Federal Grant Giving
Agency for Healthcare Policy Research
According to Mary Cummings, a grants management specialist at AHCPR's Office of Outcomes and Effectiveness, AHCPR recently awarded a small $50,000 grant to look at ambulatory care. The survey will examine the back problems doctors treat, who they see, the diagnostic and therapeutic methods they employ, and time they spent with each patient. There will also be questions addressing the content of back care in physician offices over period of time.
Epidemiologist Dan Cherkin, Ph.D., Group Health Center for Health Studies in Seattle, Washington, and one of the grantees of the ambulatory care survey, will look at massage therapists, naturopathy, acupuncturists, and the number of patients each treats.
Physician David Eisenberg of Harvard University is also researching alternative medicine, including acupuncture. Cummings highly encourages the medical acupuncturists to invite them to a meeting if the opportunity exists or if you haven't done so already.
Off the record, we were told that there is a belief that JAMA's editor George Lundberg will be releasing proceedings that point to alternative therapies as "the second biggest thing we should be involved in." According to our sources, "Alternative medicine, not just acupuncture, is really hot. This is a prime time to have your client get their act together and gear up."
The process requires that you submit a concept letter or memo based on their guidelines. While you don't have to do this as a first step, Cummings advises that it would be a practical step, especially if you want a little feedback before going the full route and expense and time of a proposal. Your concept letter can be mailed to Mary Cummings or emailed to her at firstname.lastname@example.org. And she notes, "You don't make or break yourself on the concept letter ... If it's totally awful, you will not waste time, or if it's totally something we would not fund, you won't waste your time. She can be tapped for insight prior to your submission of an application. Cummings serves as the project officer to grantees but her responsibilities also include international work, serving on committees, rewriting papers.
The contractor, Global Exchange, Inc., handles issuing NIH grant application kits. Both Peter and Pattie have very good contacts at this Bethesda firm. We have enclosed a grant application kit for your review. We have asked Joanne Book at AHCPR to provide us with a sample concept letter.
Reviews and Reviewers
Generally two or three people review the smaller grant applications which can be submitted throughout the year. The turnaround time for small grants is fairly quick, taking up to three or four months.
There are study sections and grant review sections for larger grants. "Big grants are awarded to those conducting effectiveness studies so Congress can say what does this mean." Large grants are reviewed in spring and funded in August/September of the same year.
What positions one application submission over another? "Things that happen to large members of people - back pain, pain period, headaches (interest AHCPR). Not just illnesses that happen to a few people. We are interested in changing behavior that means something. If behavior change occurs, it saves money, saves the healthcare system money."
AHCPR has an extensive roster of reviewers and obviously avoids anyone who might appear to have a conflict of interest. You can, however, approach the project officer and request experts to be part of a review committee.
For example, medical acupuncturists themselves could be asked to participate on a study section. As a group, they could recommend people who might sit on the review committee. For professionals, AHCPR might easily tap Eisenberg or Cherkin to be reviewers. AHCPR would make sure they identify those who don't think "acupuncture is a big hoakie ... someone who respects the topic, knows research methodology ... interested in getting real experience people, not just doctors interested in the topic."
Cummings sounded very encouraging about the sea change in interest in alternative therapies that includes acupuncture. "Times have changed. I believe there is interest in our agency." At the same time, she notes that competition can be tough. "It's always in competition with everything else... competing with other grant (seekers), getting ranked by score. You must give knowledge of what research has been done in the field. A well thought out literature review; a solid good background; really coherent objectives; methods must match objectives. You have to think about your plan for analysis -- what is it, why is the study important -- the budget should match what it is you plan on doing."
Having sat in a grants review recently, she pointed out an example of how AHCPR liked the proposal but suggested the prospect come in a second time. They didn't think he could realistically carry out the plan under the money earmarked. Applicants can try to get funding from various sources like the Office of Alternative Medicine, private foundations and AHCPR.
Where Do We Go From Here? Recommendations/Discussion
The NIH's Consensus Conference generated high profile media coverage and began to position medical acupuncture as a mainstream therapy.
To capitalize on the heightened awareness and credibility, F-H recommends that we:
1. Review the field of potential funding sources.
2. Narrow our "targets" to a handful of prospective grantors/funders based
on our insight into the sea change of perceptions in the funding arena
in this field.
3. Bolster the positioning of our message by leveraging NIH's panel findings,
the need for research to widen acceptance from medicine professionals
and to an extent, the public, our positive attributes, addressing potential
negatives and "hot buttons", unifying our communications platform.
4. Package positive national media stories, solid science, and define where
the research gaps are and what role medical acupuncturists have
played in improving the health of Americans.
5. Edit/leverage the video as a communications tool to tell our story visually.
6. Set up briefings with select foundations/agencies for insights, inputs,
guidance on positioning the medical acupuncturists' needs.
7. Secure application guidelines.
8. Enlist top-notch grants proposal writer.
Toward the Year 2000 -
The National Health Objectives
Where will federal health grant funding programs be headed in the years ahead? If past history is any indication, it is a good bet that funding will be made available for those areas that have been targeted as priorities under the year 2000 National Health Objectives.
The priority areas for the National Health Objectives for the Year 2000 include: reductions in tobacco use, alcohol and other drug abuse, improving nutrition, increasing physical activity and fitness and improving mental health and prevention of mental illness.
The report, Healthy People 2000, The National Health Promotion And The Disease Prevention Objectives For The Nation, noted that if tobacco use stopped entirely today throughout the nation, an estimated 390,000 fewer Americans would die "before their time" each year. If all Americans reduced their consumption of foods high in fat to well below current levels and engaged in physical activity no more strenuous than sustained walking for 30 minutes a day, additional results of a similar magnitude could be expected.
Concerning alcohol, the report noted that if alcohol were never carelessly used in our society, about 100,000 fewer people would die from unnecessary illness and injury. "Together, death from these causes comprise a sizable share of the 2.1 million deaths that occur annually and are examples of the impact of personal lifestyle choices on the health destiny of individual Americans and the future of the nation," it said.
Healthcare grantseekers should review the national health objectives because they will continue to serve as a virtual roadmap to where government funding will be targeted in the years ahead.
"The objectives are quantified, measurable, national targets for reducing preventable disease and disability," said the PHS. The objectives are scientifically sound, attainable with current resources and measurable, the PHS said.
The report makes it even easier for grantseekers to identify the federal agency responsible for coordinating grant programs.
The 21 priority areas are grouped into three categories: health promotion, health protection, and preventive services. Another category is surveillance and data systems. This category is for centrally monitoring progress toward data targets.
Following is a complete list of the priorities by category.
Healthcare grantseekers tailoring grant proposals need to be aware of the objectives when developing proposals for submission to federal agencies. For instance, goals to improve maternal and infant health will be reflected in the priority areas of the grants programs of the
- physical activity and fitness
- alcohol and other drugs
- mental health and mental disorders
- violent and abusive behavior
- educational and community-based programs
- unintentional injuries
- occupational safety and health
- environmental health
Food And Drug Safety
- oral health
- maternal and infant health
- heart disease and stroke
- diabetes and chronic disabling conditions
- HIV infection
- sexually transmitted diseases
- immunization and infectious diseases
- clinical preventive services
HRSA of the federal HHS. Likewise, efforts to combat the spread of HIV infection are administered by the National AIDS Program Office, while the CDC is the lead agency for grant programs to combat sexually transmitted diseases. For information on the objectives for the nation, contact: The Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Washington, DC 20201.
AHCPR Small Grants for Health
Research Linked to Healthy People 2000
The AHCPR is awarding small grants -- $50,000 over a project period -- for health services research, including conferences on selected priority areas.
The selected areas include but are not limited to: healthcare services for the underserved or disadvantaged populations; cost, access and quality of care for the uninsured and underinsured; healthcare services for HIV-infected persons; access, cost and quality of care for HIV-infected persons; medical liability issues; problems in primary care practices; management strategies for common outpatient clinical problems; factors influencing patient behavior; and determination of primary care provider behavior and practice patterns.
AHCPR said applicants should submit applications for priority consideration that address specific objectives of the publication Healthy People 2000.
AHCPR is especially interested in receiving grant applications from individuals new to the health services research field. Applicants will be notified of the funding decision within six months of the receipt date of their grant application. Receipt deadlines are Jan. 15, May 15, and Sept. 15 of any year. Address: Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Parklawn Building, Room 1812, Rockville, MD 20857.
See list of FEDERAL GRANT PROGRAMS for pain and rehabilitative medicine