Grants for Independent School Districts

The purpose of the NIH Pathway to Independence Award (K99/R00) program is to increase and maintain a strong cohort of new and talented, NIH-supported, independent investigators. This program is designed to facilitate a timely transition of outstanding postdoctoral researchers with a research and/or clinical doctorate degree from mentored, postdoctoral research positions to independent, tenure-track or equivalent faculty positions. The program will provide independent NIH research support during this transition in order to help awardees to launch competitive, independent research careers.

The purpose of the NIH Pathway to Independence Award (K99/R00) program is to increase and maintain a strong cohort of new and talented, NIH-supported, independent investigators. This program is designed to facilitate a timely transition of outstanding postdoctoral researchers with a research and/or clinical doctorate degree from mentored, postdoctoral research positions to independent, tenure-track or equivalent faculty positions. The program will provide independent NIH research support during this transition in order to help awardees to launch competitive, independent research careers. Frequently Asked Questions for NOT-HL-23-083 General Questions Q: What is the purpose of the Notice of Special Interest (NOSI) NOT-HL-23-083? The NOSI on Assessing Real-World Effectiveness and Implementation of Telehealth-Guided Provider-to-Provider Communication among Rural Communities (NOT-HL-23-083) aims to support research that generates evidence on the real-world effectiveness of telehealth collaboration among healthcare providers for consultation, second opinions, and other purposes, referred to as provider-to-provider telehealth (PPT). The NOSI is intended to support the use of telehealth interventions and tools for the prevention, management and treatment of heart, lung, blood, and sleep conditions, as well as cancer, in rural communities. Q: Are foreign applications allowed under this NOSI? Yes. Non-domestic entities (Foreign Institutions) and Non-domestic components of U.S. Organizations are eligible to apply under the Notice of Funding Opportunities (NOFOs) relevant to this NOSI (PA-20-185; PAR-22-105; PAR-21-035; PAR-21-341) – additional information regarding eligibility is available in Section III. Eligibility Information of each NOFO. Q: How is “rural” defined for the purposes of this NOSI? Different definitions of “rural” are used by various entities for different purposes. Rurality can be conceptualized based on administrative boundaries, land-use patterns, or economic influence; can reflect several different dimensions, such as population density, population size, and degree of remoteness; and can be delineated at different spatial scales (e.g., zip code, county, census district). Applicants should operationalize “rural” in the way that best serves the aims of their study. However, applicants should clearly state how they are defining rural in their application and provide a justification for the criteria they are using. A few widely used classification systems for defining rural and urban areas are provided below. Additionally, the Health Resources and Services Administration (HRSA) provides a tool on their website that enables users to see whether a specified geographic area is considered “rural” for the purposes of HRSA Rural Health Grant eligibility: https://data.hrsa.gov/tools/rural-healthexternal link. This may be a good starting point for assessing whether an area of interest might be considered “rural”. Census Bureau Urban-Rural Classificationsexternal link - The Census Bureau delineates urban areas by applying specified criteria to the decennial census and other data. For the 2020 Census, an urban area comprises a densely settled core of census blocks that meet minimum housing unit density and/or population density requirements of having at least 2,000 housing units or a population of at least 5,000. This includes adjacent territory containing non-residential urban land uses. Rural areas encompass all population, housing, and territory not included within an urban area. National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Countiesexternal link – NCHS has developed a six-level urban-rural classification scheme for U.S. counties and county-equivalent entities. The scheme is based on the Office of Management and Budget’s (OMB) delineation of metropolitan statistical areas (MSA) and micropolitan statistical areas, as well as Vintage postcensal estimates of the resident U.S. population. The scheme has two levels nonmetropolitan counties. USDA Rural Urban Continuum Codes (RUCC)external link - Rural-Urban Continuum Codes are a 9-level classification scheme that categorizes metropolitan counties by the population size of their metro area, and nonmetropolitan counties by their degree of urbanization and adjacency to a metro area. USDA Rural Urban Commuting Area (RUCA) Codesexternal link - RUCA codes categorize census tracts based on measures of population density, urbanization, and daily commuting patterns. This classification system consists of 10 levels that delineate metropolitan, micropolitan, small town, and rural commuting areas based on the size and direction of the primary (largest) commuting flows. These 10 codes are further subdivided based on secondary commuting flows. USDA Urban Influence Codesexternal link (UIC) – Urban influence codes are a 12-level classification scheme that distinguishes metropolitan counties by the population size of their metro area, and nonmetropolitan counties by the size of the largest city or town and proximity to metro and micropolitan areas. There are two metro and ten nonmetro categories. Frontier and Remote Area (FAR) Codesexternal link – Developed by the USDA Economic Research Service, Frontier and Remote Area codes are based on ZIP-codes. The term "frontier and remote" is used to describe territory characterized by some combination of low population size and high geographic remoteness. FAR areas are defined in relation to the time it takes to travel by car to the edges of nearby Urban Areas (UAs)external link. Four levels are necessary because rural areas experience degrees of remoteness at higher or lower population levels that affect access to different types of goods and services. Q: My project focuses on “direct-to-consumer/ direct-to-patient” telehealth, would it still be responsive to this NOSI? No. This NOSI focuses on “provider-to-provider” telehealth (PPT), which is a telehealth modality that fosters collaboration among healthcare providers for consultation, second opinions, and other purposes. Please refer to the “Background” section of the NOSI for some examples of PPT in heart, lung blood, sleep and cancer conditions. Q. My university/institution is located in an urban area, would I still qualify for this NOSI? There is no restriction regarding the location of the Principal Investigator’s university, institution, or center and if it is in an urban or rural area. The limiting factor is the population of interest. The focus of this NOSI is the use of provider-to-provider telehealth (PPT) to benefit rural communities. For the definition of rural areas, please refer to the previous questions “How is “rural” defined for the purposes of this NOSI?” Q. One of the components of my research involves a center or hospital located in an urban center/hospital, would I still qualify for this NOSI? It depends. The focus of this NOSI is the use of provider-to-provider telehealth (PPT) to benefit rural communities. As such, considering a hub-and-spoke telehealth model, the healthcare providers who require consultation and their patients (spoke component) must be in a rural area, assuring that the benefited population served by the PPT intervention is rural. Example 1: If both communicating sides of providers (hub and spoke) are in urban areas, it is not responsive to this NOSI. Example 2: If the provider receiving the consultation or training (spoke) is in a rural area, and the consulted team (hub or hub-less provider) is in an urban area, it is responsive to this NOSI, given that the population of interest benefitted by the PPT intervention is still in a rural area. For the definition of rural areas, please refer to the previous questions “How is “rural” defined for the purposes of this NOSI?” Q. Is the NOSI restricted to telemedicine between physicians? No. The focus of the NOSI is not just telemedicine, but telehealth, which goes beyond the communication between physicians, and would include a series of healthcare providers, allied health providers, and their teams. For some examples, please refer to the “ Background” section of the NOSI. Q: What are some of the research examples that might be responsive to this NOSI? There are a series of research projects that might be of interest for this NOSI. For some examples, please refer to the ones listed in the “Selected Research Examples ” section of the NOSI. Please be aware that these are meant to illustrate some of the projects of interest for this NOSI, and other research projects not exemplified here might still be of interest. Investigators are encouraged to reach out to the Scientific and Research Contacts listed in the NOSI to discuss their research ideas and their relevance to the NOSI as well as institute funding priorities. Q. Who do I contact for more information from specific participating Institutes, Centers, and Offices? To whom should I direct my questions regarding this NOSI? To access the complete list of contacts, please refer to the “Inquiries” Section of the NOSI, which includes Scientific and Research Contacts and Financial/Grants Management Contacts. For programmatic questions at NHLBI, please contact Dr. Fernando P. Bruno fernando.bruno@nih.govmailto:, for programmatic questions at NCI, please contact Dr. Robin C. Vanderpool robin.vanderpool@nih.govmailto:. If you have submission questions, please contact the eRA Service Desk. Application Preparation and Submission Questions Q: NHLBI and NCI are collaborating on this NOSI. If an applicant has a proposal that is relevant to both cancer and to heart, lung, blood, and sleep conditions, which institute will the application be assigned to? Applicants are advised to make use of the Assignment Request Form to request the institute they would prefer to act as the “Awarding Component.” These requests are taken into consideration. Applicants are further advised to consider the institute they plan to choose on the Assignment Request Form when framing their specific aims. The Awarding Component Section of the PHS Assignment Request Form * All assignment suggestions will be considered; however, not all assignment suggestions can be honored. Applications are assigned based on relevance of the application to an individual awarding component mission and scientific interests in addition to administrative requirements. * Applicants may enter up to three preferences for primary assignment in the boxes in the "Suggested Awarding Component(s)" row. Note: the application will be assigned based on the most appropriate match between it, the terms of the FOA, and the mission of each possible awarding component, with your preference(s) taken into consideration when possible. Applicants do not need to make entries in all three boxes of the "Awarding Component Assignment Suggestions" section. Q: If a proposal has aims that might be responsive to more than one eligible Notice of Funding Opportunity (NOFO) – should an investigator submit an application that is targeted at two different eligible funding opportunities, or separate those aims into two different applications and submit one to each corresponding NOFO? Each application in response to this NOSI must target only one of the eligible NOFOs. An applicant can elect to submit two different applications to two different NOFOs as long as the specific aims are sufficiently distinct. If the Division of Receipt and Referral determines there is significant overlap between the two applications, the applicant could be asked to withdraw one of them.

The purpose of the NIH Independent Scientist Award (K02) is to foster the development of outstanding scientists and enable them to expand their potential to make significant contributions to their field of research. The K02 award provides three to five years of salary support and "protected time" for newly independent scientists who can demonstrate the need for a period of intensive research focus as a means of enhancing their research careers. Each independent scientist career award program must be tailored to meet the individual needs of the candidate. This Parent Funding Opportunity Announcement is for basic science experimental studies involving humans, referred to in NOT-OD-18-212 as prospective basic science studies involving human participants. These studies fall within the NIH definition of a clinical trial and also meet the definition of basic research. Types of studies that should be submitted under this FOA include studies that prospectively assign human participants to conditions (i.e., experimentally manipulate independent variables) and that assess biomedical or behavioral outcomes in humans for the purpose of understanding the fundamental aspects of phenomena without specific application towards processes or products in mind. Applicants not planning an independent clinical trial or basic experimental study with humans, or proposing to gain research experience in a clinical trial or basic experimental study with humans led by another investigator, must apply to the 'Independent Clinical Trial Not Allowed' companion FOA. The proposed project must be related to the programmatic interests of one or more of the participating NIH Institutes and Centers (ICs) based on their scientific missions.

The purpose of the NIH Independent Scientist Award (K02) is to foster the development of outstanding scientists and enable them to expand their potential to make significant contributions to their field of research. The K02 award provides three to five years of salary support and "protected time" for newly independent scientists who can demonstrate the need for a period of intensive research focus as a means of enhancing their research careers. Each independent scientist career award program must be tailored to meet the individual needs of the candidate. This Funding Opportunity Announcement (FOA) is designed specifically for applicants proposing to serve as the lead investigator of an independent clinical trial, a clinical trial feasibility study, or a separate ancillary clinical trial, as part of their research and career development. Applicants not planning an independent clinical trial, or proposing to gain research experience in a clinical trial led by another investigator, must apply to companion FOA

The purpose of the NIH Independent Scientist Award (K02) is to foster the development of outstanding scientists and enable them to expand their potential to make significant contributions to their field of research. The K02 award provides three to five years of salary support and "protected time" for newly independent scientists who can demonstrate the need for a period of intensive research focus as a means of enhancing their research careers. Each independent scientist career award program must be tailored to meet the individual needs of the candidate. This Funding Opportunity Announcement (FOA) is designed specifically for applicants proposing research that does not involve leading an independent clinical trial, a clinical trial feasibility study, or a separate ancillary clinical trial. Applicants to this FOA are permitted to propose research experience in a clinical trial led by another investigator. Applicants proposing a clinical trial or an ancillary clinical trial as lead investigator, should apply to the companion FOA

Small research (R03) grants provide flexibility for initiating studies which are generally for preliminary or short-term projects. These grants are non-renewable. Some examples of the types of projects that R03 research supports include: Pilot or feasibility studies Secondary analysis of existing data Small, self-contained research projects Development of research methodology Development of new research technology The AHRQ small grant is a mechanism for supporting discrete, well-defined projects that realistically can be completed within two years (or less) within the budget constraints of the mechanism. Because the research strategy section of the application is limited to 6 pages, an R03 grant application may not contain the same level of detail as that found in an R01 application. Accordingly, appropriate justification for the proposed work can be provided through literature citations, data from other sources, or from investigator-generated data. Preliminary data are not required, particularly in applications proposing pilot or feasibility studies. The Small Research Grant (R03) is an award made by AHRQ to an institution/organization to support a discrete health services research project. The R03 research strategy proposed by the applicant institution/organization must be related to the mission and research interests of AHRQ, which are detailed below. Although the PD/PI is responsible for conducting and supervising the research, the actual applicant is the research institution/organization legally accountable for the performance of the award and the expenditure of funds. AHRQ Mission and Research Areas of Interest: The AHRQ mission is to produce evidence to make health care safer, higher quality, more ac­cessible, equitable and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used. Within this mission, AHRQ’s specific priority areas of focus are: Research to improve health care patient safety. Harnessing data and technology to improve health care quality and patient outcomes and to provide a 360-degree view of the patient. Research to increase accessibility and affordability of health care by examining innovative market approaches to care delivery and financing. Research to Improve Health Care Patient Safety Patient safety is defined as the freedom from accidental or preventable injury produced by health care as well as the practices that create a safe environment of care. The ultimate goal of AHRQ-supported Patient Safety research is to improve the safety of health care delivery. Patient safety research initiatives that lead to this goal can be considered in three different stages: Identification of risks, hazards, and patient harm. Design, implementation, dissemination and spread, and evaluation of interventions to improve patient safety. Establishment of strategies to sustain patient safety improvements such as just culture, incident/event reporting, measurement, monitoring, and surveillance. AHRQ's Patient Safety Research Program: (1) identifies specific areas of focus through targeted grant funding announcements (i.e., Program Announcements, Requests for Applications, and Special Emphasis Notices) and (2) encourages investigators to utilize the Agency's general funding announcements to apply this research framework in response to other patient safety threats and opportunities for improvement. The Patient Safety Portfolio will support research projects to create new knowledge by identifying the risks, hazards, and harm encountered by patients as a result of health care. The Portfolio will also support projects that mitigate those risks, hazards, and harm including the design, implementation and evaluation of strategies (patient safety practices) and the adaptation, refinement, and sustainment of those strategies. These initiatives are part of the Agency's overall mission to improve the quality of health care. AHRQ encourages an interdisciplinary, systems science patient safety approach. In addition to health services research, perspectives from organizational theory, human factors, industrial engineering, facilities design, education, and other disciplines can be incorporated in research plans. Projects may address important topics such as: the surveillance, measurement, detection, and reporting of patient safety events; the impact of human performance, work flow, and working conditions on patient safety; the patients' role and contribution to patient safety; health care safety culture, leadership, communication, teamwork, and simulation; prevention and control of healthcare-associated infections (HAIs); diagnostic safety and quality; the safe use of medical devices and medications, including safely prescribing opioids; the role of Patient Safety Organizations; and the challenges inherent in transitions of care in the same setting and between settings and handoffs between health care providers. Research related to the prevention and control of HAIs is an instructive example of AHRQ’s Patient Safety research interests. AHRQ supports research whose short-term or long-term aim is to develop improved methods for preventing HAIs and to develop effective implementation strategies for HAI prevention in all health care settings. Accordingly, AHRQ’s foci of interest in HAI research are the following broad areas: Determination of the clinical efficacy and effectiveness of preventive interventions, including unintended adverse consequences. Characterization and assessment of relevant epidemiological aspects of HAIs, including but not limited to patient risk factors, clinical presentation, and sources of antibiotic-resistant organisms involved in the development of HAIs. Demonstration, dissemination, and evaluation of strategies and approaches for prevention and reduction of HAIs. Research regarding adoption and implementation (including sustainment, spread, and scale-up) of evidence-based approaches for prevention of HAIs. The HAI research portfolio also encompasses generation of knowledge for combating antibiotic resistant bacteria. AHRQ is interested in studies to promote appropriate antibiotic use, reduce the transmission of resistant bacteria, and prevent HAIs in the first place. The last contributes to antibiotic stewardship by avoiding the need for antibiotic therapy and precludes the possibility of a resistant infection. Clinical investigations that seek to establish the efficacy or effectiveness of preventive interventions, as noted above, typically involve a comparison of the intervention in question to routine care or, less frequently, to a placebo (when the latter is ethical). Such clinical studies are included in the scope of AHRQ’s HAI research portfolio. The HAI Portfolio does not fund comparisons of two interventions of known efficacy or effectiveness to determine which is more efficacious or effective. Such studies are comparative effectiveness research, which is more appropriately funded by other funding sources. The Portfolio supports research in all health care settings including the hospital, long-term care, ambulatory care, home health care, pharmacy, and transitions of care between settings. Patient safety research involves many stakeholder groups including patients, families, clinicians, non-clinical health care staff, policymakers, payers, and health care organizations including providers and accreditors, local and State governments, and the Federal Government, Patient Safety Organizations, and many others. Projects in this area may also address patient characteristics that might influence the risk of experiencing a patient safety event, for example, attributes of AHRQ's priority populations that can impact patient safety and address strategies to address barriers to safe care. Harnessing Data and Technology To Improve Health Care Quality and Patient Outcomes and To Provide a 360-Degree View of the Patient AHRQ is interested in research to: advance the methods of evidence synthesis to ensure scientific rigor and unbiased reviews, make evidence-based recommendations on clinical preventive services, conduct research on how health information technology can improve the quality of health care, advance the science of clinical practice improvement, evaluate and support innovative models of practice transformation in primary care and other ambulatory settings, and facilitate communities of learning to promote the implementation of evidence for practice improvement. Further, AHRQ is interested in studying and improving upon the process by which health systems and ambulatory care practices select evidence to implement and how to determine what strategies are used to implement the evidence into everyday practice. The study of implementation strategies and processes is critical because interventions developed in the context of publically funded efficacy and effectiveness trials are rarely scalable without adaptations to specific settings and additional tools and guidance to support uptake and implementation. AHRQ is also interested in research that advances whole-person, 360-degree care especially those with multiple chronic conditions and/or socioeconomic disadvantage. Whole person, 360-degree care is defined as the coordination of health, behavioral health, intellectual/developmental disabilities, and social services in a person-centered manner with the goals of improved health outcomes and more efficient and effective use of resources in the context of people’s lives and the communities they live in. Emphasis is on the orientation of the health care team to consider all domains of a person’s life when assessing and addressing needs. The following lists examples of AHRQ research priorities: Improving health care quality outcomes by providing integrated, coordinated whole-person, 360-degree care to optimize individual and population health outcomes: Generation of knowledge about how clinical teams can most effectively elicit and use a patient’s values; preferences; and personal, social, and clinical context to formulate and use plans of care in partnership with patients, caregivers, and families. Preferences, values, and context may be specific to the situation and also can change over time. Therefore, proposals that address how the process of care planning and the care plans themselves will identify and respond to the specific and dynamic nature of patients’ circumstances are of interest. Development of information and data to create/foster/support partnerships and linkages between health care and human service systems (community-based organizations and public health) to improve whole-person care. These could be focused on improving care coordination and strengthening care transitions, ensuring that care is fully integrated to support the whole person and family. Improvement of health care quality through the use of information systems and data resources that both provide meaningful clinical decision support to health care professionals and patients and families at the point of care and that capture important actions and outcomes of health care to increase evidence on effective practices and support clinical and organizational improvement. Implementation of clinical prevention guidelines into learning health systems with innovative ways to include patients’ preferences and values in order to empower whole person-centered care. Development and study of models of shared decision making that are tailored to the needs of disadvantaged populations. Development of whole-person care research to improve health and health services efforts in persons with multiple chronic conditions. Development, implementation, and evaluation of models of primary care for individuals with complexity, including multiple chronic conditions, disability, and socioeconomic disadvantage that improve individual and population health while reducing disparities. Implement research findings in order to accelerate the spread of evidence-based practices by: Implementation of evidence-based approaches to identify, understand, and overcome barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines. Research on de-implementation of the use of health system procedures and clinical practices that are ineffective, have been prematurely widely adopted, or are harmful or wasteful. Development of a parsimonious set of meaningful measures to evaluate implementation and impact of whole-person care. Development of innovative ways to use data and health information technology (IT) in primary care practices in order to increase uptake and implementation of preventive services, especially those involving behavioral change (e.g. obesity prevention, substance use prevention). Development of methods underlying the fields of evidence synthesis, stakeholder and patient engagement, decision making, and practice improvement. Accelerating the ability of health care organizations to evolve as learning health systems that effectively apply data and evidence to improve patient outcomes by: Synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level. Discovering, testing, and spreading methods and strategies for health care practice improvement to improve health care quality, including accelerating the sustainable implementation of evidence-based practice. AHRQ has particular interest in practice improvement in primary care and ambulatory settings. Demonstrating the effectiveness of synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level. Research to Increase Accessibility and Affordability of Health Care by Examining Innovative Market Approaches to Care Delivery and Financing Producing evidence that can be used to increase the affordability and efficiency of health care for all Americans is a major AHRQ priority. Potential research areas and questions include but are not limited to the following: Reducing Cost Growth: In order to make health care more affordable, we must understand the drivers of those costs and their growth, as well as the relationship between cost and quality. Comparing Performance of Systems and Providers: AHRQ is interested in research that will allow comparison of delivery system and provider performance by health care stakeholders such as consumers, providers, payers, insurers, and policymakers. Incentives for Improving Performance: Public and private payers have provided a variety of financial and nonfinancial incentives to improve the performance of health care providers and systems. AHRQ is interested in research on the impacts of these changes—both intended and otherwise—as well as how to improve incentive programs. Interventions to Improve Performance: While alignment with external incentives is very important, it is the provider or system that implements interventions to increase performance. AHRQ is interested in research on how interventions to improve quality or cost are best implemented within and spread across providers and systems.

This FOA solicits Large Research (R01) Project applications that focus on AHRQ's mission and/or any aspect of its specific priority areas, described in detail below.. The Research Project Grant (R01) is an award made by AHRQ to an institution/organization to support a discrete, specified health services research project. The R01 research plan proposed by the applicant institution/organization must be related to the mission and portfolio priority research interests of AHRQ. Although the PD/PI is responsible for conducting and supervising the research, the actual applicant is the research institution/organization legally accountable for the performance of the award and the expenditure of funds. The AHRQ mission is to produce evidence to make health care safer, higher quality, more ac­cessible, equitable and affordable, and to work with HHS and other partners to make sure that the evidence is understood and used. Within the mission, AHRQ’s specific priority areas of focus are: Research to improve health care patient safety. Harnessing data and technology to improve health care quality and patient outcomes and to provide a 360-degree view of the patient. Research to increase accessibility and affordability of health care by examining innovative market approaches to care delivery and financing. Research to Improve Health Care Patient Safety Patient safety is defined as the freedom from accidental or preventable injury produced by health care as well as the practices that create a safe environment of care. The ultimate goal of AHRQ-supported Patient Safety research is to improve the safety of health care delivery. Patient safety research initiatives that lead to this goal can be considered in three different stages: Identification of risks, hazards, and patient harm. Design, implementation, dissemination and spread, and evaluation of interventions to improve patient safety. Establishment of strategies to sustain patient safety improvements such as culture, incident/event reporting, measurement, monitoring, and surveillance. AHRQ's Patient Safety Research Program: (1) identifies specific areas of focus through targeted grant funding announcements (i.e., Program Announcements, Requests for Applications, and Special Emphasis Notices) and (2) encourages investigators to utilize the Agency's general funding announcements to apply this research framework in response to other patient safety threats and opportunities for improvement. The Patient Safety Portfolio will support research projects to create new knowledge by identifying the risks, hazards, and harm encountered by patients as a result of health care. The Portfolio will also support projects that mitigate those risks, hazards, and harm including the design, implementation and evaluation of strategies (patient safety practices) and the adaptation, refinement, and sustainment of those strategies. These initiatives are part of the Agency's overall mission to improve the quality of health care. Projects may address important topics such as: the surveillance, measurement, detection, and reporting of patient safety events; the impact of human performance, work flow, and working conditions on patient safety; the patients' role and contribution to patient safety; health care safety culture, leadership, communication, teamwork, and simulation; prevention and control of healthcare-associated infections (HAIs); diagnostic safety and quality; the safe use of medical devices and medications, including safely prescribing opioids; the role of Patient Safety Organizations; and the challenges inherent in transitions of care in the same setting and between settings and handoffs between health care providers. AHRQ’s focus of interest in HAI research include the following broad areas: Determination of the clinical efficacy and effectiveness of preventive interventions, including unintended adverse consequences. Characterization and assessment of relevant epidemiological aspects of HAIs, including but not limited to patient risk factors, clinical presentation, and sources of antibiotic-resistant organisms involved in the development of HAIs. Demonstration, dissemination, and evaluation of strategies and approaches for prevention and reduction of HAIs. Research regarding adoption and implementation (including sustainment, spread, and scale-up) of evidence-based approaches for prevention of HAIs. The HAI research portfolio also encompasses a generation of knowledge for combating antibiotic resistant bacteria. AHRQ is interested in studies to promote appropriate antibiotic use, reduce the transmission of resistant bacteria, and prevent HAIs in the first place. The last contributes to antibiotic stewardship by avoiding the need for antibiotic therapy and precludes the possibility of a resistant infection. Clinical investigations that seek to establish the efficacy or effectiveness of preventive interventions, as noted above, typically involve a comparison of the intervention in question to routine care or, less frequently, to a placebo (when the latter is ethical). Such clinical studies are included in the scope of AHRQ’s HAI research portfolio. The HAI Portfolio does not fund comparisons of two interventions of known efficacy or effectiveness to determine which is more efficacious or effective. Such studies are comparative effectiveness research, which is more appropriately funded by other funding sources. The Portfolio supports research in all health care settings including the hospital, long-term care, ambulatory care, home health care, pharmacy, and transitions of care between settings. Patient safety research involves many stakeholder groups including patients, families, clinicians, non-clinical health care staff, policymakers, payers, and health care organizations including providers and accreditors, local and State governments, the Federal Government, Patient Safety Organizations, and many others. Projects in this area may also address patient characteristics that might influence the risk of experiencing a patient safety event, for example, attributes of AHRQ's priority populations that can impact patient safety and address strategies to address barriers to safe care. Harnessing Data and Technology To Improve Health Care Quality and Patient Outcomes and To Provide a 360-Degree View of the Patient AHRQ is interested in research to: advance the methods of evidence synthesis to ensure scientific rigor and unbiased reviews, make evidence-based recommendations on clinical preventive services, conduct research on how health information technology can improve the quality of health care, advance the science of clinical practice improvement, evaluate and support innovative models of practice transformation in primary care and other ambulatory settings, and facilitate communities of learning to promote the implementation of evidence for practice improvement. Further, AHRQ is interested in studying and improving upon the process by which health systems and ambulatory care practices select evidence to implement and how to determine what strategies are used to implement the evidence into everyday practice. The study of implementation strategies and processes is critical because interventions developed in the context of publically funded efficacy and effectiveness trials are rarely scalable without adaptations to specific settings and additional tools and guidance to support uptake and implementation. AHRQ is also interested in research that advances whole-person, 360-degree care especially those with multiple chronic conditions and/or socioeconomic disadvantage. Whole person, 360-degree care is defined as the coordination of health, behavioral health, intellectual/developmental disabilities, and social services in a person-centered manner with the goals of improved health outcomes and more efficient and effective use of resources in the context of people’s lives and the communities they live in. Emphasis is on the orientation of the health care team to consider all domains of a person’s life when assessing and addressing needs. The following lists examples of AHRQ research priorities: Improving health care quality outcomes by providing integrated, coordinated whole-person, 360-degree care to optimize individual and population health outcomes: Generation of knowledge about how clinical teams can most effectively elicit and use a patient’s values; preferences; and personal, social, and clinical context to formulate and use plans of care in partnership with patients, caregivers, and families. Preferences, values, and context may be specific to the situation and also can change over time. Therefore, proposals that address how the process of care planning and the care plans themselves will identify and respond to the specific and dynamic nature of patients’ circumstances are of interest. Development of information and data to create/foster/support partnerships and linkages between health care and human service systems (community-based organizations and public health) to improve whole-person care. These could be focused on improving care coordination and strengthening care transitions, ensuring that care is fully integrated to support the whole person and family. Improvement of health care quality through the use of information systems and data resources that both provide meaningful clinical decision support to health care professionals and patients and families at the point of care and that capture important actions and outcomes of health care to increase evidence on effective practices and support clinical and organizational improvement. Implementation of clinical prevention guidelines into learning health systems with innovative ways to include patients’ preferences and values in order to empower whole person-centered care. Development and study of models of shared decision making that are tailored to the needs of disadvantaged populations. Development of whole-person care research to improve health and health services efforts in persons with multiple chronic conditions. Development, implementation, and evaluation of models of primary care for individuals with complexity, including multiple chronic conditions, disability, and socioeconomic disadvantage that improve individual and population health while reducing disparities. Implement research findings in order to accelerate the spread of evidence-based practices by: Implementation of evidence-based approaches to identify, understand, and overcome barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines. Research on de-implementation of the use of health system procedures and clinical practices that are ineffective, have been prematurely widely adopted, or are harmful or wasteful. Development of a parsimonious set of meaningful measures to evaluate implementation and impact of whole-person care. Development of innovative ways to use data and health information technology (IT) in primary care practices in order to increase uptake and implementation of preventive services, especially those involving behavioral change (e.g. obesity prevention, substance use prevention). Development of methods underlying the fields of evidence synthesis, stakeholder and patient engagement, decision making, and practice improvement. Accelerating the ability of health care organizations to evolve as learning health systems that effectively apply data and evidence to improve patient outcomes by: Synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level. Discovering, testing, and spreading methods and strategies for health care practice improvement to improve health care quality, including accelerating the sustainable implementation of evidence-based practice. AHRQ has particular interest in practice improvement in primary care and ambulatory settings. Demonstrating the effectiveness of synthesizing, translating, and communicating complex scientific evidence to facilitate informed care planning and health care decision making by patients, families, and health care professionals at the individual level and informed policy decision making at the health system and population level. Research to Increase Accessibility and Affordability of Health Care by Examining Innovative Market Approaches to Care Delivery and Financing Producing evidence that can be used to increase the affordability and efficiency of health care for all Americans is a major AHRQ priority. Potential research areas and questions include but are not limited to the following: Reducing Cost Growth: In order to make health care more affordable, we must understand the drivers of those costs and their growth, as well as the relationship between cost and quality. Comparing Performance of Systems and Providers: AHRQ is interested in research that will allow comparison of delivery system and provider performance by health care stakeholders such as consumers, providers, payers, insurers, and policymakers. Incentives for Improving Performance: Public and private payers have provided a variety of financial and nonfinancial incentives to improve the performance of health care providers and systems. AHRQ is interested in research on the impacts of these changes—both intended and otherwise—as well as how to improve incentive programs. Interventions to Improve Performance: While alignment with external incentives is very important, it is the provider or system that implements interventions to increase performance. AHRQ is interested in research on how interventions to improve quality or cost are best implemented within and spread across providers and systems. Understanding how changes in policy affect the evolution of health insurance markets and the health insurance landscape is an important area for study. For example, innovations in health insurance markets, such as the increasing use of high-deductible health plans or changes in the cost-sharing structure of plans, are important developments to be analyzed. Other issues of interest include the relationship between changing health insurance markets and structural changes in the American workplace; analyses to improve our understanding of the impact of health care reform on coverage, access, and affordability; and evaluating the effects of changes in health insurance benefits on consumers' financial burdens and access to care. AHRQ is engaged in efforts to provide evidence related to topics such as health insurance coverage, access to care and health care costs. AHRQ is interested in funding research that will have an important impact on health care practice and policy.