Transcript Title VII Primary Care Training Grants for PA Programs

PAEA Government Relations Committee
Health Care Reform Update, Title VII Opportunities, HRSA Q&A,
and Teaching Advocacy Skills to Students
David Keahey, PA-C, MSPH
PAEA Annual Education Forum
October 20, 2010
Baltimore, MD
Title VII Opportunities
Goal:
– Attendees will utilize these grant writing
suggestions to improve the odds of
achieving Title VII Health Resources and
Services Administration (HRSA) funding.
Title VII Opportunities
Objectives:
– Develop the skills necessary to identify needs in
their programs that would benefit from Title VII
funding.
– Acquire the knowledge of the application format,
review criteria, budget justification, and funding
priorities and preferences to permit the successful
authorship of a Title VII grant.
My biases . . . as far as I know
HRSA (The Access Agency) Mission:
HRSA provides national leadership, program resources and
services needed to improve access to culturally competent,
quality health care.
Five Health Profession program areas (FM/GIM/Peds):
– Residency Training
– Predoctoral Training
– Faculty Development Training
– Academic Administrative Units
– Physician Assistant Training
Physician Assistant HRSA
Training Grant Purpose
• “To meet the costs to plan, develop, and
operate or maintain programs for the training
of physician assistants and for the training of
individuals who will teach in programs to
provide training of physician assistants”
Helpful Applicant Resources:
http://www.hrsa.gov/grants/apply/TechnicalAssistance/index.html
What Just Happened to HRSA?
• Shortage of approximately 21,000 primary
care physicians in 2015
• $250 million in 2010 to increase the number
of primary care providers
• Builds on the $500 million for health workforce investments made by the American
Recovery and Reinvestment Act of 2009
• Evolution to 5 year grant periods
http://bhpr.hrsa.gov/grants/default.htm
One Time Opportunities?
What Does Your Program
Want or Need to Do?
• Recent strategic planning/brainstorming?
• Recent needs assessment/ARC-PA visit?
• Innovation in didactic and/or clinical instruction (especially
re: primary care)?
• Implementation of a new or improved program/service to
learners or the community?
• Faculty development?2
• Bottom line: Focus on activities you need to accomplish
for which you lack the resources (with a caveat)
2 Glicken,
AD. Excellence in Physician Assistant Training Through Faculty Development.
Academic Medicine. 2008;83(11): 1107-1110.
Step 1: Are you connected with a grants
management division in your institution?
• Start the process before the grant announcement
• Obtain/Register/Identify/Confirm your acronyms
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DUNS
CCR
POC
M-PIN
AOR
http://www.palmbeachpost.com/
Step 2: Funding Factors: Priorities and
Preferences
• A funding priority is defined as a numeric
adjustment of an application’s review score
when specific criteria are met.
• Each funding priority has a point value of five
( ) points.
• Partial points not awarded
• Disadvantaged (student) Priority
Disadvantaged Priority
Funding Factors
Medically Underserved Community
(MUC) Funding Preference
• Have a high rate (55%) for placing graduates/program
completers* in practice settings having the principal
focus of serving residents of medically underserved
communities; or
• During the 2-year period preceding the fiscal year for
which an award is sought, have achieved a
significant increase (50%) in the rate of placing
graduates/program completers in such settings; or
• Meet the criteria for a new program.
*Must practice at least .5 FTE
2006 Program Comple ters as of July 2006
Re si de n cy
FM
GIM
GP
Faculty
FM
De velopme n t GIM
GP
PA
De n tal
Gen
Re si de n cy
P eds
2003 Gradu ate sas of July 2006
Pre doc/AAU
FM/GIM/GP
TO TAL
2007 Program Comple ters as of July 2007
Re si de n cy
FM
GIM
GP
Faculty
FM
De velopme n t GIM
GP
PA Stu de n ts
De n tal
Gen
Re si de n cy
P eds
2004 Gradu ate sas of July 2007
Pre doc/AAU
FM/GIM/GP
TO TAL
% Grads
or Prog
Comp
in these
settings
Total # Grads
or Prog Comp
Total # of
Grads or
ProgComp in
these settings
Sites
Designated
by State Gov.
Health Depts
HPSAs,
Dental
HPSAs
FQHCs
IHS
Sites
NHSC
Sites
Rural Health
Clinics
Public Housing
Primary
Care
Grantees
Health
Care for
the
Homeless
MHC
MUC
Prefere n ce
Re qu e st Tab
le
CHC
MUC Table
Step 3: Special Considerations
• Special consideration shall be given to
projects that prepare practitioners to care for:
– Underserved populations
– Other high risks groups, e.g.,
Elderly, individuals with HIV/AIDS, substance
abusers, the homeless, and victims of domestic
violence
– Healthy People 2010 goals (2020?)
– Culturally and linguistically appropriate care
Step 4: Writing the Grant
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•
•
•
•
•
Use the Program Guidance
Create the
from the Program Guidance
One person should coordinate the grant
Assign action items and timelines for each objective
Don’t forget the progress report if previously funded
Write the content to be consistent with the 6 (?)
Review Criteria
Organizing the Grant
• Organize a small team (2-4?) with diverse skills—Original
brainstorming/strategic planning group may be larger
• Develop timeline for grant prep/writing/submission
• Task responsible persons with internal deadlines
• Negotiate needs of the project (space, curriculum time,
faculty resources)
• Identify partnerships/collaborators where and think about
potential letters of support (e.g.,
interdisciplinary/interprofessional)—may need to do this
earlier
Focus on access and improving healthcare outcomes
Program Guidance Outline—65 pages
• Project Abstract--1 pages
• Progress Report*--3 pages
– Specific Objectives and
Methodology
– Outcomes and Evaluation
• Project Narrative
– Introduction
– Organizational Information
– Needs Assessment
(Rationale)
–
–
–
–
Methodology
Work Plan
Resolution of Challenges
Outcome Measures and
Dissemination
– Evaluation and Technical
Support Capacity
• Attachments
– Organizational charts
– Letters of agreement
– Budget**
*Heed the Progress Report Requirements
**Heed Funding Restrictions
Application Review Information
100 Points* Total--6 Criteria
1. Need (15 pts)
– Needs Assessment
2. Response (30 pts)
– Methodology, Work Plan,
Resolution of Challenges
3. Evaluative
Measures (15 pts)
– Evaluation and Technical
Support
4. Impact (10 pts)
– Outcome Measures and
Dissemination
5. Resources/Capabilities (20
pts)
– Organizational Information,
Work Plan, and Progress
Report
6. Support Requested (10 pts)
– Budget Justification
*TA FY 2010 has 7 Review Criteria and points for Specific Program Criteria:
Special Considerations
Narrative
(the meat of the proposal)
• Intro/Org Info/Rationale
– Description of
• Your current program, setting, and resources
• Your program’s/institution’s strengths relevant to the project
• Need for the project (from the Needs Assessment)
– National trends/drivers
(e.g., service learning, learner-centered instruction, patientcentered home care models, HP 2010+)
– Impact on learners, educational community, and
patients
– Relevance of your project to national priorities
Rationale
• Can you provide a rationale and assumptions
upon which the project objectives will be
based? Recent Retreat/ARC-PA Review?
• Is there an emerging medical education topic
that merits incorporation into the curriculum?
• What does the literature say?*
– Are there existing PA data?
• If not, what about medical school or graduate
medical education?
*Remember: PA educators are scoring your grant
Needs Assessment
• Student, faculty, community survey data—e.g.,
a competency or core clinical skill is lacking
upon graduation
– Interest of students and faculty (or community)
– Demonstrated need in a specific area—e.g., special
populations, cultural competence, health literacy
• Focus groups, census data, historical and
geographical data, local/state health
department statistical data
Alignment with Special
Consideration Areas
• Special populations
– Elderly, Homeless, Victims of Domestic Violence,
Substance Abuse, Patients with HIV/AIDS
• Areas of innovation
– Quality Improvement/Patient Safety, Health
Literacy/Cultural Competency, PCMH
• Healthy People 2010+ Overarching Goals
– Increase quality and years of life, eliminate health
disparities
Methodology/Work Plan
• Link activities to specific objectives
• Report trainee diversity and recruitment status
• Describe staffing/expertise you have in place to
conduct the activities
• Indicate Timeline (text and tables help reviewers)
• Describe how activities will be evaluated (T&T)
• Be realistic—the reviewers are experienced
educators
Challenges and Resolution of
Challenges
• For each objective, or where pertinent, what
are the specific barriers, or perceived
barriers, to success, e.g.,
–
–
–
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Hiring key personnel
Personnel training
Establishing partnerships/linkages
Competition for clinical sites
• Address how you will manage/resolve these
challenges
Outcome Measures and Dissemination/
Technical Support and Evaluation
• Be specific in the evaluation
– Have clear and measurable objectives
– Allow for feedback into the process
– Develop process and outcome measures
• Are the student evaluations summative, formative,
qualitative?
• Are evaluations objective with realistic outcome
measures?
• Staff expertise
Other Points
• Attachments—multiple
• Make it easy for reviewers to find required elements
– Follow the Narrative Outline and Review Criteria!
• Sustainability after the grant (+/-)
• The proposed project should be doable by your
program: highlight your track record
• The proposed project should be relevant to the
mission of HRSA
Budget
• What will it cost to undertake each
component of the project
• Account for time, equipment, office costs, etc.
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Faculty support and consultant costs
Student stipends? (check the guidance)
Travel? (check the guidance)
Rental and leases
Office supplies
Equipment cost/maintenance
Other…
Budget Justification
• Justify all personnel
– List all personnel, including those without
requested salary support : “in kind contributions”
• Identify unique roles each person will play
• Justify all costs/travel/expenses
– Who will travel and for what purpose, estimate
expenses
• Indirect costs (F&A): “It depends”
Performance Reviews and Progress
Reports
• Set up monitoring system (enrollees and
graduates, see preferences/priorities tables)
• Involve key support personnel—”buy-in”
• Continuously gather data
• PD (PI) should monitor due dates and assure
that reports are submitted in a timely manner
Take Home Points
• Know the purpose of HRSA grant support
• Identify program needs within the HRSA framework
• Strongly consider investing faculty time as HRSA grant
reviewers
• Register at Grants.gov or become familiar with grants
management at your institution (DUNS, POC, M-PIN, AOR)
• Utilize Program Guidance and Technical Assistance
– Use the Program Guidance as an outline
– Employ the Review Criteria as a sub-outline
Take Home Points
• Write the content in the comprehensive framework and to
be consistent with the 6 (7?) Review Criteria
• From the outset, use tables from the Program Guidance
to track faculty and students for future performance
reviews and progress reports
• Contact successful Program Directors (PIs) to see if they
will offer support and mentoring
• Early in the process: beg, borrow, or steel a majorly
awesome impertial editer
References
• Catalog of Federal Domestic Assistance (CFDA) No.
93.884. Training in Primary Care Medicine and
Dentistry. Authority: Title VII, Section 747, Public
Health Service Act, as amended, (42 U.S.C-293k).
• Cawley, JF. Physician Assistants and Title VII Support.
Academic Medicine. 2008;83(11):1049-1056.
• Glicken, AD. Excellence in Physician Assistant Training
Through Faculty Development. Academic Medicine.
2008;83(11): 1107-1110.