Cheryl Bland Jones, Ph.D., R.N. |
Lorraine Tulman, D.N.Sc., R.N., F.A.A.N.
Carolyn M. Clancy, M.D.
Given the impact on the nursing profession of changes in health care delivery and financing, contributions from nurse researchers are critically important to the development of health services research. This article highlights research funding opportunities available through the Agency for Health Care Policy and Research (AHCPR), now the Agency for Healthcare Research and Quality (AHRQ). It also reviews the application process and the history of grant funding between fiscal years 1994 and 1997.
The information presented in this article was originally published in Nursing Outlook (Volume 47, Number 4, 1999).
Note: Some information has changed since publication. Go to Disclaimer for details.
Overview
AHCPR's Application, Review, and Funding Process
Research Funding at AHCPR, 1994-97
Considerations in Applying for Funding
Concluding Remarks
References
Disclaimer
The Agency for Health Care Policy and Research (AHCPR), now the Agency for Healthcare Research and Quality (AHRQ), within the US Department of Health and Human Services, was created in 1989 to fill the gap in knowledge that exists between biomedical research and the actual delivery of health care services to the U.S. public. (See also Bavier,1 Cummings,2 and Kovner3 for additional insight into AHCPR's history and past initiatives.) A driving force behind its creation was the desire of policymakers to support research that would improve practice and delivery of care.4 AHCPR's research focuses on addressing the following questions: What works? At what cost? For which patients? Thus, studies that examine clinical as well as organizational interventions, such as changes in the organization of nurse staffing, are primary to AHCPR's mission.
AHCPR supports extramural and conducts intramural health services research aimed at:
In addition, AHCPR emphasizes research pertaining to minority, women's, and children's health, international health, ethical issues in health care, and the application of cost-effectiveness analyses.
Health services research is the use of scientific inquiry to develop and produce knowledge of health care delivery that is applied and addresses issues that cross disciplinary boundaries, such as resource utilization and policymaking.5 Health services research is part of the overall continuum of health care research (Figure 1 [17 KB]; Text Version), which integrates biomedical knowledge of disease processes or treatments with:
These patient, provider, organizational, and system aspects of care delivery are ultimately targeted at addressing policy needs at the public, healthcare system, and clinical levels.6
AHCPR's mission and goals are congruent with the interests of the clinical nursing research community, yet general uncertainty exists about AHCPR's viability as a funding source for nurses. This article provides an overview of the types of grants available through AHCPR, the application process, and the history of grant funding between fiscal years (FYs) 1994 and 1997. Given the impact of changes in healthcare delivery and financing on the nursing profession, it is clear that contributions from nurse researchers to health services research are critically important.
Extramural research, or investigator-initiated research, is funded through research grant applications, and awards are made based on:
Extramural research is also funded through cooperative agreements and contracts. Cooperative agreements are special types of grants aimed at supporting collaborative research arrangements programmatic involvement. Contracts, a type of arrangement initiated by a Federal Agency, are available to support research, but the focus is primarily on AHCPR administrative initiatives. In both cases, research efforts are under the direction of AHCPR, and announcements and requests for proposals are typically made through the Federal Register and/or the Commerce Business Daily. Given that the aim of this article is to address investigator-initiated research, cooperative agreements and contracts will not be discussed in detail.
AHCPR communicates general research interests for grant applications and research priority areas to the research community through program announcements (PAs) and peer-reviewed journal articles. For example, AHCPR released a program announcement communicating general health services research interests in March 1998. (This announcement, PA 98-049 is no longer active. It was superseded in June 2000 by PA-00-111, available at http://grants.nih.gov/grants/guide/pa-files/PA-00-111.html).
The time frame for responding to a PA is open, but no specific funds are designated for awards. On the other hand, a request for application (RFA) solicits research proposals in a specific research area of interest to AHCPR for a onetime competitive review and submission deadline. A limited amount of AHCPR funds are allocated for supporting proposals submitted in response to the RFA. Both types of announcements are made through the National Institutes of Health (NIH) Guide to Grants and Contracts, available through AHCPR's Web site (http://www.ahrq.gov/fund/grantix.htm)
Researchers may apply for AHCPR funding through several types of research grant application mechanisms. Table 1 provides an overview of typical grant types available at AHCPR, deadlines, and other important information. Research applications may be submitted in response to a PA or RFA, or may be submitted based on researcher interests that are consistent with AHCPR's mission. Research awards are made to principal investigators (PIs) through their affiliation with public or nonprofit private organizations, although for-profit organizations may be involved in the conduct of a study.
Select for text version of Table 1
| Type of Grant | |||||
|---|---|---|---|---|---|
| Details | R01 | R03 Small Grant1 |
R03 Dissertation2 |
R13 | F32 |
| Purpose | Supports traditional research projects building on researchers expertise; includes institutional sponsorship. | Supports small-scale projects of short time duration, 1 to 2 years (e.g., pilot or feasibility studies). | Supports dissertation research for doctoral students who have completed course work. | Supports conferences aimed at addressing critical research areas and concerns. | Supports individual post-doctoral research training sponsored by an established researcher. |
| Amount of Award | As much as $500,000 in direct costs3 | As much as $50,000 in direct costs | As much as $30,000 in direct costs | As much as $50,000 in direct costs | Depends on number of years after doctorate (eg, for 1 year of experience, the stipend is $19, 608.) |
| Duration | As long as 5 years | As long as 2 years | 12 to 17 months | 1 year | As long as 3 years |
| Receipt dates4 | Feb 1, Jun 1, Oct 1 | Mar 24, Jul 24, Nov 24 | May 1, Nov 15 | Open5 | Apr 5, Aug 5, Dec 5 |
| Application | PHS-398 | PHS-398 | PHS-398 | PHS-3986 | PHS 416-1 |
1. Applications not selected for funding by AHCPR's Small Project Grant
program on first submission cannot be revised or resubmitted. |
|||||
In general, the processes for submitting a research application to AHCPR are the same as processes in place at NIH. For example, the PHS-398 form is used for the R01 application, and all applications more than $500,000 in direct costs per year require approval by AHCPR before submission.
The NIH Grants Web site (http://grants.nih.gov/grants/oer.htm) provides important information for any investigator making application to either the NIH or AHCPR). AHCPR grant application kits and all active RFAs and PAs may be obtained from:
Publications
Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
Phone: 1-800-358-9295 (outside of the U.S., phone 410-381-3150)
E-mail: ahrqpubs@ahrq.gov
However, AHCPR and NIH processes diverge to some degree in the review and funding processes. The areas of divergence specific to AHCPR will be highlighted later.
A critical first step in formulating any research proposal for submission to AHCPR is to seek out and obtain assistance from appropriate AHCPR project officers (POs), before initiating the application process. The PO is an AHCPR staff member who has general knowledge of research and specific knowledge about a substantive area and AHCPR's research processes. The PO can provide valuable feedback to a prospective applicant about congruence between a particular research idea and research priorities, as well as guidance and suggestions during proposal development.
AHCPR is comprised of six centers, each of which supports an aspect of the research enterprise:
Select for a list of contacts for each center.
Potential applicants may submit a three to seven page concept paper, outlining a potential research idea, before preparation of a formal research application, as a means of establishing contact with AHCPR and beginning dialogue between AHCPR staff and PIs. Concept papers are reviewed by staff only, maintained in a confidential file, and a staff-member provides feedback to the researcher on completion of the review. Although submission of a concept paper for review is entirely voluntary and unrelated to peer review, the informational process allows program staff to alert prospective applicants to issues that may be raised by external reviewers.
An R01 application assigned to AHCPR is distributed to one of four study sections for peer review:
These study sections are comprised of scientists from the external research community with related substantive, methodological, or disciplinary expertise who review and evaluate applications for scientific and technical merit based on established review criteria. PIs should request assignment to AHCPR on submission of a grant application via cover letter and alert POs of an incoming application.
Peer review includes the assignment of priority scores. Those proposals deemed noncompetitive are reviewed, but are not assigned priority scores. Incomplete proposals are returned to the applicant without review.
The disciplines of medicine, economics, sociology, and nursing are often represented on each of the study sections. Study section members and all staff at AHCPR adhere to strict confidentiality guidelines in the review and discussion of all applications.
If a proposal is submitted to a study section that requires review expertise on a topic not represented by study section members, ad hoc reviewers may be added to augment study section membership. Following review, summary statements, often referred to as "pink sheets," are compiled through AHCPR's Office of Research Review, Education, and Policy, and a copy of the statement is provided to the PO for review. In turn, the PO sends the summary statement to the applicant.
The AHCPR process diverges somewhat from the NIH approach in that the PO may (and often does) contact the PI after study section review but before the time that AHCPR funding decisions are made, to request minor revisions or clarify issues raised through the review process. However, from application submission, until and including study section review, POs limit direct contact with investigators, to eliminate potential conflicts of interest. Instead, Pls should contact the Office of Research, Review, Education, and Policy to clarify any procedural questions.
Funding decisions are made within AHCPR, and are based on:
Applications selected for funding are forwarded to the AHCPR Grants Management Office, which reviews project budgets and coordinates the disbursement of funds. At this point, a cycle is put into place whereby the applicant is notified of potential funding, budget negotiations are made if necessary, and awards are issued.
Completed R03 (small grant) applications also are mailed directly to the NIH Center for Scientific Review. However, receipt and award processes are on a different time line than the R01. Review for scientific and technical merit is conducted either by field reviewers with knowledge and expertise in a substantive or methodological area relevant to the proposal, or by assignment to standing AHCPR study section. R03 applicants also receive summary statements following application review, and funding decisions are made in a manner similar to that of R01 applications. R03 grant applications selected for award are notified within approximately four months of receipt and review of the application.
Unlike the R01 application, investigators are directed to submit R13 (conference grant) applications directly to AHCPR's Office of Research Review, Education, and Policy. While investigators submitting any type of research grant application can voluntarily establish contact with an AHCPR PO and submit a concept paper before initiating the application process, the R13 application requires the submission of a concept letter and receipt of approval by AHCPR staff before submission of a full application. The assignment of R03 and R13 applications to AHCPR Centers and staff is similar to the process for assigning R01 applications.
Finally, AHCPR accepts grant applications for research training support. The National Research Service Award (F32), is a fellowship available to support postdoctoral educational training for persons pursuing a career in health services research. This award affords recipients the opportunity to study with an identified faculty sponsor in health services research for one or more years, and to focus on acquiring advanced methodological training necessary to analyze and evaluate health services. Similar to the R01 applications, F32 applications are submitted to the NIH Center for Scientific Review and undergo study section review. Review criteria include:
Funding decisions are similar to to the R01 process.
Figure 2 (40 KB) (Text Version) displays the total number of applications that were:
Information used to create these figures was retrieved from AHCPR's grants management database, and includes applications that might have been revised and resubmitted during the period. It includes only those grant applications eligible for new funding (i.e., no continuation funding is reflected), and excludes applications that were not reviewed in study section because of incomplete application submission or failure to follow application guidelines. Further, these numbers were adjusted to account for the possibility that an application may have been submitted and reviewed during one fiscal year but funded in another.
The number of applications submitted to AHCPR declined considerably between FYs 1995 and 1997, most likely because of word spreading within the health services research community about decreased appropriations for extramural research. During FY 1997, the proportion of applications funded to assigned increased significantly, most likely because of the decreased number of applications.
A question that logically follows is: given overall applications and funding at AHCPR, how successful are nurse researchers in obtaining funding through AHCPR Figure 3 (46 KB) (Text Version) shows the number of applications assigned, reviewed, and funded by AHCPR with nurse PIs between FYs 1994 and 1997. These data were retrieved from AHCPR grants database as described previously and also by specifically searching for the following:
Similar to other investigators who sought funding through AHCPR, the number of nurse PIs applying to AHCPR declined dramatically between FYs 1975 and 1997, the proportion of applications funded to assigned increased in 1975. Furthermore, compared with the overall pool of applicants to AHCPR during the entire period, nurse investigators submitted very few applications. The ratio of scored to assigned applications for nurse researchers was similar to the ratio for all AHCPR applications, ranging from 61 percent to 67 percent, with the exception of FY 1997, when the ratio of scored to submitted applications for nurse PIs dropped to 44 percent.
Considering the proportion of nurse PIs funded in relation to all applications funded through AHCPR:
Select for text version of Table 2
| FY 1994 | FY 1995 | FY 1996 | FY 1997 | |||||
|---|---|---|---|---|---|---|---|---|
| Type of grant | No. submitted | No. funded | No. submitted | No. funded | No. submitted | No. funded | No. submitted | No. funded |
| R0-1 | 25 (399) | 1 (30) | 23 (466) | 1 (43) | 5 (256) | 0 (41) | 3 (59) | 0 (11) |
| R0-3 Small grant Dissertation |
4 (21) 10 (64) |
0 (5) 2 (22) |
3 (52) 8 (64) |
1 (9) 3 (15) |
11 (132) 0 (0)2 |
3 (32) 0 (0) |
9 (136) 1 (66) |
0 (40) 0 (17) |
| F-32 | 0 (8) | 0 (7) | 1 (10) | 1 (5) | 0 (9) | 0 (2) | 0 (6) | 0 (7)3 |
1. The number of applications received from all disciplines
is noted in parentheses. |
||||||||
Table 2 presents information on the number of research applications by grant type (exclusive of conference grants) for nurse PIs and for all PIs submitted and funded through AHCPR between FYs 1994 and 1997. During this time, two R0ls, four small grant R03s, five dissertation R03s, and 1 F-32 (postdoctoral training) awards were made to nurse PIs. Corresponding figures were considerably higher for AHCPR overall, although a breakdown by discipline is not available.
Hence, nurse PIs have been successful in receiving funding when applications were made to AHCPR, but perhaps they could be more successful if the numbers of strong applications being submitted were increased. Given that AHCPR is interested in many of the same research topics of interest to the discipline of nursing (e.g., disease prevention, health promotion, primary care, quality of care delivery, service delivery, etc.), and that AHCPR's immediate funding outlook is good, the potential return on investment for nurse PIs is good. AHCPR's FY 1993 budget is $171 million for AHCPR, a $25 million or 17 percent increase. (AHCPR's budget increased from roughly $45 million in 1989 to approximately $146 million in FY 1993.)
At the same time that funding has increased in FY 1999, existing AHCPR commitments are ending and the existing application pool is small (but growing), which makes this a particularly good time for nurse PIs to apply for AHCPR research funding.
Obviously, research applications submitted to AHCPR, similar to NIH or any funding agency, should be innovative and well-written. In addition to the health services research focus discussed earlier, three aspects of proposal development are somewhat unique to AHCPR:
First, given AHCPR's policy emphasis, specific focus on the policy relevance of a proposal will strengthen the application.
Investigators should address the practical and applied clinical origin of the proposal, anticipated impacts of the proposed study on health care policy-making, and strengths of the design and methods that facilitate addressing current and future policy concerns. 5 A section within the grant application devoted to a discussion of policy relevance, which complements the narrative related to clinical implications and patient outcomes, will draw reviewers' attention to emphasis in this area.
Second, an interdisciplinary research team-beyond the statisticians and clinicians who are typically included on nursing research teams-strengthens a proposal by supporting the interdisciplinary nature of healthcare delivery and health services research.
Team representation obviously depends on the nature of the proposed research. bur integrating nonclinical disciplines from the social sciences, economics, administration, engineering, and information sciences, to name a few, will likely broaden the type of questions posed in the study, the philosophic approach of the study, and the study design. However, as Shi notes,5 the team should be interdisciplinary, as opposed to multi-disciplinary, in nature. A truly interdisciplinary research team fuses knowledge from all represented disciplines to develop an integrated approach for studying an area of concern, rather than reflecting the work of a single discipline, making use of scientists from other disciplines to fill real or perceived skill deficiencies, or simply "tacking on" persons to give the appearance of an interdisciplinary ream. This integrated approach necessitates that the research team come together during the formative stages of proposal development to develop the conceptual base that will guide the study.
Finally, investigators also should consider that health services focus on individual and aggregate population health needs,5 which should be emphasized in proposal development.
For example. AHCPR emphasizes priority population interests in the areas of minority, women's, and children's health; recognition of the special needs of these and other relevant populations, and the implications of the proposed study related to those population needs should be addressed in the research proposal.
Several issues seem particularly relevant to nursing with respect to future health services research efforts. As an area of inquiry, health services research shares common questions, approaches, methods, and designs with the discipline of nursing and the area of science recognized as nursing research. These commonalities are important to recognize and build into research programs to expand nursing's existing capacity and infrastructure for conducting and using health services research.
Although at times the relationship between the nursing research community and AHCPR has been tentative, mutual benefit can be gained by strengthening the relationship and communication linkages. Specifically, the relationship is, or should be, reciprocal. Put simply, AHCPR needs nurse researchers to submit applications, use health services research findings, contribute to building an evidence base for practice, and support proposed budget initiatives. On the other hand, nursing needs funding from AHCPR to subsidize research efforts, expand the science base, and build health services research capacity. The nature of this relationship should be recognized, and even exploited, if healthcare related knowledge is to approach the level of current capacity or future potential.
The nursing research community has supported AHCPR in the past, and AHCPR has supported efforts of interest to the nursing community. For example, AHCPR supported and provided leadership on a collaborative effort with the National Institute of Nursing Research and the Division of Nursing at the Health Resources Services Administration on nurse staffing and quality of care in hospitals.
AHCPR also provides research opportunities for senior nurse scientists through the collaborative AHCPR-American Academy of Nursing Nurse Scholars Program and appoints nurses to study sections and the AHCPR National Advisory Council. In fact, AHCPR's Nurse Staffing Agenda grew out of the work of Christine T. Kovner, R.N., Ph.D., F.A.A.N., an AHCPR Academy of Nursing Scholar. (Nurses serving on the AHCPR National Advisory Council in 1999 were Colleen Conway-Welch, R.N., Ph.D., F.A.A.N., Professor and Dean, Vanderbilt School of Nursing, and Ada Sue Hinshaw, R.N., Ph.D., F.A.A.N., Professor and Dean, University of Michigan School of Nursing).
Nursing has directed considerable effort toward building its science base. Systematically shifting nursing research along the continuum of healthcare related research into the arena of health services research, thereby expanding research capabilities in areas such as the quality of care, costs of care, and access to care are reasonable steps in nursing and healthcare knowledge development. The relationship between AHCPR and the nursing research community is a two-way street, with the efforts of both groups ultimately aimed at improving health care for all persons. Future efforts to strengthen the relationship will benefit all concerned and likely will provide new knowledge about health care delivery and best practices to better in form consumers, clinicians, and policymakers.
I. Bavier AR. Where research and practice meet: opportunities at the Agency for Health Care Policy and Research. Nurs Policy Forum 1995;1:20-5, 38.
2. Cummings MA. Patient outcomes research: nursing, an important component. J Prof Nurs 1992;8:1-2.
3. McCormick KA, Cummings MA, Kovner C. The role of the Agency for Health Care Policy and Research in improving outcomes of care. Nurs Clinics North Am 1997;32:521-42.
4. Gray BH. The legislative battle over health services research. Health Affairs 1992;11:38-66.
5. Shi L. Health services research methods. Albany (NY): Delmar Publishers; 1997.
6. Eisenberg JM. Health services research in a market-oriented health care system. Health Affairs 1998;17:98-108.
Cheryl Bland Jones is senior health services researcher at the Center for Primary Care Research, AHCPR. Rockville, MD.
Lorraine Tulman is an associate professor at the University of Pennsylvania and was the Senior Scholar in Residence at the Center for Outcomes and Effectiveness Research, AHCPR, University of Pennsylvania, Philadelphia, when this manuscript was submitted.
Carolyn M. Clancy is a Director at the Center for Outcomes and Effectiveness Research, AHCPR, Rockville, MD.
We acknowledge the work of Ms. Kelly Morgan in pulling together data for this effort.
This article provides valuable information about funding opportunities for nursing scholars. However, some information has changed since publication:
Internet Citation:
Research Funding Opportunities at the Agency for Health Care Policy and Research. AHRQ Publication No. 99-R80, July 1999. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/nursing/nrsfundop.htm
Return to Nursing Research
AHRQ Home Page
Department of Health and Human
Services