Recovery Act Limited Competition: Behavioral Economics for Nudging the Implementation of Comparative Effectiveness Research: Pilot Research (RC4)
National Institute on Drug Abuse
This NIH Funding Opportunity Announcement (FOA), supported by funds provided to the NIH and AHRQ under the American Recovery & Reinvestment Act of 2009 ("Recovery Act" or "ARRA"), Public Law 111-5, invites applications to study how the principles of behavioral economics could be used to enhance the uptake of the results of comparative effectiveness research (CER) among health care providers in their practice. (For this FOA, applications should be thought of as large pilot or preliminary studies rather than definitive trials.) This funding opportunity seeks applications that will investigate whether the principles of behavioral economics could be used to enhance the uptake of the results CER among health care providers and also enhance the maintenance of such treatments in patient populations. Behavioral economics refers to the interdisciplinary efforts involving cognitive and social psychologists, decision scientists, and other social scientists together with economists to model economic decision-making and consequent actions. It is hoped that this line of research will lead to significantly greater understanding of the adoption of CER by health care providers and therefore enhance the quality of the nation's health.
This initiative is one of several being offered to help fulfill the goals of the American Recovery and Reinvestment Act (ARRA) to help stimulate the economy through support of biomedical and behavioral research. Additional information the Recovery Act and related NIH opportunities is available through the Office of Extramural Research (http://grants.nih.gov/recovery/ )
Participating NIH Institutes:
This FOA invites applications to understand better how the principles of behavioral economics could be used to enhance the uptake of the results of comparative effectiveness research (CER) among health care providers in their practice. In addition, the projects could also be designed to understand the maintenance of CER-supported treatments and procedures once prescribed in patient populations. Moreover, this FOA also encourages applications to use behavioral economics to examine the sustained uptake of CER - to investigate the dynamics of why a provider may delay uptake, later adopt a CER result, and then later stop using it.
For the purposes of this FOA, the definition of comparative effectiveness research will adhere to that adopted by the Federal Coordinating Council: "Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in "real world" settings. The purpose of this research is to improve health outcomes by developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.
- To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations and subgroups.
- Defined interventions compared may include medications, procedures, medical and assistive devices and technologies, diagnostic testing, behavioral change, and delivery system strategies.
- This research necessitates the development, expansion, and use of a variety of data sources and methods to assess comparative effectiveness and actively disseminate the results."
It should, however, be noted that applicants are not restricted to focusing on CER from any one source. Valid CER findings can be taken from a variety of sources including the findings of AHRQ (http://effectivehealthcare.ahrq.gov/), the conclusions of NIH Consensus Conferences (http://consensus.nih.gov/), the recent Institute of Medicine (IOM) report on Initial National Priorities for Comparative Effectiveness Research (http://www.iom.edu/CMS/3809/63608/71025.aspx), or sufficiently convincing CER results from literature. Note also that this FOA is dedicated to enhancing the uptake of existing CER research rather than to find new comparatively effective treatments.
In the context of this FOA, behavioral economics refers to the interdisciplinary efforts involving cognitive and social psychologists, decision scientists, and other social scientists together with economists to model economic decision-making and consequent actions. For a recent review of behavioral economics from an economic perspective, Dellavigna (2009) is useful; from a psychological standpoint, Kahneman and Tversky (2000) provides useful data and historical context. There is growing evidence that such approaches may hold more promise than approaches based on either conventional theories of behavior change or neoclassical economics. The application of approaches from behavioral economics to the health care field could be valuable in the development of incentives or disincentives to motivate sustainable changes in provider and patient behavior.
Priority-Setting Process and Inputs for use of ARRA OS Funds
There were four main inputs for priorities for ARRA OS CER funds: public input, an internal Departmental workgroup, the FCC report, and the IOM report. The FCC identified the following as minimum threshold criteria which must be met to be considered for funding:
- Included within statutory limits of ARRA and the Council's definition of CER;
- Potential to inform decision-making by patients, clinicians or other stakeholders;
- Responsiveness to expressed needs of patients, clinicians or other stakeholders;
- Feasibility of research topic (including time necessary for research).
The CER-CIT will require the use of the FCC's prioritization criteria for scientifically meritorious research and investments for all projects funded with OS ARRA funds. These criteria are:
- Potential impact (based on prevalence of condition, burden of disease, variability in outcomes, costs, potential for increased patient benefit or decreased harm),
- Potential to evaluate comparative effectiveness in diverse populations and patients sub-groups and engage communities in research,
- Addresses existing uncertainty within the clinical and public health communities regarding management decisions and variability in practice,
- Addresses a need or is unlikely to be addressed through other organizations,
- Potential for multiplicative effect.
Finally, investments funded from this appropriation must address at least one of the following topic areas:
- One of the 100 IOM topic recommendations or the 10 general recommendations and/or
- An issue within one the MMA 14 priority conditions identified by AHRQ which are not currently addressed;
- Fall into one of the AHRQ identified evidence gaps or be identified in the FCC report to the Congress.
The current list of priority conditions includes:
- Arthritis and nontraumatic joint disorders (Muscle, bone, and joint conditions)
- Cancer (Cancer)
- Cardiovascular disease, including stroke and hypertension (Heart and blood vessel conditions)
- Dementia, including Alzheimer's Disease (Brain and nerve conditions)
- Depression and other mental health disorders (Mental health)
- Developmental delays, attention-deficit hyperactivity disorder, and autism (Developmental delays, ADHD, autism)
- Diabetes mellitus (Diabetes)
- Functional limitations and disability (Functional limitations and physical disabilities)
- Infectious diseases including HIV/AIDS (Infectious diseases and HIV/AIDS)
- Obesity (Obesity)
- Peptic ulcer disease and dyspepsia (Digestive system conditions)
- Pregnancy including preterm birth (Pregnancy and childbirth)
- Pulmonary disease/asthma (Breathing conditions)
- Substance abuse (Alcohol and drug abuse)
Scope: This FOA solicits applications for small, 3-year projects proposing pilot clinical trials, observational studies, or demonstration projects from multidisciplinary teams with relevant expertise in behavioral economics, psychology, and health services targeting the uptake of specific, previously identified CER. (Note: this FOA does not target establishment of new CER findings, but the uptake of previously validated CER.)
The scope of possible approaches to the behavioral economics/CER problem is left open. The general guideline is that the results of grants following from this FOA could set the stage for other, future studies establishing the effectiveness of the intervention proposed. But the intervention itself could have been identified as promising as the result of a small-scale randomized clinical trial (RCT) or clustered randomized trial (CRT), or identified as a result of secondary analysis of provider performance or claims data, or identified as a possible intervention in an observational study of health care delivery programs that systematically differ in their uptake of CER (possibly due to differences in standard operating procedure or payment systems), or identified using any other valid method. Applicants must provide a rationale for the specific behavioral economic methods they propose to evaluate, and demonstrate how they differ from currently implemented pay for performance (P4P) methods.
Applicants should plan to attend an AHRQ CER conference of awardees supported under this FOA for dissemination purposes. For budgetary purposes, applicants should plan for two representatives to travel to the Washington, DC, area for conference presentations as arranged by AHRQ and NIA. To this end, applicants should present a relevant plan, to include involved personnel, budget justifications, and timetables appropriate to participating in such a conference.
In addition, applicants should plan to attend an annual investigator's meeting including grantees from this FOA and, the companion Clinical Trials FOA, and other currently funded investigators working in the areas of behavioral economics and increasing the uptake of CER.
This initiative is supported by funds provided to the NIH and AHRQ under the American Recovery & Reinvestment Act of 2009 ("Recovery Act" or "ARRA"), Public Law 111-5. The NIH and AHRQ intend to commit $5,000,000 for use under this FOA. We anticipate that 4-5 awards will be made for fiscal year 2010, pending the number and quality of applications and availability of funds.
The total project period for an application submitted in response to this funding opportunity may not exceed 3 years. Although the size of award may vary with the scope of research proposed, applications must stay within the budgetary guidelines for this FOA; total costs are limited to $1,250,000 over an RC4 three-year period, with no more than $500,000 in total costs allowed in any single year. Grants that are awarded will have to use a non-modular budget.
This program is supported by funds provided to the NIH and AHRQ under the Recovery Act. The purpose of the Recovery Act is to stimulate the American economy through job preservation and creation, infrastructure investment, energy efficiency and science, and other means. Consistent with these goals, domestic (United States) institutions/organizations planning to submit applications that include foreign components should be aware that requested funding for any foreign component should not exceed 10% of the total requested direct costs or $25,000 per year (aggregate total for a subcontract or multiple subcontracts), whichever is less.
Eligible Institutions: Consistent with the purposes of the Recovery Act (in particular, to preserve and create jobs and promote economic recovery in the United States, and to provide investments needed to increase economic efficiency by spurring technological advances in science and health), applicants must be a domestic (United States) institution/organization. Foreign organizations/institutions are not permitted as the applicant organization.
- More than one PD/PI (i.e., multiple PDs/PIs) may be designated on the application
- This is a one-time-only solicitation, resubmissions are not permitted.
- The RC4 application Research Strategy component of the PHS398 (Items 3-5) may not exceed 12 pages, including tables, graphs, figures, diagrams, and charts.
Release/Posted Date: December 28, 2009
Opening Date: February 19, 2010 (Earliest date an application may be submitted to Grants.gov)
Application Due Date(s): March 19, 2010
Peer Review Date(s): May/June 2010
Earliest Anticipated Start Date(s): August 31, 2010
Expiration Date: March 20, 2010
Applicants are requested to notify the National Institute on Aging Referral Office by email (vemuriR@nia.nih.gov) when the application has been submitted. Please include the FOA number and title, PD/PI name, and title of the application.
Jonathan W. King, Ph.D.
Division of Behavioral and Social Research
National Institute on Aging
7201 Wisconsin Ave. #533
Bethesda, MD 20892-9205
Telephone: (301) 402-4156
Fax: (301) 402-0051
Bill Encinosa, Ph.D.
Center for Delivery, Organization and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850