[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]


-----------------------------------------------------------------------

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]
BILLING CODE 4160-15-P