patient participation in their own care and for facilitating shared patient- physician decision-making; ways in which patients, consumers, purchasers, and practitioners acquire new information about best practices and health benefits, and the determinants and impact of their use of this information; and mechanisms for the integration of information on quality into purchaser and consumer decision-making processes. Objectives and Scope AHRQ and NCI seek demonstrations that: (a) develop and test methods and models for developing information on quality for use by the public in health care decisions and behaviors; and (b) evaluate the impact of strategies to provide information on quality. These two priority areas are described below. 1. Methods and Models: Improved methods and models are essential to understand how consumers and patients value and use information about quality in health care decisions and behaviors. Recent studies have found that, although consumers and patients want information about quality (KFF-AHRQ, 1996), they do not find current quality indicators useful (Tumlinson, 1997) or understandable (Hibbard, 1996). As a result, the information is rarely used (KFF-AHRQ, 1996; Chernew, 1998; Wicks, 1999). Reasons postulated for why consumers and patients do not use information on quality include: a) Current information focuses on health insurance plans while consumers and patients are more interested in doctors (NCQA, 1995; KFF-AHRQ, 1996; Chernew, 1998); b) People are interested in a wider range and different set of attributes than those currently provided in comparative reports (Chernew, 1998); c) The measures are not about "people like them;" that is, people of similar ethnic, socioeconomic, or cultural backgrounds (Edgman-Levitan, 1996; Hibbard, 1997); d) The link between quality indicators and quality care is not immediately apparent (Gibbs,1996; McCormack,1996); e) People do not think that health insurance plans influence quality (McGee, 1996); f) The statistical information presented is difficult to understand (Gibbs, 1996); g) Using unfamiliar quality and performance indicators to support decision- making is a cognitively difficult task (Hibbard, 1997); and, h) Although the information provided is based on what people say is important, preferences change with exposure to more information (Slovic 1995; Sainfort, 1996). The Consumer Assessment of Health Plans Study (CAHPS) reporting and evaluation projects (McGee, 1999) and a small number of other efforts are underway to design and test consumer reports, but many questions remain. AHRQ is interested in demonstrations of methods and models that address deficiencies in current approaches. Possible Study Questions: What is known about the factors that predispose consumers and patients to seek information about quality and to use that information in health care decision making? What is the effect of family characteristics (presence of children, elderly, people with disabilities) on the role of decision maker? What are the models for assisting different types of decision makers? What can be learned about the timing factors that need to be considered when disseminating information about quality? How can this knowledge be translated into methods and models for more effective communications? How do consumers and patients process and use information on quality in health decisions? How does this vary for vulnerable populations, such as frail elderly, persons with disabilities or sensory impairments, limited education? How do personal characteristics, such as age, gender, race and ethnicity or presence of chronic conditions, affect decision making? What can be learned about the number of tradeoffs among access, cost, and quality that can be integrated into decision making while keeping the process as cognitively simple as possible? What are the effective models for collecting, summarizing, organizing, formatting and presenting quality data at different levels of health system aggregation (health insurance plan, facility, clinician, groups of clinicians)? How can the models reduce the information processing burden on people? Which strategies are optimal for consumers and patients of varying characteristics, particularly those with communication limitations such as differences in language or culture, sensory impairments or disabilities? What are the models to balance the need of the majority of consumers for general quality information and the needs of many smaller groups (such as individuals with chronic conditions) for more specific information? What can be learned about the validity of aggregating measures of quality to create index scores? What methods should be used to assign quality ratings and rankings? Do summaries and indices of quality data assist public understanding and promote the use of quality data in decision making? What modifications to existing quality measures and reporting methods are needed to ensure relevance to, and impact upon, vulnerable groups? What are the methods and technologies for tailoring quality information to language, cultural, developmental, sensory and physical needs? What are the models for using community organizations and intermediaries to support use of information? How and under what circumstances is assistance in interpreting and using quality data most effectively delivered - particularly to the frail elderly, individuals with disabilities or sensory impairments and those with limited education? What are the methods for adapting materials as the public's knowledge and preferences change with exposure to information about health care quality? What are the best practices for addressing the needs of different segments of the public at varying stages of awareness and preference development? What can be learned about the usefulness of emerging information technologies (e.g., the Internet, web TV, interactive video technologies, and information kiosks) in assisting consumer use of information about quality? Which types of individuals and families use these technologies and why? How do peoples' information needs differ according to health status? Do healthy individuals have different information needs than do those with chronic illnesses, or those who care for family members who have chronic illnesses? 2. Impact of Information Strategies There is a widespread movement in the United States to publish "report cards" for the public that compare the quality of health care organizations, but very little is known about whether or how consumers and patients respond to this information (Scanlon, 1997; Wicks 1999; Lubalin, 1999). In recent years, a wide range of organizations including consumer groups, patient advocacy groups, private companies, states, health insurance plans, and Federal agencies have produced comparative quality reports. These have largely focused on health insurance plans, but some have focused on hospitals and medical groups. Only a few of these efforts have been formally evaluated - the report card for Minnesota state employees (Knutson, 1998), the Oregon model scorecard project (Hanes, 1996), the NCQA report card evaluations (NCQA, 1996), and the current CAHPS evaluations (McGee, 1999). Demonstrations are needed to understand the impact of information about quality on consumer and patient awareness, knowledge, decisions, and behaviors. AHRQ and NCI are particularly interested in demonstrations that shed light on the impact of efforts that assist health care decisions by using intermediaries and community organizations and with new and emerging technologies, including informatics. These strategies and technologies may be particularly useful for people with poor cognitive skills or cognitive skills impaired by disease; chronic conditions, sensory impairments, language or cultural barriers, including the need for materials in languages other than English. Within the area of chronic disease, we are especially interested in the development and evaluation of products to assist cancer patients throughout the continuum of care, from screening through long-term survivorship. We are also interested in the development and evaluation of products for families and care givers of cancer patients. Possible Study Questions: What is the effect of information about quality on consumer and patient awareness of health care delivery, quality and costs issues, understanding of the health care system, and purchase of health insurance? When consumers and patients have access to information about quality of care, what is the impact on knowledge, decision making, and behaviors? Do expectations and resource utilization change based on the availability of information about access, quality and effectiveness? Do impacts vary across population groups? What is the impact of efforts to tailor information about quality for vulnerable populations? In particular, what is the effect of efforts to develop and deliver culturally appropriate information about quality? What are the characteristics of successful intermediaries and community organizations? What are the measures for assessing "improved" or "better" decisions? How is the impact measured and evaluated over time? Over what time period should these evaluations occur? What is the relative impact of quality factors on decisions such as choosing among practitioners, providers, plans or coverage? How do the factors vary by characteristics of the individual? What are the methods for considering these factors in presenting information on quality to consumers and patients? How do benchmarks or standards (such as Healthy People 2010) affect purchasers' use of information? What can be learned from subgroups of consumers and patients that use information about quality more readily and successfully than others? Are there specific formats or media approaches that best fit the needs and preferences of particular subgroups, especially vulnerable populations? What can be learned about the effectiveness of newer technologies and informatics in providing information about quality that assists decisions? SPECIAL REQUIREMENTS Data Privacy Pursuant to section 903(c) of the Public Health Service Act (42 USC 299a- 1(c)), information obtained in the course of any AHRQ-study that identifies an individual or entity must be treated as confidential in accordance with any promises made or implied regarding the use and purposes of the data collection. Applicants must describe in the Human Subjects section of the application procedures for ensuring the confidentiality of such identifying information. 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 safeguarded. The grantee 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/handbook.pdf. The application of these standards to subcontractors should be addressed as necessary. Rights in Data AHRQ grantees may copyright 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 Federal government license to use and permit others to use these products and materials for AHRQ purposes. In accordance with its legislative dissemination mandate, AHRQ purposes may include, subject to statutory confidentiality protections, making research materials, data bases, 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 in peer-reviewed journals and to market grant- supported products. 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). INCLUSION OF WOMEN, MINORITIES, AND CHILDREN IN RESEARCH STUDY POPULATIONS To be funded by AHRQ, applicants must follow AHRQ guidelines for inclusion of women, children and minorities in research. 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. AHRQ also encourages investigators to consider including children in study populations, as appropriate. AHRQ announced in the NIH Guide of May 9, 1997, that it is developing a policy and implementation plan on the inclusion of children in health services research. This Notice is available through the AHRQ Website http://www.AHRQ.gov (Funding Opportunities) and InstantFAX (see instructions under INQUIRIES). To be funded by NCI, applicants must follow NIH guidelines for inclusion of women, children and minorities in research. 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 policy results from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43). All investigators proposing research involving human subjects should read the "NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research," which have been published in the Federal Register of March 28, 1994 and in the NIH Guide for Grants and Contracts of March 18, 1994 . 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 Website http://grants.nih.gov/grants/guide/index.html. AHRQ and NCI program staff may also provide additional information concerning these policies (see INQUIRIES). LETTER OF INTENT Prospective applicants are asked to submit, by February 11, 2000, a letter of intent that includes a descriptive title of the proposed research, the name, address, and telephone number of the Principal Investigator, the identities of 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 consideration of any subsequent application, the information allows government staff to estimate the potential review workload and avoid conflict of interest in the review. Neither AHRQ nor NCI will provide responses to letters of intent. The Letter of Intent is to be sent to Christine Crofton, Ph.D. (see address under INQUIRIES) APPLICATION PROCEDURES The research grant application form PHS 398 (rev. 4/98) is to be used in applying for these grants. State and local government applicants may use PHS 5161-1, Application for Federal Assistance (rev. 5/96), and follow those requirements for copy submission. Application kits are available at most institutional offices of sponsored research. They may also be obtained from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone (301) 710-0267, E-mail: grantsInfo@nih.gov. AHRQ applicants are encouraged to obtain application materials from the AHRQ Publications Clearinghouse (see INQUIRIES). The RFA label and line 2 of the application from PHS 398 (rev. 4/98) should both indicate RFA number. The RFA label must be affixed to the bottom of the face page. 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 must also be typed on line 2 of the face page and the YES box must be marked. The sample RFA label available at http://grants.nih.gov/grants/funding/phs398/label-bk.pdf has been modified to allow for this change. Please note this is in pdf format. Applicants are encouraged to read all PHS Form 398 instructions prior to preparing an application in response to this RFA. The PHS 398 type size requirements (p.6) will be enforced rigorously and non- compliant applications returned. 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: Lisa Krever Center for Quality Measurement and Improvement Agency for Healthcare Research and Quality 2101 E. Jefferson St, Suite 502 Rockville, MD 20852 Telephone: (301) 594-6625 FAX: (301) 594-2155 E-mail Address: lkrever@ahcpr.gov Applications must be received by March 24, 2000. An application received after the deadline may be acceptable if it carries a legible proof-of-mailing date, assigned by the carrier, and the proof-of- mailing is not later than 1 week prior to the deadline date. If an application is received after that date, it will be returned to the applicant without review. Application Preparation (for Using HCFA Data) Applicants to AHRQ who plan to use HCFA data should follow these procedures: 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 PHS 398) the specific files, time periods, and cohorts proposed for the research. In consultation with the Health Care Financing Administration (HCFA), AHRQ will use this information to develop an estimate of the cost of borrowing the data. This estimate will be included in the estimated AHRQ cost of funding the grant and may affect the fundability of the application. To avoid double counting, applicants should not include the cost of the data in the budget. 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 HCFA to protect the confidentiality of data in accordance with standards set out in OMB Circular A-130, Appendix III Security of Federal Automated Information Systems. The use of the data is restricted to the purposes and time period specified in the DUA. At the end of this time period, the grantee is required to return the data to HCFA or certify that the data have been destroyed. Grantees must also comply with the confidentiality requirements of Section 903(c) of the PHS Act. See the Data Privacy Section for details on these requirements as well as references to Circular A-130 and its implementation guides from the National Institute of Standards and Technology. In developing research plans, applicants should allow time for refining, approving, and processing their data requests. Requests may take 6 months from the time they are submitted to complete. Applications proposing to contact beneficiaries or their provider require the approval of the HCFA Administrator and may require meeting(s) with HCFA staff. HCFA 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. Applicants to NCI who plan to use HCFA data should only include the cost of those data in their budgets. Questions regarding HCFA data should be directed, as appropriate, to the AHRQ or NCI program officials listed under INQUIRIES. REVIEW CONSIDERATIONS Upon receipt, applications will be reviewed for completeness and responsiveness. Incomplete applications will be returned to the applicant without further consideration. If the application is not responsive to the RFA, AHRQ Referral staff may contact the applicant to determine whether to return the application to the applicant or hold 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 AHRQ in accordance with the review criteria stated below. As part of the merit review, all applications will receive a written critique, and also may undergo a process in which only those applications deemed to have the highest scientific merit will be discussed and assigned a priority score. General Review Criteria The criteria to be used in the evaluation of grant applications are listed below. The goals of AHRQ-supported research are to enhance the quality, appropriateness, and effectiveness of health care services, and access to such services. The reviewers will comment on the following aspects of the application in their written critiques in order to judge the likelihood that the proposed research will have a substantial impact on the pursuit of these goals. Each of these criteria will be addressed and considered by the reviewers in assigning the overall score, weighting them as appropriate for each application. Note that the 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. For example, an investigator may propose to carry out important work that by its nature is not innovative but is essential to move a field forward. 1. Significance. Does this study address an important problem? If the aims of the application are achieved, how will scientific knowledge be advanced? What will be the effect of these studies on the concepts or methods that drive this field? 2. Approach. Are the conceptual framework, design, methods, and analyses adequately developed, well-integrated, and appropriate to the aims of the project? Are the proposed data sources appropriate and adequate? Does the applicant acknowledge potential problem areas and consider alternative tactics? 3. Innovation. Does the project employ novel concepts, approaches or method? Are the aims original and innovative? Does the project challenge existing paradigms or develop new methodologies or technologies? 4. Investigator. Is the investigator appropriately trained and well suited to carry out this work? Is the work proposed appropriate to the experience level of the principal investigator and other researchers (if any)? Is the project (or work plan) well organized? 5. Environment. Does the scientific environment in which the work will be done contribute to the probability of success? Do the proposed experiments take advantage of unique features of the scientific environment or employ useful collaborative arrangements? Is there evidence of institutional support? The initial review group will also examine: the appropriateness of proposed project budget and duration; the adequacy of plans to include both genders, children, and minorities and their subgroups as appropriate for the scientific goals of the research and plans for the recruitment and retention of subjects; the provisions for the protection of human and animal subjects; and the safety of the research environment. Special Review Criteria In addition to the general review criteria above, the reviewers will assess the application's responsiveness to the RFA and other critical aspects such as: 1) Extent to which the findings will be generalizable to other settings, and situations; 2) Feasibility of answering the proposed research question(s) within the project period; 3) Extent to which the research design and methods integrate clinical, behavioral, social and decision sciences; and, 4) Extent to which and immediacy with which the research findings and products can be expected to be used in practice. This may be evidenced by the direct involvement and investment in the demonstration project by insurer, provider, or consumer groups whose participation heightens the probability of application in practice. AWARD CRITERIA Applications will compete for available funds with all other applications under this RFA. The following will be considered in making funding decisions: 1) quality of the proposed project as determined by peer review; 2) availability of funds; 3) program balance with respect to types of health care insurance and organizational delivery system features, enrollee versus community studies, populations studied, geography including rural/urban mix, regional representation, and targeting understudied areas with unmet evaluation needs; 4) compatibility with other awardees with respect to cooperative activities; and 5) policy relevance. INQUIRIES Copies of the RFA and the "Quality First: Better Health Care for All Americans, Final Report to the President" may be obtained from: AHRQ Publications Clearinghouse P.O. Box 8547 Silver Spring, MD 20907-8547 Telephone 1-800-358-9295 The RFA is also available on AHRQ's Web site, http://www.AHRQ.gov, 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 RFA number). The RFA 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. The "Making Quality Count: Helping Consumers Make Better Health Care Choices" Report may be obtained from the HCFA web site at http://www.hcfa.gov/events/qualsum.htm. The full-text of the Institute of Medicine report from the National Cancer Policy Board, "Ensuring Quality Cancer Care," is available on a read-only basis at http://books.nap.edu/catalog/6467.html This web site also provides instructions for ordering a hard copy of the report. AHRQ and NCI welcome the opportunity to clarify any issues or questions from potential applicants who have read the RFA. Written and telephone inquiries concerning this RFA are encouraged. Direct inquiries regarding programmatic issues, including information on the inclusion of women, minorities, and children in study populations to: Christine Crofton, Ph.D. Center for Quality Measurement and Improvement Agency for Healthcare Research and Quality 2101 E. Jefferson Street, Suite 502 Rockville, MD 20852 Telephone: (301) 594-2003 FAX: (301) 594-2155 Email: ccrofton@ahcpr.gov Gary L. Kreps, Ph.D., Chief Health Communication and Informatics Research Branch Behavioral Research Program Division of Cancer Control and Population Sciences National Cancer Institute Executive Plaza North, Room 239 6130 Executive Blvd., MSC 7326 Bethesda, Maryland 20892-7326 Telephone: (301) 496-7984 FAX: (301) 496-8675 Gary.Kreps@NIH.Gov Direct inquiries regarding fiscal and eligibility matters to: Al Deal Grants Management Specialist Agency for Healthcare Research and Quality 2101 East Jefferson Street, Suite 601 Rockville, MD 20852 Telephone: (301) 594-1843 FAX: (301) 594-3210 Email: adeal@ahcpr.gov Brian Albertini Grants Administration Branch National Cancer Institute 6120 Executive Boulevard, Room 243 Bethesda, MD 20892-7399 Rockville, MD 20852 (for express/courier service) Telephone: (301) 496-7244 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.226 (AHRQ) and No. 93.399 (NCI). Awards are made under authorization of: For AHRQ, Title IX of the Public Health Service Act (42 USC 299-299c-6). Awards are administered under the PHS Grants Policy Statement and Federal Regulations 42 CFR 67, Subpart A, and 45 CFR Parts 74 and 92. For NCI, section 301 and 405 of the Public Health Service Act (42 USC 241 and 284) and administered under NIH Grant policies and Federal Regulations 42 CFR Parts 74 and 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 Chernew M, Scanlon DP, 1998. Health Plan Report Cards and Insurance Choice. Inquiry, 35:9- Edgman-Levitan S, Cleary P, 1996. What Information Do Consumers Want and Need? Health Affairs, 15(4):42-55. Gibbs D, Sangl J, Burrus B, 1996. Consumer Perspectives on Information Needs and Health Plan Choice. Health Care Financing Review, 18(1):55-73. Hanes P, Greenlick M, 1996. Oregon Consumer Scorecard Project Final Report. Agency for Healthcare Research and Quality, Pub No. 97-N008. Hibbard JH, Jewett JJ, 1996. What Type of Quality Information Do Consumers Want in a Health Care Report Card? Medical Care Research and Review, 53:28-47. Hibbard JH, Slovic P, Jewett J, 1997. Informing Consumer Decisions in Health Care: Implications from Decision-Making Research. Milbank Quarterly, 75(3):395-413. Kaiser Family Foundation and the Agency for Health Care Policy and Research (AHCPR), 1996. Americans as Health Care Consumers: The Role of Quality Information. A National Survey. Highlights. Menlo Park, Calif: Kaiser Family Foundation. Knutson DJ, Kind EA, Fowles JB, Adlis S, 1998. Impact of Report Cards on Employees: A Natural Experiment. Health Care Financing Review, 20(1):5-27. Lubalin JS, Harris-Kojetin LD, 1999. What Do Consumers Want and Need to Know in Making Health Care Choices? Medical Care Research and Review, 56:67-102. McCormack, L., Garfinkel, S., Schnaier, J., Lee, A.J., Sangl, J., 1996. Consumer Information Development and Use, Health Care Financing Review, 18(1):15-30. McGee J, Sofaer S, Kreling B, 1996. Findings from Focus Groups Conducted for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects. Washington, DC: NCQA. McGee J, Kanouse DE, Sofaer S, Hargraves JL, Hoy E, Kleimann S, 1999. Making Survey Results Easy to Report to Consumers: How Reporting Needs Guided Survey Design in CAHPS. Medical Care Supplement, 37(3):32-40. National Committee for Quality Assurance (NCQA), 1995. NCQA Consumer Information Project: Focus Group Report. Executive summary, Washington, DC. National Committee for Quality Assurance (NCQA), 1996. Testing the "Choosing Quality Health care" report card results from Denver: a final report. Washington, DC: NCQA. National Committee for Quality Assurance (NCQA), 1996. Testing the "Choosing Quality Health Care' report card results from St. Louis: a final report. Washington, DC: NCQA. Quality First; Better Health Care for all Americans, 1998. Final Report of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Washington, DC: U.S. Government Printing Office. Sainfort F, Booske BC, 1996. Role of Information in Health Plan Choice. Health Care Financing Review, 18(1):31-54. Scanlon DP, Chernew M, Lave JR, 1997. Consumer Health Plan Choice: Current Knowledge and Future Direction. Annual Review of Public Health, 18:507-528. Slovic P, 1995. The Construction of Preference. American Psychologist, 50:364-71. Tumlinson A, Bottigheimer H, Mahoney P, et al., 1997. Choosing a Health Plan: What Information will Consumers Use? Health Affairs, 16(3):229-238. Wicks EK, Meyer JA, Rybowski LS, Perry MJ, 1999. Report on Report Cards. Washington, DC:Economic and Social Research Institute in collaboration with MBGH.


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