AHCPR Conference Offers Advice to Grant Applicants

Funding opportunities are growing for health services research, said Linda Blankenbaker, a spokesperson for the Agency for Health Care Policy and Research (AHCPR), during a recent conference at Baylor College of Medicine.

The conference, sponsored by the new section of health services research in the department of medicine at Baylor and directed by Dr. Nelda P. Wray, featured Blankenbaker and local experts who shared advice with local researchers on submitting grants to AHCPR, a major supporter of health services research.

AHCPR, an office of the Public Health Service in the U.S. Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost, and broaden access to essential services. "When we look at grant applications, we look for research that addresses different decision-making levels such as health care systems, public policy- makers and clinical decision-makers," said Blankenbaker.

Blankenbaker told the conference attendees that the agency would be emphasizing health outcomes research, quality measurement and improvement and health care access, use and expenditures in 1999. "Our goal is to facilitate research opportunities for experienced researchers and for newly trained health services researchers," she said.

According to Blankenbaker, AHCPR seeks projects that:

• Develop and disseminate research-based information to increase the scientific knowledge needed to enhance decision-making, improve quality, and promote efficiency in health care delivery;
  
  
• Draw from the literature on practice variations and chronic diseases, and focus on the impact of different delivery modalities and financing arrangements on the outcomes of care;
  
  
• Strengthen quality measurement and improvement through studies to develop valid and reliable quality measures, and strategies for incorporating quality measures into programs of quality improvement;
  
  
• Identify strategies to improve access, foster appropriate use, and reduce unnecessary expenditures of health care services that Americans use;
  
  
• Consider as a special focus of research health issues related to minority populations, women, and children.

During the conference, expert panelists Dr. Lu Ann Aday, professor of behavioral sciences from The University of Texas-Houston School of Public Health; Dr. Jay Glasser, professor of biometry from UT-Houston School of Public Health; Dr. Carol M. Ashton, associate professor of medicine at Baylor College of Medicine; and Dr. Nancy J. Petersen, assistant professor of medicine at Baylor College of Medicine, described the peer review and approval process to conference attendees. Through the peer review process, applicants receive a written critique by expert reviewers and projects of highest scientific merit are chosen for funding.

"I like to think of the review board in an anthropological way," said Dr. Glasser. "Several people from different disciplines are thrown together and they don't get compensated for it; but they are very dedicated to the task. It's a very heterogeneous group, so a balanced proposal is a very practical tip."

Dr. Aday, a world-renowned health services researcher, described the commitment of reviewers. "The study section works very hard beforehand, investing lots of time and effort. They see their role as a public good and they take it very seriously," Dr. Aday said. Dr. Ashton, who is director of the Houston VA's Center for Quality of Care and Utilization Studies, mentioned that reviewers often spend eight hours or more evaluating each proposal they've been assigned, in preparation for the study section meeting.

Panelists noted several key areas of the application that receive scrutiny, including the literature review. "A comprehensive literature review is important, and the question is how well the researcher has synthesized the current state of knowledge," said Dr. Ashton. "In part, your literature review should suggest where in the 'life-cycle' the research is presently located, an important consideration in research funding. The literature review must state what is known, what is unknown and what is sought."

Research projects must also have an integrated design and analysis plan to receive funding approval. "There must be a coherent theory, a conceptual framework or underlying set of relationships that can serve as anchors for your study," said Dr. Aday.

Dr. Petersen, a biostatistician at the Center for Quality of Care and Utilization Studies, told conference attendees that statistical rendering - the specialized understanding of how the concept relates to the statistical modeling - is also key. "Often the difference between funded and unfunded proposals is the attention to statistical elements, including the power calculations," she said.

Dr. Petersen also cautioned against overly ambitious projects. "Young investigators have a tendency to have too large a scope; the scale and scope of the project must be reasonable. Often simple is best," she said.

Often new studies are not approved because they lack a pilot study, said Dr. Glasser. "A pilot study can be small, using 25 subjects or a data set. The panel will want to see if you've tested out your idea."

In summarizing, Dr. Ashton said applicants must convince a diverse and demanding audience. "Persuading this heterogeneous group of reviewers is of utter importance. By means of the content and format of your proposal, you must 'herd' your review panel to the inescapable fact that they should fund your study."

For more information about AHCPR grants and program announcements visit their web site at http://www.ahcpr.gov.

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©2006 Texas Medical Center

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