[Federal Register Volume 66, Number 124 (Wednesday, June 27, 2001)]
[Notices]
[Pages 34225-34227]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-16023]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Notice of a Cooperative Agreement to Develop and Manage a Program
for Faculty Leadership in Interdisciplinary Education to Promote
Patient Safety (FLIEPPS)
The Health Resources and Services Administration (HRSA) announces
that applications will be accepted for a Cooperative Agreement for
fiscal year (FY) 2001 to Develop and Manage a Program for Faculty
Leadership in Interdisciplinary Education to Promote Patient Safety
(FLIEPPS).
The purpose of this Cooperative Agreement is to develop a ``train
the trainers'' program to create nurse and physician faculty leaders in
interdisciplinary education specifically directed toward enhancing
patient safety. Graduates of the program could then lead in the
training of other faculty in curricula and techniques in
interdisciplinary education to promote patient safety. The ultimate
goal of this program is to bridge the separate cultures of practice in
medicine and nursing by expanding numbers of professionals who are
trained to work together in teams to improve systems for safe patient
care and to prevent errors.
Authorizing Legislation
This Cooperative Agreement is solicited under the following
authorities of titles VII and VIII of the Public Health Service (PHS)
Act: (1) Section 747, as amended, which authorizes grants for training
of physicians who plan to teach in training programs for primary care
medicine (family medicine, general internal medicine, general
pediatrics, and/or geriatrics); and (2) section 811, as amended, which
authorizes grants to strengthen programs that enhance advanced nurse
education and practice.
The Federal role in the conduct of this Cooperative Agreement is
substantial and will be maintained by the Bureau of Health Professions
(BHPr) staff through technical assistance and guidance to the awardee
considerably beyond the normal stewardship responsibilities in the
administration of grant awards. This Federal role may include any or
all of the following:
(a) Technical assistance and participation in the planning,
development, and implementation of all phases of the program, including
consultation about contracts and agreements developed during the
implementation of the program, all curricula developed for the program,
content and staffing of training workshops, and the development of an
evaluation plan for the project which would be initiated at its
inception;
(b) Assistance with identification of Federal and other
organizations with whom collaboration is essential in order to further
the Cooperative Agreement mission and to develop specific strategies to
support the work of these related activities;
(c) Participation in the development of funding projections;
(d) Participation in the development of data collection systems and
procedures;
(e) Participation in appropriate meetings, committees,
subcommittees, and working groups related to the Cooperative Agreement
and its projects as well as site visits.
The successful applicants will be included in the overall program
activities of the Department of Health and Human Services (HHS) in
patient safety and will participate in the programs and support
services that will be offered by the Patient Safety Research
Coordinating Center supported under a contract from the Agency for
Healthcare Research and Quality (AHRQ). The Cooperative Agreements are
part of an overall HHS funding effort to improve patient safety
research, demonstration and education through a series of RFAs and
Cooperative Agreements (related RFAs are listed at www.ahrq.gov,
particularly the AHRQ Patient Safety Research Dissemination and
Education RFA that was published on April 23, 2001).
Availability of Funds
Up to $400,000 will be available in FY 2001 to fund one award for
the first year. Funding may be continued to complete a 3-year total
project period. It is expected that the award will be made on or before
September 30, 2001. Support beyond the first year of the project period
will be based on the achievement of satisfactory progress and the
availability of funds.
Background
In September 2000, shortly after the Institute of Medicine (IOM)
published its widely discussed report: ``To Err is Human: Building a
Safer Health System'' (Kohn, Corrigan and Donaldson, National Academy
Press, Washington, DC, 2000), the Council on Graduate Medical Education
(COGME) and the National Advisory Council on Nurse Education and
Practice (NACNEP) jointly focused on nurse-physician collaboration in a
report entitled, ``Collaborative Education Models to Ensure Patient
Safety.'' COGME-NACNEP joint recommendations stressed the need for
changing the norms of professional education and practice so that
physicians and nurses would function as part of collaborative teams to
improve patient safety and the overall quality of care. COGME and
NACNEP are charged with advising and reporting to the Secretary of HHS
and the Congress on workforce, education, and practice improvement
policies.
These joint Advisory Council recommendations highlighted the
critical importance of developing educational leaders in
interdisciplinary education to promote patient safety to effect
positive changes toward developing systems of care that stress
professional collaboration and teamwork.
This Cooperative Agreement requests the planning, development, and
implementation of interdisciplinary educational and training programs
for the education of physicians and nurses directed toward improving
patient safety. This will involve the development of formal curricula
in interdisciplinary leadership and training in interdisciplinary
teamwork focused on building safer systems of patient care. Curricula
must include both didactic and experiential learning (in both
simulations and practice settings) with each team being supported by a
mentor. In particular, safety issues must target those areas of care
which require physician-nurse communication, especially recognition and
elimination of situations which create discontinuities in communication
and apparent responsibilities that may increase the likelihood of
errors. Curricula must contain elements that emphasize cultural
competency, to broaden physicians' and nurses' understanding of how
differences in race, ethnicity, language, gender, and sexual
orientation may affect communication between physicians, nurses, and
patients, interpretations of patients' histories and responses to
recommendations and, thereby, affect patient safety.
Educational efforts will be directed at teams of faculty sponsored
by health care organizations (universities, teaching hospitals,
ambulatory centers or consortia involved in training). Each team to be
trained must include at least
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several allopathic or osteopathic physicians and nurses, but must
include at least one allopathic or osteopathic physician and one nurse.
Inclusion of trained medical educators must be encouraged.
Programs may be directed toward developing faculty leaders for
undergraduate, graduate, and/or continuing professional education for
those who provide clinical care. Faculty leadership development
programs must address: (1) The development of curricular design for
collaborative education of physicians and nurses, and improvement in
leadership and interdisciplinary teaching skills; (2) the development
of interdisciplinary collaborative curricula designed to promote
patient safety. The emphasis must be on improving communications and
teamwork, and identifying and reducing discontinuities in patient care
routines and systems, which will eliminate common sources of errors. At
the completion of the specified educational and training program, the
trainees must be certified by the awardee through a mechanism
determined during the initial planning phase as competent faculty to
develop and lead collaborative programs in interdisciplinary education
to enhance patient safety in their own organizations. The awardee will
be expected to perform a comprehensive outcome evaluation of all
efforts delivered through this Cooperative Agreement. Evaluations of
the individual projects supported by this Cooperative Agreement must be
reported along with the evaluation of the overall faculty leadership
development program as proposed and implemented through the overall
plan.
Applicants must show experience in professional faculty
development, physician-nurse collaborative interdisciplinary education,
and/or addressing practical patient safety issues, or be able to
demonstrate their expertise in these areas.
Eligible Applicants
Eligible applicants are accredited schools of nursing, schools of
medicine and osteopathic medicine, academic health centers, public and
nonprofit private hospitals, and other public or private nonprofit
entities which provide educational programs for undergraduate,
graduate, or graduate medical and nursing education.
Applicants should have a demonstrable track record in (1) The
design and implementation of training or educational programs for
physicians and nurses; (2) inter-disciplinary education and/or training
for physicians and nurses; and (3) experience and/or expertise in
education to improve patient safety.
Funding Preference
A funding preference is defined as the funding of a specific
category or group of approved applications ahead of other categories or
groups of applications. The following preferences are available under
this Cooperative Agreement:
As provided in section 791(a) of the PHS Act, preference will be
given to any qualified applicant that: (a) Has a high rate for placing
graduates in practice settings having the principal focus of serving
residents of medically underserved communities, or (b) during the 2-
year period preceding the fiscal year for which such an award is
sought, has achieved a significant increase in the rate of placing
graduates in such settings; or (c) qualifies for the funding preference
by meeting the criteria for a new program.
Definition of High Rate: At least 20 percent of graduates from
academic years 1998, 1999, and 2000 devote at least 50 percent of their
time working in clinical practice in medically underserved community
(MCH) settings.
Definition of Significant Increase: During the past two years (1999
and 2000), the rate of placing graduates in MUC settings has increased
at least 50 percent (with a minimum of 2 graduates) and at least 15
percent from the last year are working in MUC settings.
Established clinical sites identified under the ``medically
underserved community'' definition are used as proxies for rural and
underserved populations.
The term ``medically underserved community (MUC)'' means an urban
or rural area or population that:
(a) Is eligible for designation under section 332 as a Health
Professional Shortage Area (HPSA);
(b) Is eligible to be served by a Migrant Health Center under
section 330 of the PHS Act, a Community Health Center under section 330
of the Act, a grantee under section 330 of the Act (relating to
homeless individuals), or a grantee under section 330 of the Act
(relating to residents of public housing);
(c) Is eligible for certification under section 1861(aa)(2) of the
Social Security Act (relating to rural health clinics); or
(d) Is designated by a State Governor (in consultation with the
medical community) as a shortage area or MUC. (Section 799B(6) of the
PHS Act.)
In reference to section 332 (HPSA) listed above, the following
instructions apply:
(a) To determine if any applicant fits the standards for
eligibility when they are not so designated, the applicant must
demonstrate that an application has been submitted for such designation
and include proof of acceptance of that application from the
designating authority.
(b) The MUC preference will not be applied without proof of
approval of that application.
For new programs (those having graduated three or fewer classes),
applicant proposals will be evaluated by the criteria in the Act used
to define a ``new program'' and a preference will be given to those new
programs that meet at least four of the following seven criteria:
(1) The mission statement of the program identifies a specific
purpose of the program as being the preparation of health professionals
to serve underserved populations.
(2) The curriculum of the program includes content which will help
to prepare practitioners to serve underserved populations.
(3) Substantial clinical training experience is required under the
program in MUCs.
(4) A minimum of 20 percent of the clinical faculty of the program
spend at least 50 percent of their time providing or supervising care
in MUCs.
(5) The entire program, or a substantial portion of the program, is
physically located in a MUC.
(6) Student assistance, which is linked to service in MUC's
following graduation, is available to the students in the program.
(7) The program provides a placement mechanism for deploying
graduates to MUCs.
As provided in section 805 of the PHS Act, a funding preference
will be applied to approved applications that will substantially
benefit rural OR underserved populations, OR help meet public health
nursing needs in State or local health departments.
These statutory general preferences will only be applied to
applications that rank above the 20th percentile of applications
recommended for approval by the peer review group.
Special Consideration
A special consideration is the enhancement of priority scores by
individual merit reviewers of approved applications which address
special areas of concern.
Section 747(c)(3) provides for a special consideration to be given
to projects that prepare practitioners to care for underserved
populations and other high risk groups such as the
[[Page 34227]]
elderly, individuals with HIV/AIDS, substance abusers, homeless, and
victims of domestic violence.
Section 811(f)(3) provides for a special consideration to eligible
entities that agree to expend the award to train advanced education
nurses who will practice in HPSAs designated under section 332.
Review Criteria
The specific review criteria used to review and rank applications
are included in the application guidance that will be provided to each
potential applicant. Applicants should pay strict attention to
addressing these criteria, as they are the basis upon which
applications will be judged by the reviewers.
The following generic review criteria are also applicable to this
Cooperative Agreement:
(a) That the estimated cost to the Government of the project is
reasonable considering the level and complexity of activity and the
anticipated results.
(b) That project personnel are well qualified by training and/or
experience for the support sought, and the applicant organization or
the organization to provide training has adequate facilities and
manpower.
(c) That insofar as practical, the proposed activities, if well
executed, are capable of attaining project objectives.
(d) That the project objectives are capable of achieving the
specific program objectives defined in the program announcement and the
proposed results are measurable.
(e) That the method for evaluating proposed results includes
criteria for determining the extent to which the program has achieved
its stated objectives and the extent to which the accomplishment of
objectives can be attributed to the program.
(f) That, insofar as practical, the proposed activities, when
accomplished, are replicable, national in scope, and include plans for
broad dissemination.
Letters of Intent and Deadline Date
Applicants are encouraged to submit a letter of intent to apply for
this request for applications for a Cooperative Agreement. The letter
is requested to assist staff in planning for the review based on
anticipated number of applications. The letter of intent is due by July
11, 2001. Simultaneously mail or e-mail one copy of the letter to each
of the following representatives from the Division of Medicine and
Dentistry and the Division of Nursing within the Bureau:
Dr. Richard D. Diamond, Medical Officer, Policy and Special Projects
Branch, Division of Medicine and Dentistry, Bureau of Health
Professions, HRSA, Room 9A-27, ParklawnBuilding, 5600 Fishers Lane,
Rockville, MD 20867; or e-mail address at [email protected]. Dr.
Diamond's telephone number is (301) 443-1082.
Dr. Madeleine Hess, Deputy Chief, Nursing Special Initiatives and
Program Systems Branch,Division of Nursing, Bureau of Health
Professions, HRSA, Room 9-35, ParklawnBuilding, 5600 Fishers Lane,
Rockville, MD 20867; or e-mail address at [email protected]. Dr. Hess'
telephone number is (301) 443-6336.
Application Requests, Dates and Address
Federal Register notices and the application form and guidance for
this Cooperative Agreement are available on the HRSA web site address
at http://bhpr.hrsa.gov/grants2001/. Applicants may also request a hard
copy of these materials from the HRSA Grants ApplicationCenter (GAC) at
1815 North Fort Myer Drive, Suite 300, Arlington, VA 22209; telephone
number 1-877-477-2123. The GAC e-mail address is: [email protected].
In order to be considered for competition, applications for this
Cooperative Agreement must be received by mail or delivered to the GAC
no later than July 27, 2001.
Completed applications must be submitted to the GAC at the above
address. Applications received after the deadline date or sent to any
address other than the Arlington, Virginia address above will be
returned to the applicant and not reviewed.
National Health Objectives for the Year 2010
The PHS urges applicants to submit their work plans that address
specific objectives of Healthy People 2010, which potential applicants
may obtain through the Superintendent of Documents, Government Printing
Office, Washington, DC 20402-9325 (telephone: (202) 783-3238).
Particular attention should focus on Healthy People 2010 Workforce
Objectives, such as Objectives 1-8 (achieving minority representation
in the health professions) and 23-8 (incorporating specific
competencies into the public health workforce).
Smoke-Free Workplace
The PHS strongly encourages all grant recipients to provide a
smoke-free workplace; to promote the non-use of all tobacco products;
and to promote Pub. L. 103-227, the Pro-Children Act of 1994, which
prohibits smoking in certain facilities that receive Federal funds in
which education, library, day care, health care, and early childhood
development services are provided to children.
Additional Information
Questions concerning programmatic aspects of the Cooperative
Agreement may be directed to the same representatives of the Division
of Medicine and Dentistry and the Division of Nursing listed above in
the Letters of Intent section of this notice.
Paperwork Reduction Act
The standard application form HRSA-6025-1, the HRSA Competing
Training Grant Application, has been approved by the Office of
Management and Budget (OMB) under the Paperwork Reduction Act. The OMB
clearance number is 0915-0060. If the methods for developing the
proposed comprehensive outcome evaluation of all efforts delivered
through thisCooperative Agreement (as described in the Background
section of this notice) falls under the purview of the Paperwork
Reduction Act, awardees will assist HRSA in seeking OMB clearance for
proposed data collection activities.
This program is not subject to the provisions of Executive Order
12372, Intergovernmental Review of Federal Programs (as implemented
through 45 CFR part 100). This program is also not subject to the
Public Health Systems Reporting Requirements.
Dated: June 19, 2001.
Elizabeth M. Duke,
Acting Administrator.
[FR Doc. 01-16023 Filed 6-26-01; 8:45 am]
BILLING CODE 4160-15-P