Full Text HS-95-003 CONSUMER ASSESSMENTS OF HEALTH PLANS STUDY NIH Guide, Volume 24, Number 9, March 10, 1995 RFA: HS-95-003 P.T. 34 Keywords: Surveys & Survey Research Data Management/Analysis+ HEALTH CARE Agency for Health Care Policy and Research Letter of Intent Receipt Date: May 20, 1995 Application Receipt Date: June 20, 1995 PURPOSE The Agency for Health Care Policy and Research (AHCPR) invites applications for cooperative agreements to: (1) produce reliable, valid and rigorously tested survey protocols for collecting information from consumers regarding their assessments of health plans and services; (2) develop and test the effectiveness of different formats for conveying resulting information to consumers; (3) demonstrate the resulting survey protocols in real world settings; and (4) evaluate the usefulness of this information in assisting consumers, and purchasers acting on their behalf, in making informed selections of health care plans and services. The long term goal of this project is to strengthen the science base underlying the evolution and the use of consumer surveys within the health care industry. 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, Consumer Assessments of Health Plans Study (CAHPS), is related to the priority areas of access to and use of clinical preventive services, maternal and child health services, and health services related to major disease categories. 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 202-783-3238). ELIGIBILITY REQUIREMENTS Applications may be submitted by public and private non-profit private domestic organizations or associations, including universities, units of State and local governments, non-profit firms and foundations; or a consortium of organizations. If the application is submitted by a domestic, non-profit, public or private organization, a consortium may include other types of organizations, such as for-profits. Racial/ethnic minorities, women, and persons with disabilities are encouraged to apply as Principal Investigators. MECHANISM OF SUPPORT The administrative and funding instrument will be the cooperative agreement (U18), an "assistance" mechanism in which substantial AHCPR scientific and programmatic involvement with the awardee(s) is anticipated during the performance of the project. The total project period for each application submitted in response to this RFA may not exceed five years. The anticipated award date is September 30, 1995. Funding beyond the initial budget period will depend upon annual progress reviews by AHCPR and the availability of funds. FUNDS AVAILABLE The AHCPR expects to award up to $2 million for two projects not to exceed $1 million in total costs for each project for the first year. The number of awards is dependent on the number of high quality applications responding to this RFA. This is a one time solicitation. RESEARCH OBJECTIVES Background Public and private organizations are surveying consumers to collect information on access to care, use of health services, health outcomes, and patient satisfaction. The results of these surveys are being used by: consumers to inform their choices about health care plans; purchasers to assess the value of the services they buy; and health insurers, quality assurance managers and policy makers, to plan programs and services. Existing tools for obtaining information from health plan enrollees vary on several dimensions: content of the questions; characteristics of intended respondents; and fit to particular health care settings. The extent to which these instruments have been tested and the methods used to accomplish the testing also differ across surveys. Because of these variations, it is unlikely that any single existing instrument will produce accurate and useful assessments from (and for) consumers across different types of plans and health care settings. Potential survey users require responses to a range of critical questions including, but not limited to, the following: Are existing instruments capable of producing reliable and valid assessments of consumer evaluations of health care services? Do they include the full range of topics important to consumers? Can they be used to obtain information from the full range of audiences of interest, including high users of health care services; people insured under managed care as well as fee-for service plans; consumers with poor literacy skills; plan disenrollees; participants in publicly subsidized programs; and relatively healthy middle-class health care consumers? Even if reliability and validity can be demonstrated, will potential users, particularly inexperienced ones, know how to conduct a valid survey? Will different users collect data in a manner that allows valid comparison across a variety of health plans? And most importantly, if these efforts can be accomplished, will they yield the expected pay-off; that is, the production of accurate, understandable information that enables consumers and purchasers acting on their behalf to identify and select appropriate, high-quality health care coverage? In September 1994, AHCPR co-sponsored a conference with the Robert Wood Johnson (RWJ) Foundation, "Consumer Survey Information in a Reformed Health Care System." Conference papers and discussions identified no single instrument that could be used across a wide variety of consumer groups and within multiple service settings to obtain assessments of health plans and services. Some of these surveys are effective, though, for a specific purpose, population or service. Thus, these various instruments offer the possibility of constructing "question modules" -- sets of questions drawn from a variety of sources and relating to diverse concepts, consumers and delivery settings -- to use as the basis for activities to be performed under this agreement. The AHCPR is currently supporting a project with that goal: to construct question modules from existing survey instruments. This Survey Design Project, through contract to the Research Triangle Institute, is developing modules of consumer survey questions. These modules ask about the experiences of consumers regarding access to care, use of specific health services, health outcomes, and satisfaction with the care received. The goal of the project is to produce modules that are adaptable to a variety of health care settings. The Survey Design Project began with an extensive search for question modules and items. This search was guided by recent published and unpublished studies on consumer information needs. The contractor then developed an Adult Health Care Survey and began developing modules and items related to other areas of interest. Although validity and reliability studies were not within the scope of work, items in the modules were subjected to rigorous cognitive testing to ensure appropriate interpretation by respondents. Items in the modules were then revised as necessary to be understandable to consumers who receive care through different benefits arrangements (e.g., fee for service as well as managed care plans). Finally, this project's methods and products were reviewed by as many interested parties as could be identified. This review included two public meetings, one held at the beginning of the contract and one at the end. Draft modules and materials were circulated for comments to over 100 researchers, consumers and potential users. The project was also informed by a technical panel of researchers and representatives of health insurance organizations, managed care organizations, clinical associations and other groups. Because AHCPR wishes to provide rapid access to products from the Survey Design Project and to products resulting from CAHPS, we plan to disseminate both through the AHCPR User Group Initiative. This effort is being developed to respond to requests from potential users who wish to begin using consumer question modules as early as possible, even before the completion of the systematic demonstration called for in this RFA. Points at which grantees are expected to coordinate activities with the User Group Initiative are noted under RESEARCH OBJECTIVES, Study Design. The results of the Survey Design Project, including limited technical and operational instructions, will be placed in the public domain no later than March 30, 1995. The results of the Survey Design Project, the AHCPR/RWJ conference and other relevant efforts are being made available to potential applicants and others (see INQUIRIES). Objectives and Scope The objectives of this RFA are to: (1) produce reliable, valid and rigorously tested survey protocols for collecting information from consumers regarding their assessments of health plans and services; (2) develop and test the effectiveness of different formats for conveying resulting information to consumers; (3) demonstrate the resulting survey protocols in real world settings; and (4) evaluate the usefulness of this information in assisting consumers, and purchasers acting on their behalf, in making informed selections of health care plans and services. To save time and resources, applicants should select the best existing set of questions currently in the public domain and use it to accomplish objectives 1 and 2. For purposes of this RFA, the "best existing set of questions" is that which most successfully addresses the following questions and concerns: 1. Who are the critical consumers from whom to collect assessments of health care plans and services? Successful applicants will develop and test a core question module designed to obtain a basic assessment of plan features and services from relatively healthy, adult, middle-level socioeconomic status (SES) Americans who receive care through the predominant types of benefits plans and delivery settings (e.g., indemnity plans, managed care plans, etc). Grantees should develop and test additional modules, as time and budget permit, to obtain assessment data from some of the following types of consumers: a. Parents of young children, especially those of low SES, b. Racial and ethnic minorities, c. Participants in publicly subsidized health programs, such as Medicaid or State health programs, d. High users of health care services, such as the chronically ill, those suffering severe acute episodes of illness, and persons with disabilities, e. Persons living in rural areas, f. Persons with poor literacy skills, and g. Disenrollees from health plans. For which of these potentially important consumer groups should question modules be developed? After the core module is completed, what should be the sequence of module development? What rationale supports this prioritization? Applicants should address these questions as part of their application. If applicants discover that items or question modules for use with a consumer group perceived as high- priority do not exist, they should propose development of those modules as part of this project. 2. What information on access and quality do consumers want and need to assist in selecting health care plans and services? How do information needs vary by type of audience? Although a large-scale, fully developed needs assessment covering the entire range of topics and consumers may not exist, a number of qualitative (e.g., focus group studies by AHCPR and the National Committee on Quality Assurance in 1994) and quantitative (e.g., a survey by Consumers Union 1995) studies conducted recently provide information related to this question. If an applicant discovers an access or quality-related information need for which items/questions modules do not exist, the applicant may propose development of those modules as part of this project. 3. Through what types of benefits arrangements and delivery settings are the consumer groups of interest likely to receive services? Consumers may conceivably obtain health care services through fee for service plans, diverse types of managed care plans, public assistance programs or other types of benefits arrangements. These benefits may be offered through public or private employers, purchasing cooperatives, multi-state health plans, or public health clinics. This diversity of benefits and settings means that items, or the wording of items, from any given set of questions may not be appropriate for all consumers in all situations. In selecting their core questions module, applicants should consider that the overall goal of CAHPS is to produce modules (especially a core module) that will allow comparability across the greatest possible range of plans and benefits arrangements. Since it is unlikely that any existing module was designed with application to multiple settings in mind, applicants should discuss in their application the extent to which their selected module will require post-award testing to meet this goal. 4. What evidence exists to ensure that consumers interpret proposed survey items as the developers intended? As mentioned under RESEARCH OBJECTIVES, Background, a variety of instruments exist with which to obtain consumer perceptions about health care services. A limitation of some of these instruments is their lack of cognitive testing of survey items with members of the target audience. In selecting question modules for use in this RFA, applicants should obtain information about the extent to which item interpretation was tested and the methods used to accomplish this. Because the AHCPR wishes to build on existing work to the greatest extent possible and to accomplish objectives 1 and 2 rapidly, it is recommended that the results of the Survey Design Project form the basis for activities to be performed under this agreement. The modules developed in the Survey Design Project, to AHCPR's awareness, best satisfy the concerns discussed above. Although use of the modules from the Survey Design Project is recommended, itis anticipated that applicants may make revisions, additions, or other alterations to them. Changes or alternatives to the modules are acceptable and appropriate to the extent that they address the concerns discussed above. In any case, each applicant must: (a) specify instruments or question modules and (b) discuss their suitability for accomplishment of study objectives. Applicants' responses to the four preceding questions should form the basis for Phase 1 of this project as described in the next section. Study design Grantees will need to accomplish a number of objectives in two phases, a project planning phase (Phase 1) and a demonstration and evaluation phase (Phase 2). During both phases, grantees will collaborate with the AHCPR project officer (and the advisory committee, when appropriate) to define and respond to key questions and issues that will guide the development of CAHPS products. Grantees are expected to prepare interim reports and a final report that summarizes all Phase 1 and 2 activities. Elements of these reports will be determined jointly by the grantees and AHCPR. Phase 1: Project planning The major goals of Phase 1 include: (a) development and initial implementation of a project work plan, (b) production of survey protocols suitable for use in real-world settings, (c) development and testing of report formats for survey information, (d) development and initial implementation of a process and outcome evaluation plan, and (e) recruitment of demonstration sites and development of a demonstration time table. Phase 1 is expected to be completed within 15 months of the award date. Applicants should provide information that demonstrates their ability to accomplish the activities listed below. Applicants may include in appendices descriptions of prior projects that demonstrate their experience in performance of similar activities. 1. Develop a work plan. This should include specification of project activities, linked to a listing of products and a time table for their execution or development. 2. Propose advisory committee (see SPECIAL REQUIREMENTS). Applicants should discuss proposed composition of the advisory committee (i.e., types of expertise required) and ways in which the advisory committee may be used most effectively during the course of the project. 3. Characterize focal consumer populations. Applicants will have laid the groundwork for this step as part of their application. In Phase 1, grantees and AHCPR (with input from the advisory committee) should complete specification of focal consumer groups, as well as determine their quality-related information needs. As they make these decisions, the project team should keep in mind that products resulting from CAHPS must be appropriate for use in a variety of settings as discussed in RESEARCH OBJECTIVES, Objectives and Scope, number 1. 4. Refine the question modules. Applicants will have selected existing modules and identified items/modules that need to be developed as part of the application. As the grantees develop new items and modules, they should make critical decisions jointly with AHCPR and with input from the advisory committee. 5. Perform all activities related to production of survey protocols that are ready for use in real world settings. This includes: testing the validity and reliability of question modules for each consumer group of interest; performing cognitive testing, as necessary, to ensure that respondents will interpret items as intended; resolving all issues related to sampling strategies; preparing alternative versions of survey instruments for administration by telephone or mail; developing and implementing plans for data analysis and processing, and other issues. As part of the application, applicants should identify criteria for site selection for Phase 1 reliability, validity and cognitive testing and obtain letters of commitment from actual sites. Because the user demand for rigorously tested survey modules is great, grantees are expected to perform reliability, validity and cognitive testing on a module-by-module schedule, with priority given to modules that have the widest applicability. As each module is tested and revised, it will be released to the public through the AHCPR User Group Initiative. Though many important activities need to be accomplished within the 15 month Phase 1 time frame, grantees should sequence activities so that the testing of questionnaire modules occurs as early as possible. 6. Coordinate activities as appropriate with AHCPR User Group Initiative. The purposes of the User Group Initiative are to disseminate modules and segments of the user manual as they are completed, track efforts at implementing the modules at sites other than those included in this cooperative agreement, and provide technical assistance to these users. 7. Develop/revise user manual. The user manual should provide thorough, comprehensive documentation to guide users, whether unsophisticated or highly experienced, through all activities associated with survey administration, including mail and telephone administration. 8. Develop and test sample reporting formats. Many different types of consumers will ultimately use reports based on data collected through these instruments. To be optimally useful to consumers, characteristics of the data-based reports should be tailored to fit characteristics of the intended user. On the other hand, some potential survey administrators will not have the resources required to develop reports specifically tailored to consumer subgroups. These users will need to know how to select appropriate formats from a stock of sample reports and how to design and test their own materials for a heterogeneous group of users. 9. Develop a process and outcome evaluation plan. One of the grantee's most important responsibilities under this agreement will be the development of a comprehensive plan to evaluate CAHPS products, procedures, and outcomes. This involves at least three components: (a) developing and implementing a plan for the evaluation of report formats; (b) developing and implementing a plan for the process evaluation of CAHPS procedures (e.g., the usefulness of the operations manual to staff at demonstration sites); and (c) developing and implementing a plan for the evaluation of the effectiveness of data-based reports to consumers. Though all of the evaluation planning must occur in Phase 1, the only evaluation data expected to be collected in Phase 1 is that related to step "a." Applications should demonstrate the applicant's ability to: o Specify appropriate evaluation questions, identify appropriate outcome measures and appropriate respondents for each question, and specify times at which these questions should be asked. o Develop an appropriate evaluation design. The design should: (a) eliminate as many threats to validity as possible; and (b) result in a clear demonstration of usefulness of the data-based reports in assisting consumer decision-making in an open enrollment situation, as well as identification of factors related to product effectiveness or ineffectiveness. o Identify and use appropriate qualitative and quantitative data collection instruments. o Analyze data appropriately. Applicants should pay particular attention to strategies for analysis of qualitative data, as well as the issue of conveying information from quantitative evaluation analyses in a manner that is understandable by and useful to personnel at sites implementing the survey protocols. o Develop recommendations based on evaluation data that can be used to modify CAHPS projects or procedures. One component of the CAHPS evaluation plan should be the development of clearly written, user-friendly recommendations designed to promote data-based changes to products and procedures. 10. Recruit sites and develop a time table for Phase 2 demonstrations. o Identify selection criteria for and propose demonstration sites. AHCPR is interested in a range of diverse demonstration sites as discussed above in RESEARCH OBJECTIVES, Objectives and Scope, numbers 1 and 3. Applicants are not required to include all of those types of settings in their applications, but should provide examples of the types of settings they intend to include, a rationale for their choice, and evidence of recent experience in undertaking large-scale, multi-site demonstrations. If necessary, AHCPR will work with the awardee to identify appropriate organizations. Final selection of sites will take place in consultation with the AHCPR Project Officer. o Identify key personnel from each potential site and specify their roles. Also, as sites are selected, grantees will need to identify appropriate demonstration site staff to be added to the advisory committee (e.g., the lead contact at each site, consumer representatives, etc.). o Building on the work plan discussed above, develop a demonstration time table. This document should contain all the information sites will need to know in order to commit themselves to the demonstration. Phase 2: Demonstration and evaluation The goals of Phase 2 are to: (a) work with demonstration sites to implement the tested survey protocols; (b) assess the effectiveness of data obtained through these surveys in assisting consumers with their health plan selections; (c) continue implementation of the process and outcome evaluation; and (d) revise CAHPS products and procedures based on evaluation data. Applicants should provide information which illustrates their ability to plan and implement large-scale, multi-site demonstrations, including their ability to accomplish the following activities. 11. Develop a demonstration management plan. After each site commits to the demonstration, the grantee should develop an overall management plan which will serve as the master plan to guide all demonstration activities. The groundwork for this plan will have been laid by development of demonstration time tables discussed at the end of Phase 1 activities. The management plan should clearly specify both grantee and site personnel roles and responsibilities and should include a time table listing key decisions related to and dates for all demonstration components. 12. Assist sites in all phases of demonstration activity as specified in the management plan, including: selecting appropriate survey modules; collecting data; using the operations manual; developing, testing, and disseminating reports in formats appropriate for the audiences of interest; and other activities. 13. Coordinate activity among all demonstration sites and work with the AHCPR User Group Initiative. 14. Collect process and outcome evaluation data at all appropriate points. The grantee should analyze evaluation data and produce reports which include recommended revisions to CAHPS products and procedures. 15. Revise products and procedures based on data-based recommendations. Before making these revisions, the grantee should consult with AHCPR and obtain input from the advisory committee. Timetable Phase 1 of CAHPS should be completed 15 months from the date of award. The entire project may take four to five years. SPECIAL REQUIREMENTS To promote the development of this multi-site collaborative project, a number of additional issues must be addressed in applications responding to this RFA, as discussed below. Budget Applicants must develop a timeline for project activities, including percentage of effort for key staff for all years, as part of the budget justification. Project Organization Applicants, or principal members of the consortium qualified to participate in this agreement, must have experience in: field survey operations; testing and improvement of survey instruments; management of multiple collaborators; program planning and evaluation; and development and evaluation of health-related materials for consumer audiences. If a consortium of institutions responds to this RFA, the application must describe a practical structure for consortium decision-making and governance, and the mechanisms designed to ensure that effective collaboration will occur among sites. Unanticipated disagreements about methods, resource allocation, standardization, authorship, etc., may arise during the course of any project. The consortium must be able to make unified decisions on the merits of these issues, without dissolving or routinely relying upon outside arbitration. Confidentiality of Data Information obtained in the course of this study that identifies an individual or entity must be treated as confidential in accordance with section 903(c) of the Public Health Service Act. Applicants must describe in the Human Subjects section number 5 procedures for ensuring the confidentiality of information. This should include a discussion of who will be permitted access to the information, both the raw data and machine readable files, and how personal identifiers will be safeguarded. Terms and Conditions of Award This cooperative agreement anticipates substantial AHCPR scientific and programmatic involvement with the awardees throughout the planning, implementation, and close-out of CAHPS. 1. Awardee Responsibilities The awardee will have primary and lead responsibility for all activities including: o Formation of the advisory committee, including convening meetings and documenting activities, with committee membership approved by the AHCPR project officer; o Development and implementation of a comprehensive process and outcome evaluation design; o Selection, in collaboration with the AHCPR project officer, of items or question modules from the consumer survey instrument that will be tested; o Identification and implementation of techniques to test the modules for reliability, validity, consistency in interpretation, and comparability across different sites/subpopulations; o Development and implementation of a module-by-module testing schedule; o Identification and recruitment of Phase 1 testing sites for reliability, validity, etc. Applicants should submit letters of commitment with the application; o Identification of characteristics of appropriate Phase 2 demonstration sites and selection, in collaboration with the project officer, of actual sites possessing these characteristics; o Development of sample selection strategy and identification of potential associated methodological issues; o Identification of methodological issues associated with administration of the survey to the subpopulations and sites of interest; o Identification of potential confidentiality concerns of test sites and individual respondents and a strategy for implementing safeguards that address these concerns; o Identification of methodological issues associated with mode of administration of the questionnaire; o Identification and implementation of procedures that enhance response rates; o Development and implementation, with project officer approval, of an appropriate data coding, preparation and analysis plan; o Development and documentation of strategies to address all outlined methodological issues; o Development, testing and revision of a comprehensive survey operations, or "user", manual suitable for use by organizations with minimal as well as extensive experience in fielding large-scale, multi-site surveys; o Provision of training and technical assistance to all Phase 2 demonstration sites; o Preparation and testing, in collaboration with project officer, of understandable, usable reports that summarize survey results and which are tailored to the subpopulations of interest; o Preparation of agreed-upon interim and final reports, including a summary report to inform AHCPR of any difficulties encountered in the course of planning, implementing and evaluating the surveys; o Provision of AHCPR access to all data generated under this award as it is collected; and o Cooperation with other key parties in this project, particularly the AHCPR User Group; other CAHPS grantees; and other complementary projects. 2. AHCPR Staff Responsibilities The AHCPR Project Officer and other AHCPR staff will have substantial scientific and programmatic involvement during the conduct of this activity, through technical assistance, advice, and coordination beyond the usual program stewardship for grants. Collaboration on the development of the testing plan, evaluation design and survey protocol will occur after the award is made. Specifically, AHCPR's role in the cooperative agreement is to provide technical assistance, advice, and support to the PI and to ensure that all related AHCPR-supported projects complement one another. AHCPR will: o Work with the grantee to structure composition of the advisory committee; o Approve composition of advisory committee, management plan and plans for data collection and analysis; o Participate in all key project decisions, including but not limited to: identification of focal consumer groups, assessment of consumer information needs, selection of items/question modules to be tested, identification and resolution of methodological issues; o Work with the grantee to identify and negotiate with Phase 2 demonstration sites, with the AHCPR project officer retaining right of final approval; o Establish collaboration with and obtain project-related information from other Federal agencies and programs; o Disseminate tested question modules and other research findings as they become available; and o Participate in or coordinate strategy sessions with the grantees on at least four occasions in the first year and up to every four months thereafter to review progress; The AHCPR will require prior written approval for the addition or deletion of a participating or collaborating institution, site, or other organizational component. The AHCPR reserves the right to terminate or curtail the study in the event of: o Insufficient progress towards completion of study goals within an agreed-upon time frame; o Inability to identify and recruit demonstration sites that include members of the subpopulations and settings of interest; o Inability to work collaboratively with demonstration sites, the advisory committee, or other necessary organizations; o Inability to successfully address key methodological issues; and o Substantive changes in the agreed-upon protocol with which the AHCPR does not agree. These special Terms of Award are in addition to and not in lieu of otherwise applicable PHS grants policies and Federal regulations. Collaborative Responsibilities As discussed under Phase 1 activities, grantees must establish an Advisory Committee to provide overall policy guidance and technical expertise, and assist in conflict resolution. The membership of the Advisory Committee may include, in addition to the Principal and Co-Investigators, the AHCPR project officer, consumers, methodology experts in the fields of health care consumer survey research, social marketing (with experience in developing health information for consumers), health insurance and other health-related research areas; representatives of public and private groups from Phase 2 demonstration sites, including employers, unions, health plan administrators, and other health insurance providers; and local and national health service providers and institutions. SPECIAL INSTRUCTIONS TO APPLICANTS CONCERNING INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of the AHCPR that women and members of minority groups be included in all AHCPR supported research projects involving human subjects, unless 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. A new NIH policy resulting from the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43) supersedes and strengthens NIH's previous policies (Concerning the Inclusion of Women in Study Populations, and Concerning the Inclusion of Minorities in Study Populations), which were in effect since 1990 and which AHCPR had adopted. The new NIH policy contains 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 28, 1994 (FR 59 14508-14513), and reprinted in the NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume 23, Number 11. Investigators may obtain copies from these sources or from the AHCPR contractor, Global Exchange listed under INQUIRIES. AHCPR staff may also provide information concerning this policy. LETTER OF INTENT Prospective applicants are asked to submit, by May 20, 1995, a letter of intent that includes the name, address, and telephone number of the proposed Principal Investigator and other key personnel; the identities of proposed consortia members, including any other participating organizations or institutions; a descriptive title of the proposed demonstration project; and the number and title of the RFA. Although a letter of intent is not required, is not binding, and does not enter into the consideration of any subsequent application, the information allows AHCPR staff to estimate the potential review workload and avoid conflicts of interest in the review. The letter of intent is to be sent to the CAHPS project officer at the address listed under INQUIRIES. APPLICATION PROCEDURES Applications are to be submitted on research grant application form PHS 398 (rev. 9/91). State and local government applicants may use form PHS 5161, Application for Federal Assistance. These forms are available at most institutional offices of sponsored research; the Office of Grants Information, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, Bethesda, MD 20892, telephone (301) 710-0267. For AHCPR, applications are available from Global Exchange Inc., 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-3015, telephone (301) 656-3100, Fax (301) 652-5264. The RFA label available in the PHS 398 (rev. 9/91) 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 2a on the face page of the application form and the YES box must be marked. Complete information must be submitted with the application. Consortium arrangements typically take the form of a formal agreement between an applicant and other organization(s). In the grant application, a separate budget page and budget justification must be included for each organization involved in the proposed consortium arrangement. Submit a signed, typewritten, original of the application, including the Checklist, and three signed legible copies (two copies when using the PHS 5161) 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 (for express mail or courier) Applications submitted under this RFA must be received by June 20, 1995, by the Division of Research Grants, NIH. If an application is received after that date, it will be returned to the applicant. At the time of submission, two additional copies of the application (one copy when using the PHS 5161) must be sent to the CAHPS project officer at the address under INQUIRIES. Conference for Prospective Applicants The AHCPR plans to convene a conference for prospective applicants on April 5, 1995 in Rockville, Maryland. Attendance is not a prerequisite to applying. Attendees must pay for their own travel and accommodation costs. For further information, contact (301) 594-1357 ext 105. REVIEW CONSIDERATIONS All applications will be judged on the basis of the scientific and technical merit of the proposed project and the documented ability of the investigator to meet the objectives of the RFA. Upon receipt, applications will be reviewed for completeness by the Referral Office, Division of Research Grants, NIH, and by AHCPR staff for responsiveness to the RFA. Incomplete and nonresponsive applications will be returned to applicants without further consideration. The determination of any application as nonresponsive will be the sole responsibility of AHCPR. All accepted applications will undergo peer review for scientific and technical merit by a special review group convened by the AHCPR. Review criteria for AHCPR grant applications are: significance and originality from a scientific and technical viewpoint; adequacy of the method; availability of data or proposed plan to collect data required for the project; qualifications and experience of the Principal Investigator and proposed staff; adequacy of the plan for organizing and carrying out the project; reasonableness of the proposed budget; and adequacy of the facilities and resources available to the applicant. Although the technical merit of the proposed protocol is important, it is not the sole criterion for selection of the awardee(s). Applications may undergo triage by the peer review group on the basis of relative scientific and technical competitiveness. The AHCPR will withdraw from further consideration those applications judged to be non-competitive for award and notify the applicant Principal Investigator and institutional official. When an application is reviewed, the peer review committee may recommend further consideration or no further consideration. The committee also assigns priority scores to the applications for which further consideration is recommended. Recommendations of the peer review committee may be reviewed subsequently by AHCPR's National Advisory Council for Health Care Policy, Research, and Evaluation. The peer review process is rigorous, and only those applications judged to be of greatest merit will be recommended for further consideration. Special Review Criteria In addition to the review criteria noted above, the review committee will evaluate each application in response to this RFA against the following special scientific and technical review criteria: 1. Understanding of issues related to completing the activities outlined in OBJECTIVES AND SCOPE and STUDY DESIGN. 2. Understanding of all issues related to the measurement of consumer assessments of health care plans and services. 3. Understanding of the needs of various audiences who may use health care information (e.g., consumers, purchasers, plans, providers, payers, State and local-level health care organizations) and the ways in which they may use this information (selection of plans and providers; comparison of plan/provider performance; identification of local or multi-site quality problems). 4. Demonstrated experience in the performance of all aspects of fielding a large-scale, multi-site survey, including but not limited to: formulation of a methodologically sound design; performance of validity and reliability studies on large-scale survey instruments; identification and resolution of methodological issues associated with sample selection and sample size, and with administration of surveys to the subpopulations of interest and within a variety of health care delivery settings; identification and resolution of methodological issues associated with mode of administration. 5. Demonstrated ability to produce detailed survey operations manuals suitable for use by groups with minimal as well as extensive experience in fielding large-scale, multi-site surveys. 6. Demonstrated ability to cooperate with, provide technical assistance or training to, and/or monitor the progress of potential collaborating organizations or test sites; particularly, other groups such as consortium members, subgrantees, subcontractors, community-based organizations, data supplying organizations, respondents, and site representatives. 7. Demonstrated ability to collaborate with government agencies in the performance of research studies and demonstrations. 8. Demonstrated ability to develop and test attractive, understandable, usable health-related materials for a variety of consumers. 9. Demonstrated ability to design and implement process and outcome evaluations, including: specification of evaluation questions and outcome measures; use of quantitative and qualitative data collection methods; data analysis; development of data-based recommendations and use of the recommendations to improve products and procedures. AWARD CRITERIA Applications will compete for available funds with all other applications for this RFA. The following will be considered in making funding decisions: quality of the proposed project as determined by scientific and technical merit; program balance, including the likelihood of successful collaboration based upon sufficient compatibility of features; and availability of funds. The earliest anticipated date of award is September 30, 1995. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. Copies of this RFA and background documents are available from: Global Exchange Inc. 7910 Woodmont Avenue, Suite 400 Bethesda, MD 20814-3015 Telephone: (301) 656-3100 FAX: (301) 652-5264 Copies of the RFA without background materials can also be requested by e-mail at cahpsrfa@PO3.AHCPR.GOV, the NIH GOPHER (gopher.nih.gov), and AHCPR InstantFAX at (301) 594-2800, AHCPR Pub. No. 95-0044. To use InstantFAX, you must call from a fax machine with a telephone handset. Use the key pad on the receiver when responding to prompts from InstantFAX. The RFA will be sent at the end of the ordering process. AHCPR InstantFAX operates 24 hours a day, 7 days a week. For questions about this service, call AHCPR's Division of Communications at (301) 594-1364 ext. 159. Direct inquiries regarding programmatic issues, including information on the policy of inclusion of women and minorities in study populations, to: Christine Crofton, Ph.D. CAHPS Project Officer Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 603 Rockville, MD 20852-4908 Telephone: (301) 594-1357 ext 105 Direct inquiries regarding fiscal matters to: Mr. Ralph L. Sloat Grants Management Officer, Office of Management Agency for Health Care Policy and Research 2101 East Jefferson Street, Suite 601 Rockville, MD 20852-4908 Telephone: (301) 594-1447 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.226. Awards are made under authorization of the Public Health Service Act, Title IX (42 U.S.C. 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. This program is not subject to the intergovernmental review requirements of Executive Order 12372. 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 routing 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. .
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