Subject: NIH GUIDE - RFA NR-92-01 - V20(41) 11/01/91
From: Dot Baker <[email-masked]>
To: [email-masked]
Date: Mon, 04 Nov 91 15:26 EST

Paul,
Another one.  Please post to the NIH Listserver as:
      RFANR-92-01.911101
                        Dottie
 ---------------------------- Text of forwarded message -----------------------
 
$$XID RFA NR9201 NR-92-01 P1O1 *****************************************
 
REQUEST FOR APPLICATIONS
 
RFA:  NR-92-01
 
COMMUNITY-BASED CARE FOR CHRONICALLY ILL OLDER PERSONS
 
P.T. 34; K.W. 0710010, 0730000, 0745035, 0785130
 
National Center for Nursing Research
 
Letter of Intent Receipt Date:  January 22, 1992
Application Receipt Date:  March 10, 1992
 
PURPOSE
 
The National Center for Nursing Research (NCNR) invites the
submission of research applications dealing with the efficacy and
effectiveness of clinical interventions for the long-term care of
chronically ill older persons who reside in the community.  The
overall purpose of the interventions must be to manage commonly
experienced symptoms, prevent the onset of further disabilities, and
facilitate the transition between health care settings and home.
These outcomes would be expected to encourage independence, enhance
health-related quality of life, and enable chronically ill older
persons to remain at home.
 
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 Request
for Applications (RFA), Community-Based Care for Chronically Ill
Older Persons, is related to the priority areas of older persons as a
targeted group and to chronically disabling conditions.  Potential
applicants may obtain a copy of the "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 domestic and foreign, for-profit and
non-profit, public and private organizations, such as universities,
colleges, hospitals, laboratories, units of State or local
governments, and eligible agencies of the Federal Government.
Applications from minority individuals and women are encouraged.
 
MECHANISM OF SUPPORT
 
This RFA is a one-time solicitation for research grant (R01)
applications. Future unsolicited competing continuation applications
will compete with all investigator-initiated applications and be
reviewed by a Division of Research Grants (DRG) study section.  If
the NCNR determines that there is a sufficient continuing program
need, the NCNR may announce a request for competitive continuation
applications for this RFA.  The total project period for applications
submitted in response to the present RFA may not exceed four years.
The anticipated award date will be September 30, 1992.
 
FUNDS AVAILABLE
 
Approximately $1,000,000 in total costs for the first year will be
committed specifically to fund applications submitted in response to
this RFA.   It is anticipated that five applications will be funded.
This level of support is dependent on the receipt of a sufficient
number of applications of high scientific merit.  Although this
program is provided for in the financial plans of the NCNR, the award
of grants pursuant to this RFA is also contingent upon the
availability of funds for this purpose.
 
RESEARCH OBJECTIVES
 
This initiative builds directly on the work of a panel of scientific
experts on long term care convened as part of the development of the
National Nursing Research Agenda.  The work of this panel is
currently nearing completion with the anticipated publication of its
report in 1992.  There has been a great deal of interest in clinical
strategies that facilitate the maintenance of health among the
Nation's older people as well as their transition through the events
that occur in conjunction with chronic illnesses.
 
The goal of this RFA is to stimulate the development of innovative
clinical interventions for community-based chronically ill older
persons in order to manage commonly experienced symptoms, prevent the
onset of further disabilities, and facilitate the transition between
health care settings and home.  These outcomes would be expected to
encourage independence, enhance health-related quality of life, and
enable the chronically ill older person to remain at home.  The
theoretical basis for the planned study must be clearly explicated
and linked to the clinical interventions to be developed and tested.
It is important that the interventions be carefully and clearly
defined in terms of their purpose, composition, means of
implementation and anticipated effect.  Particular attention must be
paid to ensuring that the anticipated effects have clearly defined
outcome measures.
 
The proportion of the population that is 65 years and greater is
increasing rapidly.  Most of these older persons live in the
community and do not need institutional care.  However, the longer a
person survives, the more likely he or she is to become chronically
ill or disabled and the more likely nursing home care will be needed
at some point in the continuum of care.  Admission to a nursing home
has been described as a terminal event for many older persons, rather
than as a useful health care setting for those who need subacute
institutional care for a period of time. Studies that have examined
the continuity of care for older persons generally have focused on
the movement between acute care and nursing homes.  The investigation
of transitions from the community to nursing home and hospital care
and back have not received much emphasis.
 
Community-based care has several perspectives.  Among them are home
health care, respite care, day care centers, and continuing care
retirement centers. Research on community-based care for older
persons was initially focused on acute care with an emphasis on
reducing the length of the acute care episode by moving convalescent
care into the home.  In the past, long term care was frequently
interpreted as meaning nursing home care; therefore, community-based
care was initially considered as a substitute for nursing home care
for older persons, particularly those chronically ill.  It is now
recognized that community-based long term care for older persons who
are chronically ill represents a continuum of care during which these
individuals make transitions through several health care settings
with the continuing emphasis on home care.  Research findings have
been mixed for home care in that they have not consistently shown
improvements for either the well-being of recipients or the informal
caregivers, although home care has been shown to be effective in
resolving unmet needs such as those related to nursing care, personal
care, and physical therapy.  Most of the studies of respite care have
been descriptive, and there have been few health-related
investigations of adult day care centers and retirement centers.
Clinical interventions are needed to address the transitions across
health care settings made by chronically ill, home based older
persons.
 
The functioning of the family and/or informal caregivers can have a
significant effect on the health outcomes of the chronically ill
older person.  There have been indications that certain factors, such
as living alone and urinary incontinence, influence the decision to
remove older persons from their homes and to admit them to a nursing
home.  It is possible that well- functioning family systems and
community social support networks are instrumental in averting or
delaying these admissions and in assisting in the return of these
individuals to the community.  The characteristics and resources of
family members and of families themselves that enable them to avert
or delay admission to nursing homes and to assist in the return to
the community need to be identified and appropriate intervention
strategies developed.  Additionally, actual caregiving behaviors that
effectively respond to the changing physical and psychosocial needs
of the chronically ill older person need to be identified.
 
In addition to these community-based care issues, the clinical
interventions may address the human responses exhibited by older
people who have chronic illness.  The older adult with chronic
illness is at risk for decline in health and functional status due to
a number of factors, including those related to adherence to
treatment regime, the onset of physical symptoms that impede daily
activities, and behavioral responses to the changes occurring with
increasing age and length of illness.  Because chronic health
problems can lead to increased disabilities and frailty, early,
efficacious and effective intervention strategies should lead to
improved outcomes.  In general, there is a paucity of research
dealing with symptom management of the chronically ill older person,
but what research exists has usually been done in either acute care
or nursing home settings.  For example, the prevalence of pressure
ulcers among persons who are cared for in home settings is not known.
Thus, the magnitude of the problem needs study as well as prevention
methods and effective interventions.  There is clearly a need to
identify strategies to deal with symptoms experienced by persons who
are community based.  Symptoms or conditions such as cognitive and
behavioral problems, confusion, decreased mobility, skin integrity
problems such as pressure ulcers, incontinence, nutrition and
hydration problems, and altered sleep and rest patterns frequently
limit the ability to function normally, impair autonomy, and decrease
the health-related quality of life.  Interventions dealing with these
and other symptoms related to chronic illnesses need to address both
behavioral and biophysiological/physical components.
 
These clinical issues are complex and interact with a variety of
other factors that influence long term care needs and requirements of
older persons and influence the efficacy and effectiveness of
clinical interventions. Among these factors are ethical, cultural,
resource, and geographical issues.  Including such factors in
proposed investigations would be appropriate.  Applications from
interdisciplinary research teams are encouraged.
 
In summary, applications are invited for support of clinical
intervention studies concerning community-based care of chronically
ill older persons.  Studies may include, but are not limited to:
 
o  design and test interventions to effectively manage physical and
behavioral symptoms of frequently occurring chronic illnesses in
older persons;
 
o  design and test interventions that prevent complications and
minimize disability in older persons with chronic illness;
 
o  design and test clinical interventions to facilitate the
coordination of care and transition across health care settings for
older adults;
 
o  design and test interventions to support family members or family
systems involved in the care of older persons with chronic illness.
SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH
POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL
RESEARCH STUDY POPULATIONS
 
NIH and ADAMHA policy is that applicants for NIH/ADAMHA clinical
research grants and cooperative agreements will be required to
include minorities and women in study populations so that research
findings can be of benefit to all persons at risk of the disease,
disorder or condition under study;  special emphasis should be placed
on the need for inclusion of minorities and women in studies of
diseases, disorders and conditions which disproportionately affect
them.  This policy is intended to apply to males and females of all
ages.  If women or minorities are excluded or inadequately
represented in clinical research, particularly in proposed
population-based studies, a clear compelling rationale should be
provided.
 
The composition of the proposed study population must be described in
terms of gender and racial/ethnic group.  In addition, gender and
racial/ethnic issues should be addressed in developing a research
design and sample size appropriate for the scientific objectives of
the study. This information should be included in the form PHS 398 in
Section 2, A-D of the Research Plan AND summarized in Section 2, E,
Human Subjects.  Applicants are urged to assess carefully the
feasibility of including the broadest possible representation of
minority groups.  However, NIH recognize that it may not be feasible
or appropriate in all research projects to include representation of
the full array of United States racial/ethnic minority populations
(i.e., Native Americans (including American Indians or Alaskan
Natives), Asian/Pacific Islanders, Blacks, Hispanics).
 
The rationale for studies on single minority population groups should
be provided.
 
For the purpose of this policy, clinical research includes human
biomedical and behavioral studies of etiology, epidemiology,
prevention (and preventive strategies), diagnosis, or treatment of
disease, disorders or conditions, including but not limited to
clinical trials.
 
The usual NIH policies concerning research on human subjects also
apply.  Basic research or clinical studies in which human tissues
cannot be identified or linked to individuals are excluded.  However,
every effort should be made to include human tissues from women and
racial/ethnic minorities when it is important to apply the results of
the study broadly, and this should be addressed by applicants.
 
If the required information is not contained within the application,
the application will be returned.
 
Peer reviewers will address specifically whether the research plan in
the application conforms to these policies,  If the representation of
women or minorities in a study design is inadequate to answer the
scientific question(s) addressed AND the justification for the
selected study population is inadequate, it will be considered a
scientific weakness or deficiency in the study design and will be
reflected in assigning the priority score to the application.
 
All applications for clinical research submitted to NIH are required
to address these policies.  NIH funding components will not award
grants or cooperative agreements that do not comply with these
policies.
 
REVIEW CONSIDERATIONS
 
Upon receipt, applications will be reviewed by NIH staff for
completeness and responsiveness.  Incomplete applications will be
returned to the applicant without further consideration.  If the
application is not responsive to the RFA or to the timeframe and
budget guidelines, NCNR staff will contact the applicant to determine
whether to return the application to the applicant or submit it for
review in competition with unsolicited applications for the next
review cycle.
 
Those applications that are complete and responsive will be evaluated
in accordance with the criteria stated below for scientific/technical
merit by an appropriate peer review group convened by the NCNR.
Applications may be subjected to triage by a peer review group to
determine their scientific merit (competiveness) relative to other
applications received in response to this RFA.  The review criteria
to be used for triage are identified below.  The NIH will withdraw
from further competition those applications judged by triage to be
noncompetitive for award and notify the applicant PI and
institutional official. Those applications judged to be competitive
will undergo further scientific merit review.  The second level of
review will be provided by the National Advisory Council for Nursing
Research.
 
Review criteria for this RFA are generally the same as those for
unsolicited research grant applications.
 
o  scientific, technical, or clinical significance and originality of
proposed research;
 
o  appropriateness and adequacy of the experimental approach and
methodology proposed to carry out the research;
 
o  qualifications and research experience of the Principal
Investigator and staff, particularly but not exclusively, in the area
of the proposed research;
 
o  availability of resources necessary to perform the research;
 
o  appropriateness of the proposed budget and duration in relation to
the proposed research;
 
o  if an application involves activities that could have an adverse
effect upon humans, animals, or the environment, the adequacy of the
proposed means for protecting against or minimizing such effects; and
 
o  appropriate inclusion of women and minorities in study population.
 
APPLICATION PROCEDURES
 
The research grant application form PHS 398 (rev. 10/88, reprinted
9/89) must be used in applying for these grants.  These forms are
available at most institutional business offices or from the Office
of Grants Inquiries, Division of Research Grants, National Institutes
of Health, 5333 Westbard Avenue, Room 449, Bethesda, MD 20892
(telephone 301-496-7441).
 
The RFA label available in the 10/88-9/89 revision of PHS 398
application form 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 and number, "Community-Based
Care for Chronically Ill Older Persons, NR-92-01" must be typed on
line 2 of the face page of the application form; check the YES box.
 
Submit a signed, typewritten original of the application, including
the checklist, and four signed, exact photocopies, in one package to:
 
DIVISION OF RESEARCH GRANTS
National Institutes of Health
Westwood Building, Room 240
Bethesda, MD  20892**
 
At the time of submission, two additional copies of the application
must also be sent to:
 
Ethel Jackson, DDS
Chief and Scientific Review Administrator
National Center for Nursing Research
Building 31, Room 5B19
9000 Rockville Pike
Bethesda, MD  20892
 
Applications must be received by March 10, 1992.  If an application
is received after that date, it will be returned to the applicant.
Also, the Division of Research Grants (DRG) will not accept any
application in response to this announcement that is essentially the
same as one currently pending initial review, unless the applicant
withdraws the pending application.  Nor will the DRG 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.
 
LETTER OF INTENT
 
Prospective applicants are asked to submit by January 22, 1992, 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 an application may be submitted.
 
Although a letter of intent is not required, is not binding, and does
not enter into the review of subsequent applications, the information
that it contains is helpful in planning for the review of
applications.  It allows NCNR staff to estimate the potential review
workload and to avoid possible conflict of interest in the review.
 
The letter of intent is to be sent to:
 
Ethel Jackson, DDS
Chief and Scientific Review Administrator
National Center for Nursing Research
Building 31, Room 5B19
9000 Rockville Pike
Bethesda, MD  20892
 
INQUIRIES
 
Written and telephone inquiries concerning this RFA are encouraged.
The opportunity to clarify any issues or questions from potential
applicants is welcome.
 
Direct inquiries regarding programmatic issues to:
 
Patricia Moritz, Ph.D., R.N.
Chief, Nursing Systems Branch
National Center for Nursing Research
National Institutes of Health
Building 31, Room 5B03
Bethesda, MD  20892
Telephone:  (301) 496-0523
 
Mary D. Lucas, Ph.D., R.N.
Chief, Acute & Chronic Illness Branch
National Center for Nursing Research
National Institutes of Health
Building 31, Room 5B03
Bethesda, MD  20892
Telephone:  (301) 496-0523
 
Direct inquiries regarding fiscal matters to:
 
Sally Nichols
Grants Management Officer
National Center for Nursing Research
National Institutes of Health
Building 31, Room 5B06
Bethesda, MD  20892
Telephone:  (301) 496-0237
 
OTHER INTERESTS IN THIS RESEARCH AREA
 
Other institutes and agencies are also interested in research dealing
with long term care of the chronically ill older person, including:
 
The National Institute on Aging (NIA) is interested in research
dealing with aging and long-term care issues.  Program contacts are:
 
Marcia G. Ory, Ph.D.
Behavioral and Social Research Program
National Institute on Aging
Building 31, Room 5C32
Bethesda, MD  20892
Telephone:  (301) 496-3136
 
and
 
Evan Hadley, M.D.
Associate Director, Geriatrics Program
National Institute on Aging
Building 31, Room 5C27
Bethesda, MD  20892
Telephone:  (301) 496-6761
 
This RFA is in addition to the ongoing program announcement on Aging
and Formal Health Care published in the NIH Guide for Grants and
Contracts, Vol. 16, No. 19, (June 5, 1987) sponsored by the NIA.  For
more information, contact Dr. Ory.
 
The Agency for Health Care Policy and Research welcomes
investigator-initiated applications that address primary
care aspects of long-term care.  Program contacts are:
 
Julius Pellegrino or Linda Siegenthaler
Division of Primary Care
Agency for Health Care Policy and Research
Executive Office Center
2101 East Jefferson Street
Rockville, MD  20852-4908
Telephone:  (301) 443-2080
 
AUTHORITY AND REGULATIONS
 
This program is described in the Catalog of Federal Domestic
Assistance No. 93.336, Nursing Research, and No. 93.866.  Awards are
made under authorization of the Public Health Service Act, Title IV,
Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC
241 and 285) and administered under PHS grants policies and Federal
Regulations 42 CFR 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, April 6, 1988.