[Federal Register Volume 66, Number 124 (Wednesday, June 27, 2001)]
[Notices]
[Pages 34227-34230]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-16024]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Notice of Cooperative Agreements to Develop, Implement and
Evaluate Safe Practices at the Patient Care Delivery Level Through
Collaborative, Interdisciplinary Education To Prepare Physicians and
Advanced Practice Nurses
The Health Resources and Services Administration (HRSA) announces
that applications will be accepted for Cooperative Agreements for
fiscal year (FY) 2001 to Develop, Implement and Evaluate Safe Practices
at the Patient
[[Page 34228]]
Care Delivery Level through Collaborative, Interdisciplinary Education
to Prepare Physicians and Advanced Practice Nurses.
The purpose of these Cooperative Agreements is to improve patient
safety in hospitals and in communities through collaborative,
interdisciplinary activities focusing on the planning, development, and
implementation of patient safety curricula/activities, including
simulations and informatics. These Cooperative Agreements build on the
recommendations of the Institute of Medicine (IOM), the reports by the
Quality Interagency Coordinating Task Force (QuiC), and a report by the
National Advisory Council on Nurse Education and Practice (NACNEP) and
the Council on Graduate Medical Education (COGME). The Councils are
charged with advising and reporting to the Secretary of Health and
Human Services (HHS) and the Congress on workforce, education, and
practice improvement policies.
The purpose of these Cooperative Agreements is to support the
development of educational activities that will focus on
interdisciplinary education of physicians and advanced practice nurses
to promote patient safety and prevent errors in health care delivery.
Authorizing Legislation
These Cooperative Agreements are 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 these Cooperative Agreements is
substantial and will be maintained by the Bureau of Health Professions
(BHPr) staff through technical assistance and guidance to the awardees
considerably beyond the normal stewardship responsibilities in the
administration of grant awards. Such aspects regarding these
Cooperative Agreements include:
(a) Consultation regarding contracts and agreements developed
during the implementation of the program;
(b) Participation in the development of an evaluation plan for the
project at its inception and to all phases of the program.
(c) Assistance in the identification of Federal and other
organizations with whom collaboration is essential in order to further
each Cooperative Agreement's mission and to develop specific strategies
to support the work of these related activities; and
(d) Authorization of the awardees to progress from the development
of the project curriculum/activity to the implementation phase.
The BHPr's Division of Medicine and Dentistry and the Division of
Nursing will manage each Cooperative Agreement through a two-member
team with one representative from each division.
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 3 or 4 awards.
It is expected that the awards will be made on or before September 30,
2001. Funding will be made available for 12 months with a 3-year
project period. 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 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),
COGME and 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
interdisciplinary education methods to improve patient safety and the
need for reforms in the education of physicians and nurses and in the
delivery of health care.
Applications for these Cooperative Agreements should address the
following elements:Interdisciplinary collaboration to improve patient
safety should be characterized by:
(1) Teaching of problem-based content to prepare physicians and
advanced practice nurses in clinical settings, linking usual
performance evaluation and content evaluation to collaboration between
medicine and nursing and improved patient safety;
(2) Improving systems to enhance patient safety educational
activities, including interdisciplinary training simulations using
teamwork, conflict resolution, or practical informatics (application of
computerized systems) to promote patient safety;
(3) Developing specialty initiatives in doctoral programs to
prepare teachers of medicine and nursing to work collaboratively using
interdisciplinary educational methods; and
(4) Establishing programs or activities to identify and eliminate
barriers that prevent faculty from participating in interdisciplinary
practice and educational programs.
These Cooperative Agreements will support the planning,
development, and implementation of interdisciplinary training projects
to improve patient safety through collaborative activities specifically
directed toward enhancing patient safety. Recipients of this training,
working in interdisciplinary teams, could become models of best
practices for patient safety at the patient care delivery level
throughout the awardee's region. The ultimate goal of this program is
to bridge the separate practice cultures of medicine and nursing by
expanding the numbers of professionals in both disciplines who are
trained to work together in teams to improve patient care systems and
prevent errors while delivering patient care in hospitals and/or in
communities.
Eligible Applicants
Eligible applicants are accredited schools of medicine and
osteopathic medicine and schools of nursing, 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 advanced practice nurses;(2) experience in identifying
and reducing patient error and/or enhancing patient safety at the care
delivery level; and (3) the capacity to provide regional collaborative,
interdisciplinary training.
[[Page 34229]]
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
these Cooperative Agreements:
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.
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
(MUC) 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 of 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 professions
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 an MUC.
(6) Student assistance, which is linked to service in MUCs
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 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 these
Cooperative Agreements:
(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 letters of intent to apply for
this request for applications for these Cooperative Agreements. The
letter is requested to assist staff in planning for the review based on
the 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 (DMD) and the Division of Nursing (DN) within the Bureau of
Health Professions (BHPr):
Dr. Richard Diamond, Medical Officer, Policy and Special Projects
Branch, Division of Medicine and Dentistry, Bureau of Health
Professions, HRSA, Room 9A-27, Parklawn Building,
[[Page 34230]]
5600 Fishers Lane, Rockville, MD 20857; or e-mail at [email protected].
Dr. Diamond's telephone number is 301-443-1082.
Dr. Madeleine Hess, Deputy Branch Chief, Nursing Special Initiatives
and Program Systems Branch, Division of Nursing, Bureau of Health
Professions, HRSA, Room 9-35, Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857; or e-mail 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
these Cooperative Agreements are available on the HRSA website address
at http://bhpr.hrsa.gov/grans2001/. Applicants may also request a hard
copy of these materials from the HRSA Grants Application Center (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 these
Cooperative Agreements must be received by mail or delivered to the GAC
no later than July 27, 2001. Geographic area and uniform national and/
or regional distribution will be considered in final funding decisions.
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 these Cooperative
Agreements may be directed to the same representatives for 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 these Cooperative Agreements (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. 01-16024 Filed 6-26-01; 8:45 am]
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