Questions and Answers from the Technical Assistance Call for RFA-HS-18-002

October 24, 2018

Questions and answers from the technical assistance conference call related to RFA-HS-18-002, "Screening and Management of Unhealthy Alcohol Use in Primary Care: Dissemination and Implementation of PCOR Evidence (R18)".

Is there a focus on certain target populations, namely youth versus adult?

AHRQ is seeking applications that focus on improving the identification and management of unhealthy alcohol use among adults. Applications that focus primarily on other populations (e.g., adolescents) will not undergo peer review.

Applicants under this RFA should also consider including AHRQ’s priority populations as appropriate.

Would a focus on improving SBI and MAT for subpopulations of adults be in keeping with the spirit of the grant's goals?

Applications that focus on subpopulations of adults are not precluded.

How is a “discrete geographic region” defined? Are there limits as to size? Are non-contiguous regions strictly disallowed?

It is up to applicants to justify that the region described in the application is clearly defined, logical, and of appropriate size to allow successful engagement with a minimum of 125 diverse primary care practices without being overly large. Non-contiguous regions are not strictly disallowed as long as applicants demonstrate an ability to adequately recruit, support, and engage practices and in community partnerships.

Is it acceptable to focus on ≤125 primary care practices for this RFA?

No. To be fully responsive to the RFA, applicants must propose a viable plan for working with at least 125 primary care practices.

Is prenatal care considered a specialty setting?

AHRQ is seeking applications that focus on improving the identification and management of unhealthy alcohol use in primary care. Settings that provide prenatal care as part of a comprehensive delivery of integrated health care services are acceptable as long as those settings meet the definition of primary care practice included in the RFA. Applications that focus primarily on other settings inconsistent with AHRQ’s definition of primary care practices will not undergo peer review.

Is there any guidance on participation of practices that are also in other APMs?

Primary care practices that meet the definition provided in the RFA are acceptable regardless of the payment approach. Accordingly, primary care practices participating in an Alternative Payment Model are acceptable.

Can Federally Qualified Health Centers be included among the primary care practices that grantees work with?

Yes, grantees may recruit and engage Federally Qualified Health Centers.

Are primary care sites locked into being with one lead applicant or can they be part of other applications? In other words, to what degree are primary care networks expected to be exclusive networks?

The same primary care practices may be identified in more than one application. However, AHRQ does not anticipate making awards to multiple institutions working with the same practices. When making funding decisions, one factor AHRQ will consider is overall programmatic and geographic balance of the proposed projects to program priorities.

Would including opioids (as well as alcohol) in an application and trainings for providers be problematic?

Applications that address opioid abuse are acceptable as long as the objectives and requirements related to unhealthy alcohol use are met.

Would a large network of primary care practices affiliated with a health care system be acceptable?

Although AHRQ encourages applicants to propose supporting small- and medium-sized primary care practices with 10 or fewer lead clinicians or small networks, a proposal to work with a large network of primary care practices is also acceptable.

The RFA states that “AHRQ also encourages applicants to propose working with practices that have low rates of screening.” Does this refer to low rates of alcohol use disorder screening, or behavioral health screening in general?

The statement refers to low rates of screening for unhealthy alcohol use, including alcohol use disorder.

Is the emphasis on low integration primary care practice sites an absolute one?

AHRQ encourages applicants to propose working with primary care practices that do not have integrated behavioral health services, but this is not a requirement. If applicants plan to work with practices that do have integrated behavioral health services, they should explain how the proposed intervention will lead to additional improvements.

How do you define integration for purposes of practice selection?

Integrated behavioral health is defined on AHRQ’s Academy for Integrating Behavioral Health and Primary Care website, but applicants are not required to use this definition.

Technology is clearly broadly supported under this FOA. Would this also extend to brief interventions delivered via technology?

Applications that propose using technology to deliver brief interventions are acceptable.

Will having a private, for-profit telemedicine service deliver the MAT with primary care collaboration meet the intent of the grant?

Primary care practices are not precluded from collaborating with a private, for-profit telemedicine service as part of the grant. However, the for-profit organization would not be eligible to lead the application.

Is there a preference in using specific screening tools (e.g., AUDIT versus AUDIT-C)?

Applicants may propose to use any evidence-based screening tool.

Is it intended for awardees to disseminate and implement strategies based on research they’ve conducted, or is the intent for non-research organizations to disseminate and implement the latest research recommendations in the broader sense?

Grantees should use evidence-based strategies to disseminate and implement patient-centered outcomes research findings to primary care practices. Grantees are not limited to disseminating and implementing findings based on their own research. Furthermore, any eligible organization may apply.

Is providing training as part of the implementation acceptable?

Yes, it is acceptable to provide training as part of the dissemination and implementation strategy.

How much of the application must be focused on research as opposed to evaluation?

The primary goal of the RFA is to fund the dissemination and implementation of patient-centered outcomes research findings, although evaluation of the effectiveness of the dissemination and implementation is also important. The RFA details the six sections to include in the research plan, including the Approach to PCOR Dissemination and Implementation (Section 3) and the Evaluation Plan (Section 4). Applicants may determine how much focus to place on each section within the application as long as the research plan is limited to 20 total pages.

The FOA states that some patient-level evaluation is acceptable. Would something like an interrupted time series design be acceptable as well, as long as dissemination and implementation were primary?

Yes, applicants may propose any study design to support the internal evaluation.

I see that clinical trials are optional. Are control conditions where some sites do not receive the implementation intervention acceptable?

A project design that includes control sites that do not receive the implementation strategy would be acceptable (e.g., to support the internal evaluation).

Many EMRs do not record screening and counseling for alcohol in structured queryable fields. Is it acceptable to do chart reviews or surveys of subsets of patients to assess screening and counseling rates? Or do we need to report on entire practice populations?

Yes, it is acceptable to propose collecting data from a subset of patients. However, AHRQ expects grantees to coordinate with its evaluation contractor prior to finalizing data collection plans to support the external evaluation.

The RFA asks applicants to “provide the theoretical basis, conceptual model, and/or logic model for the overall approach to dissemination and implementation.” Please elaborate on the expectations under this funding mechanism.

AHRQ does not have expectations regarding which theory or model applicants use to underpin their proposed projects. Applicants are free to choose among the many available theories/models, or use one of their own.

The project focuses primarily on dissemination and implementation, but the review criteria look more aligned with typical research grants (for instance, investigator). Will these be adjusted to better align with more typical community-based projects? The current criteria appear to favor research institutions.

The peer review process is designed to be fair to any eligible institution that applies for funding. Although the review criteria are organized in the same categories typically used for research grants, the criteria themselves were carefully tailored to help reviewers to evaluate each applicant’s ability to meet the goals for this specific RFA. For example, the Significance criteria address the likelihood that projects will result in successful dissemination and implementation of PCOR findings, especially SBI and MAT. Additionally, the Investigator section addresses the project team and its capacity and relationships with primary care practices.

Is there a policy on co-principal investigators?

Multiple program directors/principal investigators are allowed. Refer to the AHRQ Multiple Program Director/Principal Investigator Policy for additional information.

Page last reviewed November 2018
Page originally created November 2018

Internet Citation: Questions and Answers from the Technical Assistance Call for RFA-HS-18-002. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/funding/fund-opps/rfa-hs18002-tacall.html