HEALTH INDUSTRY by DHILNA RAJ

HEALTH INDUSTRY



AN ASSIGNMENT ON HEALTH INDUSTRY






SUBMITTED BY,

DHILNA RAJ

1ST YEAR MBA

ICM
TRIVANDRUM



























INTRODUCTION

The health care industry or health profession treats patients who are injured, sick, disabled, or infirm. The delivery of modern health care depends on an expanding interdisciplinary team of trained professionals. [1][2]

For purposes of finance and management, the healthcare industry is typically divided into several groups and sectors. The Global Industry Classification Standard and the Industry Classification Benchmark divide the industry into two main groups: (1) health care equipment & services and (2) pharmaceuticals, biotechnology & related life sciences. Health care equipment and services comprise companies that provide medical equipment, medical supplies, and health care, such as hospitals, home health care providers, and nursing homes. The second industry group comprises sectors companies that produce biotechnology, pharmaceuticals, and miscellaneous scientific services.[3]Providers and professionals
Main article: Health care provider

A health care provider or health professional is an organization or person who delivers proper health care in a systematic way professionally to any individual in need of health care services.
Delivery of services

The health care industry includes the delivery of health services by health care providers. Usually such services are paid for by the patient or by the patient's insurance company; although they may be government-financed (such as the National Health Service in the United Kingdom) or delivered by charities or volunteers, particularly in poorer countries. The structure of health care charges can also vary dramatically among countries. For instance, unlike the United States, Chinese hospital charges tend toward 50% for drugs, another major percentage for equipment, and a small percentage for health care professional fees. [4]



There are many ways of providing health care in the modern world. The most common way is face-to-face delivery, where care provider and patient see each other 'in the flesh'. This is what occurs in general medicine in most countries. However, health care is not always face-to-face; with modern telecommunications technology, in absentia health care is becoming more common. This could be when practitioner and p
d patient communicate over the phone, video conferencing, the internet, email, text messages, or any other form of non-face-to-face communication.

The World Health Organization
(WHO) is a specialized United Nations agency which acts as a coordinator and researcher for public health around the world. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the League of Nations. The WHO’s constitution states that its mission "is the attainment by all peoples of the highest possible level of health." Its major task is to combat disease, especially key infectious diseases, and to promote the general health of the peoples of the world. Examples of its work include years of fighting smallpox. In 1979 the WHO declared that the disease had been eradicated - the first disease in history to be completely eliminated by deliberate human design. The WHO is nearing success in developing vaccines against malaria and schistosomiasis and aims to eradicate polio within the next few years. The organization has already endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe from October 3, 2006, making it an international standard.[11]

The WHO is financed by contributions from member states and from donors. In recent years the WHO's work has involved more collaboration, currently around 80 such partnerships, with NGOs and the pharmaceutical industry, as well as with foundations such as the Bill and Melinda Gates Foundation and the Rockefeller Foundation. Voluntary contributions to the WHO from national and local governments, foundations and NGOs, other UN organizations, and the private sector (including pharmaceutical companies), now exceed that of assessed contributions (dues) from its 193 member nations.[12]
Toolkit e health sector and spoke of the treatment and provision

A health care provider is an organization that provides facilities and health care personnel to deliver proper health care in a systematic way to any individual in need of health care services. A health care provider could be a government, the health care industry, a health care equipment company, an institution such as a hospital or medical laboratory. Health care professionals may include physicians, dentists, support staff, nurses, therapists, psychologists, pharmacists, chiropractors, and optometrists.

Practicing health care without a license is generally a serious crime that could be punished by up to several years in prison.
Scoperevention of illness and disease. Healthcare Industry

The delivery of modern health: Care depends on an expanding group of trained professionals coming together as an interdisciplinary team.[4][5]

The Healthcare industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. According to market classifications of industry such as the Global Industry Classification Standard and the Industry Classification Benchmark the healthcare industry includes health care equipment & services and pharmaceuticals, biotechnology & life sciences. The particular sectors associated with these groups are: biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care.[6]

According to government classifications of Industry, which are mostly based on the United Nations system, the International Standard Industrial Classification, health care generally consists of Hospital activities, Medical and dental practice activities, and other human health activities. The last class consists of all activities for human health not performed by hospitals or by medical doctors or dentists. This involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, ambulance, nursing home, or other Para-medical practitioners in the field of optometry, hydrotherapy, medical massage, occupational therapy, speech therapy, chiropody, homeopathy, chiropractic, acupuncture, etc. [7].
List of health care journals
• Health Affairs
• Milbank Quarterly
• Health Economics
• Eastern Mediterranean Health Journal
• Journal for Healthcare Quality
Executive Summary
• Purpose. The purpose of this Funding Opportunity Announcement (FOA) is to support a wide variety of research designs in order to improve the quality, safety, effectiveness, and efficiency of health care through the implementation and use of health IT. These designs include: small pilot and feasibility or self-contained health IT research projects; secondary data analysis of health IT research; and economic (prospective or retrospective) analyses of health IT implementation and use. Through economic analyses estimates of health IT implementation and use costs and benefits will be generated.
• Research Areas. This FOA is focused on three research areas of interest:
o Health IT to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies;
o Health IT to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care; and,
o Health IT to improve health care decision making through the use of integrated data and knowledge management.
• Each application must clearly identify one of these research areas as the primary research area to be addressed. These three research areas are more fully discussed in Section I.1 below.
• Settings. Applications responsive to this FOA must focus on implementation of health IT in one or more of the following care settings: ambulatory setting(s); transitions in care between ambulatory settings; or transitions in care between an ambulatory setting and non-ambulatory setting. For the purposes of this FOA, ambulatory care settings include: health care clinician offices; outpatient clinics; outpatient mental health centers; outpatient substance abuse centers; urgent care centers; ambulatory surgery centers; community-based, school, or occupational health centers; safety-net clinics; pharmacies; homes; independent living centers; and, long-term residential care facilities.
• Applications that feature health IT implementation in a non-ambulatory setting such as a hospital, skilled nursing facility, or inpatient mental health facility for purposes other than facilitating transitions in care to and from an ambulatory setting will be considered non-responsive to this FOA and will not be reviewed.
• Other AHRQ-Sponsored Health IT FOAs:
• This FOA runs in parallel with a continuum of AHRQ-sponsored health IT FOAs: Exploratory and Developmental Research Grant to Improve Healthcare Quality through Health IT (R21) (PAR-08-269); Utilizing Health IT to Improve Health Care Quality (R18) Grant (PAR-08-270); and, AHRQ’s Special Emphasis Notice articulating AHRQ’s support of health IT oriented career development and dissertation research grants (http://grants.nih.gov/grants/guide/notice-files/NOT-HS-08-014.html). For further information, please see below in Section I Overview of Current AHRQ Health IT FOAs.
• Funds Available and Anticipated Number of Awards. The total amount awarded and the number of awards will depend upon the mechanism, number, quality, duration, and costs of the applications received.
• Budget and Project Period: Total costs (direct costs and associated indirect costs) are limited to $100,000 over a maximum project period of two years. An application with a budget that exceeds any of these limits will be not be reviewed.
• Eligible Organizations: Institutions/organizations listed below in Section III, 1.A are eligible to apply.
• Eligible Project Directors/Principal Investigators (PDs/PIs): Individuals with the skills, knowledge, and resources necessary to carry out the proposed research are invited to work with their institution/organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are encouraged to apply for AHRQ support.
• Number of PDs/PIs: Only one PD/PI may be designated on the application.
• Number of Applications: Applicants may submit more than one application, provided each application is scientifically distinct.
• Resubmissions: Applicants may submit up to one revised application, known as a resubmission. See Section III.3 (Other-Special Eligibility Criteria) for further information.
• Renewals: The R03 is not renewable.
• General Information. For general information on SF424 (R&R) Application and Electronic Submission, see these Web sites:
o SF424 (R&R) Application and Electronic Submission Information: http://grants.nih.gov/grants/funding/424/index.htm
o General information on Electronic Submission of Grant Applications: http://era.nih.gov/ElectronicReceipt/
• Hearing Impaired: Telecommunications for the hearing impaired are available at: TTY 301-451-0088.
While grant awards are made to institutions rather than individuals, this announcement and its instructions are written to inform individual researchers of this funding opportunity and facilitate the submission of grant applications by their organizations.
Table of Contents
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Part I Overview Information

Part II Full Text of Announcement

Section I. Funding Opportunity Description
1. Research Objectives
Section II. Award Information
1. Mechanism of Support
2. Funds Available
Section III. Eligibility Information
1. Eligible Applicants
A. Eligible Institutions
B. Eligible Individuals
2. Cost Sharing or Matching
3. Other - Special Eligibility Criteria

Section IV. Application and Submission Information
1. Request Application Information
2. Content and Form of Application Submission
3. Submission Dates and Times
A. Submission, Review, and Anticipated Start Dates
1. Letter of Intent
B. Submitting an Application Electronically to the NIH
C. Application Processing
4. Intergovernmental Review
5. Funding Restrictions
6. Other Submission Requirements and Information

Section V. Application Review Information
1. Criteria
2. Review and Selection Process
A. Additional Review Criteria
B. Additional Review Considerations
C. Resource Sharing Plan(s)
3. Anticipated Announcement and Award Dates

Section VI. Award Administration Information
1. Award Notices
2. Administrative and National Policy Requirements
3. Reporting

Section VII. Agency Contact(s)
1. Scientific/Research Contact(s)
2. Peer Review Contact(s)
3. Financial/Grants Management Contact(s)
1. Research Objectives
Background: Use of Health IT
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ achieves this mission by supporting a program of health services research and by working with partners to promote improvements in clinical and health systems practice that benefit patients.
Health IT is broadly defined as the use of information and communication technology in health care to support the delivery of patient or population care or to support patient self-management. Health IT can support patient care related activities such as order communications, results reporting, care planning and clinical or health documentation (Shortleaf, 2006). Health IT applications can use a variety of platforms, such as desktop computer applications, cellular phones, personal digital assistants (PDAs), touch screen kiosks, and others. Examples of health IT applications are electronic health records (EHR), electronic medical records (EMR), personal health records (PHR), telemedicine, clinical alerts and reminders, computerized provider order entry, computerized clinical decision support systems, consumer health informatics applications, and electronic exchange of health information.
The use of health IT has been demonstrated to improve health care in large health care delivery systems. Yet there has been limited diffusion of health IT in other care settings, where the majority of health care services are provided, and in transitions between care settings – e.g., movement of patients between health care providers and settings (DesRoches, 2008; Bates, 2005; Bodenheim, 2008; Coleman, 2004).
Even when health IT is available in an ambulatory setting, its usefulness may be limited due to lack of awareness of its functionality, insufficient training of users, inadequate considerations of workflow issues (such as integration to existing workflow and coordination between settings or staff), concerns regarding security of the data on the system, cost considerations, or other challenges. Characteristics of the practice setting, such as number of clinicians, have been shown to influence health IT adoption (DesRoches, 2008; Hing, 2007; Bates, 2005). There also appears to be significant variability in the extent to which individual physicians and practices use, or are even aware of, the range of functions of their EMRs (Hing, 2007; Simon, 2007; Jha, 2006).
Successful implementation of health IT in health care systems is in part dependent on the recognition of the varying roles and perspectives of individuals and organizational culture in the deployment process (Kaplan, 2001). Nurses and other staff often provide critical support in the successful implementation of health IT. The identification of the barriers and facilitators of successful use of health IT at the individual and organizational levels may require the application of both health care and industrial and systems engineering expertise along with other academic disciplines such as sociology, psychology, social psychology, social anthropology, human factors, organizational development, management, administration, and economics (Lorenz, 1997).
Patients and their caregivers share an increased responsibility for managing their health (Tang, 1997). The field of consumer health informatics focuses on providing consumers, patients and their caregivers, health information directly through computers and other telecommunication systems (Eysenbach, 2000). Meeting patients’ and caregivers’ increased need for health information may improve communication between health care providers, patients, and their caregivers. This may enhance patients’ abilities to self-manage chronic conditions and enhance their ability to follow treatment, medication, and monitoring regimens. Through improved control of disease there may be increased functionality and quality of life and fewer exacerbations of chronic conditions that necessitate emergency room visits and hospitalizations.
The body of literature regarding successful implementation of health IT in non-traditional ambulatory settings, such as in homes, residential settings, and various types of community centers, is underdeveloped. Successful health IT implementation in these ambulatory settings may provide much-needed tools to improve health care for various vulnerable populations including the elderly AHRQ’s Health IT Portfolio
AHRQ’s Health Information Technology (IT) Portfolio is part of the Nation’s strategy to put information technology to work in health care. By developing secure and private electronic health records for most Americans, and making health information available electronically when and where it is needed, health IT can improve the quality of care. As of 2008, AHRQ has invested over $260 million in contracts and grants to over 150 communities, hospitals, providers, and health care systems in 44 States to promote access to and encourage the adoption of health IT. These projects constitute a real-world laboratory for examining health IT at work.
One major component of AHRQ’s Health IT Portfolio is the National Resource Center (NRC) for Health IT. The NRC captures the lessons learned in health IT adoption, and documents the progress of the portfolio’s research grants. More information about AHRQ’s Health IT Portfolio
Specific Purpose of this FOA:
AHRQ seeks to support health IT-oriented small research grants that will contribute to health care providers’ ability to offer high quality health care and/or to support the use of health IT applications that enable patients and/or family members to be better informed and engaged in managing their health and health care.
This FOA supports the exploration of a wide variety of research designs in order to generate information regarding the design, development, testing, cost or impact of health IT. These research projects may generate information necessary for future health IT implementation projects or evaluations. They may involve new, on-going, or completed (in the case of retrospective data analysis) health IT implementation activities. These applications must demonstrate how findings of the R03 research project will inform future development of health IT applications, strategies for health IT implementation in real world settings and/or the conduct of future health IT implementation and/or research activities.
Depending on the research design and intent of the project, applicants may receive support for: (1) small pilot and feasibility or self-contained health IT research projects; (2) secondary data analysis of health IT research; or (3) economic (prospective or retrospective) analyses of health IT implementation and use.
• Small, pilot and feasibility and self-contained health IT research projects:
• These types of projects should be designed to inform future development of health IT applications, strategies for health IT implementation in real world settings and/or the conduct of future health IT implementation and/or research activities. Small pilot and feasibility projects can include preliminary or preparatory work such as proof of concept studies, needs assessments, or development of new health IT applications, as well as development or validation of research methodology. Small, self-contained health IT research projects should be designed to study a well circumscribed challenge in health IT development, implementation or use.
Applicants should be able to appropriately describe how the research findings will inform future research and/or other real world implementation efforts. Applicants must also address the relevance of their proposed project to AHRQ’s Health IT Portfolio and its research areas, described below under “Research Areas.”
The PI/PD for these small research projects is not expected or required to be extensively published or have prior experience in a leadership capacity in the conduct of a research project.
• Secondary data analysis of health IT research:
• These types of projects should be designed to generate insight regarding facilitators and barriers to health IT implementation through the evaluation of factors (e.g., setting characteristics, workflow, integration with pre-existing health IT) impacting utilization and implementation. Proposals featuring secondary data analysis may be related to, but must be distinct from, the specific aims of the original data collection and analytical plan. A health IT R03 proposal may test new hypotheses or synthesize existing data derived through AHRQ-funded studies or collected elsewhere. Applications must identify the source of the data, discuss the completeness, reliability and accuracy of the data; and, demonstrate that the proposed analysis is distinct from previously funded activities.
Applicants must address the relevance of their proposed secondary analysis to AHRQ’s Health IT Portfolio and its research areas, described below under “Research Areas.”
Additional information may be collected through the R03 project to supplement the data set being used for the secondary analysis. Such data collection must be well described and justified. For example, the duration of the initial research project may have been too brief to collect all relevant data for the evaluation of the health IT intervention. An applicant may wish to collect limited additional data on the outcome measures of interest.
• Prospective and retrospective economic analyses of health IT implementation:
• These types of projects should be designed to conduct sound economic evaluations of health IT implementation and use. Health IT prospective or retrospective economic analyses should feature an evaluation of financial and non-financial costs and benefits of a companion health IT implementation project.
The costs and benefits of implementing and maintaining health IT functionality can be both qualitative and quantitative. Benefits may encompass different aspects of health care delivery that can be impacted by a particular health IT implementation such as job satisfaction, quality of health care provided, or measurable impact on productivity or quality improvement indicators. Costs may include, but are not limited to: initial hardware and/or software investments; incremental costs in hardware and/or software upgrades to support health IT functionality; initial and ongoing technical support of health IT implementation and use; maintenance costs; direct and indirect costs for training; workflow redesign; lost work time while transitioning to an electronic system; and unintended workflow or health care consequences due to implementation and use of health IT.
Economic analyses should consider to whom the benefits accrue and address to the extent possible both the direct and indirect costs and benefits of implementation and use of health IT. Economic analyses may emphasize any of the following: 1) factors that influence the improvement of the quality and efficiency of health IT implementation and optimization of functionality; 2) cost-benefit, cost-effectiveness, or cost-utility analyses; or, 3) assessments of health IT implementation costs and organizational production and efficiency.
Given the potential lag time in accrual of benefits and/or costs attributable to the implementation of health IT, applicants proposing to conduct retrospective economic analyses are encouraged to consider conducting their evaluation based on data obtained for an appropriate period of time to reflect overall benefits and costs of health IT use.
Prospective or retrospective economic analysis projects must focus on a specific health IT implementation project. The specific health IT implementation project need not have been funded by AHRQ and can be an on-going or a concluded health IT implementation research study. However, applicants may choose to submit a concurrent R03 application as a companion proposal to an application under AHRQ’s Utilizing Health Information Technology to Improve Health Care Quality (R18) FOA. In this case, the merit of each application will be evaluated independently based on the review criteria for each FOA.
Research Areas
AHRQ has selected three healths IT research areas for the focus of this FOA. Each application must clearly identify one of them as the primary research area to be addressed. Given the breadth of each of these research areas and the limitation on time and financial resources of a single R03 grant, one grant is not expected to single-handedly address all elements of a health IT research area. Rather, an applicant must articulate the extent to which a specific grant would generate knowledge regarding elements of that research area and how that knowledge would advance the field of health IT and be transferable to other real world settings. The three health IT research areas are:
1) Health IT to improve the quality and safety of medication management; this includes the utilization of medication management systems and technologies; ambulatory health care providers and out-patient pharmacists’ use of electronic prescribing systems and/or medication management technologies; integration of evidence-based decision support for priority conditions within electronic prescribing systems; and, providing patients electronic tools to support medication self-management.
2) Health IT to support patient-centered care; this includes, but is not limited to, a focus on the coordination of care across transitions in care settings and the use of electronic exchange of health information to improve quality of care. Patient-centered care is responsive to the needs and preferences of individual patients, provides patients and/or their caregivers with access to their medical information, facilitates communication between patients, caregivers and providers, and empowers patients to be active participants in care decisions and in the daily management of their health and illnesses.
3) Health IT to improve health care decision making; this includes the development, implementation, and integration of health information tools, products or systems through the use of integrated data and knowledge management. AHRQ encourages research projects that propose use of health IT applications that apply principles of evidence based medicine including the use of the best available evidence, health care providers’ ability to execute their best judgment, and consideration of patients’ expressed treatment preferences. Ultimately, health IT that supports decision making should possess the capacity for the development and use of aggregate data for ongoing evaluation of quality improvement, organizational improvement, and population management in health care settings. Highly advanced health IT with this functionality should also identify unwarranted variability in practice, accommodate credible variability in recommendations, and identify gaps in the knowledge base that manifest during implementation for feedback to evidence developers and synthesizers.
Research Settings for this FOA
Applications responsive to this FOA must focus on implementation of health IT in one or more of the following care settings: ambulatory setting(s); transitions in care between ambulatory settings; or transitions in care between an ambulatory setting and non-ambulatory setting. For the purposes of this FOA, ambulatory care settings include: health care clinician offices; clinician practices; outpatient clinics; outpatient mental health centers; outpatient substance abuse centers; urgent care centers; ambulatory surgery centers; community-based, school, or occupational health centers; safety-net practices, pharmacies; patients’ homes; independent living centers; and, residential care.
Applications that feature health IT implementation in a non-ambulatory setting, such as hospital or a skilled nursing facility or inpatient mental health facility for purposes other than facilitating transitions in care to and from an ambulatory setting will be considered non-responsive to this FOA and will not be reviewed.
Elements of a Research Proposal
Overview of Current AHRQ Health IT FOAs
AHRQ provides an integrated continuum of health IT-oriented FOAs to achieve measurable improvements in quality and safety of health care in ambulatory settings and in transitions of care. These FOAs are designed to offer applicant’s opportunities to receive incremental support for the conduct of progressively more complex health IT research projects: Small Research Grants (R03), Exploratory and Developmental Grants (R21), and Demonstration Grants (R18). The program also includes opportunities for training and the acquisition of individual research skills (R36, K01, K02, and K08).
.
Career Development and Dissertation Research Grants:
A companion Special Emphasis Notice (http://grants.nih.gov/grants/guide/notice-files/NOT-HS-08-014.html) has been published to support health IT-oriented career development (K01, K02, K08) and research dissertation (R36) grants. This will support development and enhancement of expertise in health IT and related disciplines, including research and evaluation methods, as well as enhancing the capacity of grantees to participate in multi-disciplinary research teams that apply trans-disciplinary perspectives in health IT research.
Small Research Grant to Improve Healthcare Quality through Health IT (R03) FOA:
This FOA supports different types of small research studies including: 1) small pilot and feasibility or self-contained health IT research projects; 2) secondary data analysis of health IT research; and 3) economic (prospective or retrospective) analyses of health IT implementation. The total costs of a health IT R03 project are limited to $100,000 for up to two years funding. For more detailed information, please see the health IT R03 FOA. Highlights of each type of health IT R03 study are provided below:
• Health IT small pilot and feasibility and self-contained research projects may be either preliminary or preparatory work that will inform future health IT implementation and/or research activities or independent research projects designed to study a well circumscribed challenge in health IT development, implementation or use. The PI/PD for these small research projects is not expected or required to be extensively published or have prior experience in a leadership capacity in the conduct of a research project.
• Health IT secondary data analysis investigates additional research questions that are related to, but distinct from, the specific aims of the original data collection. Applicants must identify the source of the data and demonstrate that the proposed analysis is distinct from previously funded activities.
• Health IT prospective or retrospective economic analyses feature an evaluation of financial and non-financial costs and benefits of a companion health IT implementation project. The health IT implementation project need not have been funded by AHRQ. Economic analyses should consider to whom the benefits accrue and address, to the extent possible, both the direct and indirect benefits of implementation and use of health IT.
Exploratory and Developmental Grant to Improve Healthcare Quality through Health IT (R21) FOA:
The R21 FOA will support health IT exploratory and developmental research projects. These R21 health IT research grants will support the conduct of short-term preparatory, pilot or feasibility studies that are needed to inform future health IT implementation which may include but are not limited to the conduct of a health IT research demonstration grant. The R21 grants are more comprehensive and broader in scope that the small, self-contained health IT research projects supported by the health IT R03 FOA. The total costs of a health IT R21 project are limited to $300,000 over two years with no more than $200,000 in total costs in a given year.
Utilizing Health IT to Improve Health Care Quality Grant (R18) FOA:
The R18 FOA will support demonstration research grants that rigorously study health IT implementation and use to improve the quality, safety, effectiveness and efficiency of health care in ambulatory settings and in the transitions between care settings. The total costs of a health IT R18 project are limited to $1.2 million over three years with no more than $500,000 in total costs in a given year.
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Mechanism(s) of Support
This Funding Opportunity Announcement (FOA) will use the AHRQ Small Research Project (R03) grant award mechanism. The individual researcher sponsored by the organizational grantee will be solely responsible for planning, directing, and executing his or her proposed projects.
AHRQ is not using the Modular Grant Application and Award Process. Applications submitted in modular format will not be reviewed.
Renewal (formerly “competing continuation”) applications will not be accepted for the R03 grant mechanism. The small research grant mechanism may not be used for thesis or dissertation research. One resubmission of a previously reviewed small grant application may be submitted.