[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

[[Page 34226]]

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