[Federal Register Volume 60, Number 96 (Thursday, May 18, 1995)]
[Notices]
[Pages 26727-26731]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-12201]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[Announcement 565]
Health Services Research in Occupational Safety and Health;
Availability of Funds for Fiscal Year 1995
Introduction
The Centers for Disease Control and Prevention (CDC), the National
Institute for Occupational Safety and Health (NIOSH), announces the
availability of fiscal year (FY) 1995 funds for research projects
relating to health services research in the field of occupational
safety and health.
The Public Health Service (PHS) is committed to achieving the
health promotion and disease prevention objectives of ``Healthy People
2000,'' a PHS-led national activity to reduce morbidity and mortality
and improve the quality of life. This announcement is related to the
priority area of Occupational Safety and Health. (For ordering a copy
of ``Healthy People 2000,'' see section ``Where to Obtain Additional
Information.'')
Authority
This program is authorized under the Occupational Safety and Health
Act of 1970, section 20(a) [29 U.S.C. 669(a)] and section 22(e)(7) (29
U.S.C. 671(e)(7)).
Smoke-Free Workplace
PHS strongly encourages all grant recipients to provide a smoke-
free workplace and to promote the non-use of all tobacco products, and
Pub. L. 103-227, the Pro-Children Act of 1994, 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.
Eligible Applicants
Eligible applicants include domestic and foreign non-profit and
for-profit organizations, universities, colleges, research
institutions, and other public and private organizations, including
State and local governments and small, minority and/or woman-owned
businesses.
Availability of Funds
Approximately $1,000,000 is available in FY 1995 to fund
approximately five research project grants. It is expected that the
average award will be $200,000, ranging from $150,000 to $250,000 in
total costs (direct and indirect costs per year). It is expected that
the awards will begin on or about September 1, 1995, and will be made
for a 12-month budget period within a project period of up to 3 years.
Funding estimates may vary and are subject to change.
Continuation awards within the project period will be made on the
basis of satisfactory progress and availability of funds.
Purpose
The purpose of this grant program is twofold. One major purpose is
to rationally develop an estimated range of total costs and
distribution for the national burden of occupational injuries and
illnesses by comprehensively applying existing information (See Program
Interests A.1., below). The other major purpose is to conduct more
focused research into the systems that prevent, manage, and compensate
occupational injuries and illnesses, with particular focus on the
experience of the injured worker as he/she comes into contact with
components of these systems (See Program Interests 2. to 5., below). It
is the intent of this program to support broad research endeavors which
will lead to improved understanding and appreciation of the magnitude
of the aggregate national economic burden associated with occupational
injuries and illnesses, as well as to support more focused research
projects which will lead to improvements in the delivery of
occupational safety and health services and the prevention of work-
related injury and illness. Research funded will examine and evaluate
quality, outcome and costs of services provided in a variety of
settings for healthy and injured workers.
This is the first Request for Assistance (RFA) that NIOSH has
issued in the area of Health Services Research. The agency's intention
in defining the RFA's objectives broadly is to encourage proposals from
applicants with a broad range of research backgrounds, methodological
approaches, and institutional affiliations to apply their skills to
health services research in occupational health, and to enter into
collaborative agreements, and with unions, employers, providers,
insurance carriers and other relevant institutions and organizations.
NIOSH encourages efforts in which researchers work closely with
employers, worker representatives, and relevant government agencies;
collaboration with any or all may assist researchers in obtaining
access to data, and will increase the likelihood that results of the
study will be usable and used by the [[Page 26728]] parties involved.
NIOSH also recognizes, however, that in many situations collaboration
may not be possible or advantageous.
Program Interests
a. Content Areas
1. The magnitude and distribution of national costs of occupational
injury and illness. The economic and social costs of work-related
injury and illness in the United States have not been adequately
described or studied. There is programmatic interest in investigations
into developing defensible estimates for the national economic burden
of occupational injuries and illnesses, as well as into the cost of
failure to prevent occupational injury and illness in general, as well
as in specific industries and of specific conditions. There is
particular interest in developing and applying models to estimate the
distribution of these costs.
In most cases involving medical care or lost wages, workers with
occupational injuries are entitled to workers compensation benefits.
However, little is known of the costs (personal and social, economic
and non-economic) of workplace injury and illness cases that do not
enter the workers compensation system, or are incompletely compensated
by that system. Further study is needed to quantify these costs, and to
determine how much, if any, of these costs are borne by injured
workers, employers, Federal agencies, State and local government and
private philanthropy.
Little is known about the social and economic consequences of being
diagnosed with occupational injury or illness. Are workers with
occupational conditions discriminated against or likely to suffer from
job loss as a result of their condition? Are they at a disadvantage in
the job market? Does being labeled with an occupational condition
impact their attitude toward their job or their utilization of the
health care system?
2. The prevention and treatment of work-related injury and illness
through the delivery of occupational medical services Given the number
and costs of these conditions, relatively little is known about the
system for delivering medical treatment for these conditions. For both
emergency and non-emergency services, there is only limited information
on the extent, quality, outcome and costs of services provided by
employer-based employee health services, private physicians,
independent occupational health clinics, and hospital emergency
departments. There is programmatic interest in examining the types,
activities, and availability of occupational medicine service
providers, and their use by employers of differing sizes and in various
industries, including groups of workers who are underserved and in need
of occupational health and safety.
Ideally, occupational medical services provide more than the
treatment of work-related conditions, but are an integral part of the
primary and secondary prevention of occupational injury and illness. It
is of interest to examine the involvement and effectiveness of
different types of providers of occupational medical services (e.g. in-
plant medical departments, urgent care centers, local hospitals and
group health plans, independent occupational health clinics) in primary
prevention activities and how medical providers interact with other
occupational safety and health professionals. Similarly, the role and
effectiveness of payers for occupational medical services (employers
and workers compensation insurance carriers) in encouraging or
discouraging injury and illness prevention is of interest.
An alternative model for the provision of occupational health
services to groups of employers in the same industry or region is
through managed care organizations funded by capitated payments. These
provider groups may be linked to employer-based coverage for non-
occupational health conditions (sometimes referred to as 24 hour
coverage), or may be focused solely on occupational health concerns.
There is programmatic interest in examining and evaluating capitated
models for the delivery of occupational health services.
3. The experience of the injured worker in the workers compensation
system. There are few studies on the quality, cost, access and outcome
of the care received by those workers who successfully enter the
compensation system. How successful is the system in meeting its goals?
Are the financial benefits provided adequate to replace lost earnings
and compensate for work-related disability? Are the medical care
services provided claimants appropriate and accessible? (For additional
background on these and related questions, see: Shor, GM. ``Research
and Evaluation in Workers Compensation: An Assessment and An Agenda.''
Workers' Compensation Monitor. 1994,7:18- 24.)
The factors that are associated with a case being recognized as
work-related and entering the compensation system are not well
understood. In particular, additional information is needed on the
incentives of the various actors in the interface of medicine and the
workplace (e.g. workers and their families, employers, corporate
physicians, personal physicians, group health plans and insurance
carriers, attorneys) that encourage or discourage an injured worker
from receiving workers compensation benefits. Are there groups of
workers (defined by health status, age, gender, occupation, skill,
language, legal status or other characteristic) who are more or less
likely to enter the workers compensation system, and should additional
efforts be made to inform groups of injured workers about their rights
to compensation?
In an increasing number of States, employers are permitted to
select the injured worker's medical care provider. There have been few
studies comparing the experience of injured workers in employer-choice
States with those of workers in employee-choice States. How do quality,
outcome and costs differ in these States? Are there some subsets of
workers (defined by health status, wages, skill or other
characteristic) who are better served by one approach or the other?
The number and proportion of work injuries treated under workers
compensation managed care is rapidly increasing, but there is virtually
no published literature evaluating workers compensation managed care
programs. How does managed care in workers compensation compare with
fee-for-service provision of care, in terms of quality, outcome and
cost? How do differences in managed care organization structure and
practices impact quality, outcome and cost? How has the trend toward
managed care for non-work-related conditions affected the recognition
and treatment of work- related conditions. Does workers compensation
managed care generate ethical dilemmas for providers, and if so, how
can they be resolved?
It has been suggested that integrating or merging the systems to
provide medical services for work-related and non-work-related
conditions will result in cost savings, although this has been the
subject of some debate. In addition, it is not known how these changes
might impact workplace-based prevention of occupational injury and
illness, since in theory, the experience rating component of workers
compensation premiums provides a market-based incentive to prevent
injury and illness (although there is also debate over its actual
effectiveness). It is of programmatic interest to examine the effects
of (1) integration or merger of these medical care delivery systems;
and (2) uncoupling of workers [[Page 26729]] compensation medical
benefits from experience rating. Of interest are the impact of these
policies on the quality, outcome and cost of care, on indemnity
benefits, and on the primary prevention of occupational conditions.
Finally, while it is frequently alleged that fraud is relatively
widespread within the workers compensation system, there are few if any
studies that address this issue in a rigorous manner. The extent of
fraudulent claims and practices is unknown, as are the costs of these
activities to workers, employers and the compensation system. Accurate,
rigorously-gathered information on the magnitude, costs, and
characteristics of workers compensation fraud on the part of claimants,
employers, health care providers and carriers are needed in order to
better design and target fraud reduction programs.
4. Development and evaluation of treatment guidelines. Outcome of
treatment of occupational injury and illness, whether or not it is paid
for by the workers compensation system, may be measured differently
than treatment outcome of non-work-related conditions. In addition to
physiological outcome, or outcome as it relates to health status,
management and treatment of occupational conditions must consider the
impact of the condition and treatment on the worker's post-injury wages
and ability of the worker to use their valued skills and knowledge.
Since workers with occupational injury or illness may be index
cases for more widespread or prevalent conditions, treatment guidelines
should include a primary prevention component. This may involve the
provider having contact with the employer, union, or other workers at
the workplace from which the index case emerged, and should therefore
take into consideration issues of confidentiality and potential
discrimination. In developing these guidelines, it is also necessary to
address issues of worker education, how information about the nature,
prognosis and prevention of the condition is transmitted to the worker.
In the development and evaluation of guidelines for treatment of
work-related conditions, consideration should be given to economic and
social outcomes in addition to physiologic outcome. To develop and
evaluate these guidelines, it may be necessary to consider various ways
to conceptualize and measure ``return-to-work,'' beyond merely the end
of the period in which an injured worker is not working, and possibly
to develop new measures or indices for describing the long-term
experience of the injured worker.
5. Workplace based injury and illness prevention. Workplace health
and safety committees are widely seen as playing an important role in
preventing occupational injury and illness. In recent years, several
States have enacted legislation mandating these committees. Additional
data are needed to evaluate the acceptance of these committees by
employers, unions, workers and others; and their functioning and
effectiveness. Are they successful in reducing workplace hazards, and,
if so, what characteristics contribute to their ability to do so? How
successful are other state-mandated hazard prevention programs?
Surveillance programs for injury and illness are widely used as
part of larger work related injury and illness prevention programs.
There are insufficient data on the effectiveness of these programs, and
on the factors that increase these programs' likelihood of success.
Many workers compensation carriers, often through loss-control
units, offer hazard prevention consulting services to employers. There
is interest in examining the experience of these carriers. In
particular, have these programs been evaluated to measure their
effectiveness in preventing work-related injury and illness? If so, are
there lessons to be drawn for injury and illness prevention in general?
Cost-benefit and cost-effectiveness studies are needed to assess
occupational health programs at all levels from direct interventions in
the workplace to comprehensive national programs. Such studies should
include measuring the impact and costs of Federal or State regulation
of workplace hazards. While many economic analyses have been done to
project the costs of proposed standards, the actual economic and social
impact of regulations that have gone into effect is rarely measured and
deserving of study.
B. Methodological Approaches
The purpose of this RFA is to encourage submission of proposals
that address some of the questions raised above. Since these questions
lend themselves to a variety of quantitative and qualitative
methodological approaches, NIOSH encourages applications from
researchers in a range of academic disciplines. For example, the
development of a comprehensive and defensible estimated range of the
national economic burden of occupational injuries and illnesses may
involve expertise representing a variety of fields (e.g., health
economics, sociology, epidemiology, safety specialists and occupational
medicine.) Also, the experience of injured workers in the workers
compensation system could be examined quantitatively, using traditional
economic or epidemiologic approaches, or could be examined
qualitatively, employing techniques generally used by anthropologists
or some sociologists. Multi-disciplinary approaches applied to the same
issue are encouraged.
NIOSH envisions that some researchers may propose case studies,
examining the experience of workers in one industry or workplace, or
with a particular work-related condition, while others will propose
studies analyzing large sets of data previously collected by
compensation systems or carriers, or health insurers. Economic studies
might be undertaken of costs of work-related injury, or of regulation,
in one industry. In areas where adequate research has already been
undertaken, programs that demonstrate the utility of new approaches to
injury and illness prevention may be considered.
In many of the areas described, the foundation for analytical
research may not exist, and it may be appropriate for researchers to
apply for preliminary or descriptive studies that will generate
hypotheses for future endeavors. For example, it may be difficult to
identify populations of workers with occupational injury or illness who
do not enter the workers compensation system. An applicant might
propose a preliminary study to determine the number and characteristics
of workers who may be work-injured but never applied for compensation
by examining one or more provider-based data systems, or by surveying
the memberships of one or more community-based organizations.
Research and evaluation methods in occupational health services may
also need additional development. An applicant might propose to develop
and test a series of quality indicators to be employed in evaluating
occupational health services.
Applicants may apply for seed money to develop study protocols and
the methodology for future scientific studies to address those
questions for which rigorous investigation are needed but that are not
easily accomplished. For example, although the application of managed
care to workers compensation medical services has undergone a dramatic
expansion, few scientific investigations have been conducted on the
extent and impact of this growth. A descriptive approach that generates
hypotheses might be warranted before proceeding to analytical and
evaluation studies.
As noted above, it is an objective of this program to encourage
scientists to [[Page 26730]] apply their skills to health services
research in occupational health, and to enter with collaborative
agreements with each other, and ``stakeholder'' institutions and
organizations. In particular, NIOSH encourages efforts in which
researchers work closely with employers, unions, and relevant
government agencies in order to assist researchers in obtaining access
to data, and to increase the likelihood that study results will be
usable and used by the parties involved.
Inclusion of Minorities and Women in Study Population
Applicants are required to give added attention (where feasible and
appropriate) to the inclusion of minorities and/or women study
populations for research into the etiology of diseases, research in
behavioral and social sciences, clinical studies of treatment and
treatment outcomes, research on the dynamics of health care and its
impact on disease, and appropriate interventions for disease prevention
and health promotion. Exceptions would be studies of diseases which
exclusively affect males or where involvement of pregnant women may
expose the fetus to undue risks. If minorities and/or women are not
included in a given study, a clear rationale for their exclusion must
be provided.
Evaluation Criteria
1. General
Upon receipt, applications will be reviewed for completeness and
responsiveness by CDC/NIOSH. Incomplete applications will be returned
to the applicant without further consideration. If CDC/NIOSH staff
finds that the application is not responsive to this announcement, it
will be returned without further consideration. If the proposed project
involves organizations or persons other than those affiliated with the
applicant organization, letters of support and/or cooperation must be
included.
2. Peer Review
Applications that are complete and responsive to the announcement
will be evaluated for scientific and technical merit by an appropriate
peer review group convened by the CDC in accordance with the review
criteria stated below. As part of the initial merit review, a process
(triage) may be used by the initial review group in which applications
will be determined to be competitive or non-competitive based on their
scientific merit relative to other applications received in response to
this announcement. Applications judged to be competitive will be
discussed and be assigned a priority score. Applications determined to
be non-competitive will be withdrawn from further consideration and the
principal investigator/program director and the official signing for
the applicant organization will be promptly notified.
Review criteria for this announcement are as follows:
a. Scientific, technical, or medical significance and originality of
proposed research;
b. Appropriateness and adequacy of the experimental approach and
methodology proposed to carry out the research;
c. Qualifications and research experience of the Principal Investigator
and staff, particularly but not exclusively in the area of the proposed
research;
d. Availability of resources necessary to perform the research;
e. Adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.
The review group will critically examine the submitted budget and
will recommend an appropriate budget and period of support for each
scored application.
3. Secondary Review
In the secondary (programmatic importance) review, the following
factors will be considered:
a. Results of the initial review;
b. Magnitude of the problem in terms of numbers of workers affected;
c. Severity of the disease or injury in the worker population; and
d. Usefulness to applied technical knowledge in the identification,
evaluation, and/or control of occupational safety and health hazards.
4. Funding Decisions
Applicants will compete for available funds with all other approved
applications. The following will be considered in making funding
decisions:
a. Quality of the proposed project as determined by peer review;
b. Availability of funds; and
c. Program balance among research areas of the announcement.
Executive Order 12372 Review
This program is not subject to the Executive Order 12372 review.
Public Health System Reporting Requirement
This program is not subject to the Public Health System Reporting
Requirements.
Catalog of Federal Domestic Assistance Number
The Catalog of Federal Domestic Assistance number is 93.262.
Other Requirements
Human Subjects
If the proposed project involves research on human subjects, the
applicant must comply with the Department of Health and Human Services
Regulations, 45 CFR part 46, regarding the protection of human
subjects. Assurance must be provided to demonstrate that the project
will be subject to initial and continuing review by an appropriate
institutional review committee. The applicant will be responsible for
providing assurance in accordance with the appropriate guidelines and
form provided in the application kit.
Application Submission and Deadlines
1. Preapplication Letter of Intent
Although not a prerequisite of application, a non-binding letter of
intent-to-apply is requested from potential applicants. The letter
should be submitted to the Grants Management Branch, CDC (see
``Applications'' for the address). It should be postmarked no later
than June 19, 1995. The letter should identify the announcement number,
name of principal investigator, and specify the priority area to be
addressed by the proposed project. The letter of intent does not
influence review or funding decisions, but it will enable CDC to plan
the review more efficiently, and will ensure that each applicant
receives timely and relevant information prior to application
submission.
2. Applications
Applicants should use Form PHS-398 (OMB Number 0925-0001) and
adhere to the ERRATA Instruction Sheet for Form PHS-398 contained in
the application package. The original and five copies of the
application must be submitted to Henry S. Cassell, III, Grants
Management Officer, Grants Management Branch, Procurement and Grants
Office, Centers for Disease Control and Prevention, (CDC), 255 East
Paces Ferry Road, NE., Room 300, Mailstop E13, Atlanta, GA 30305 on or
before July 14, 1995. [[Page 26731]]
3. Deadlines
A. Applications shall be considered as meeting a deadline if they
are either:
1. Received at the above address on or before the deadline date; or
2. Sent on or before the deadline date to the above address, and
received in time for the review process. (Applicants must request a
legibly dated U.S. Postal Service postmark or obtain a legibly dated
receipt from a commercial carrier or the U.S. Postal Service. Private
metered postmarks shall not be accepted as proof of timely mailing.)
B. Applications which do not meet the criteria in 3.A.1. or 3.A.2.
above are considered late applications. Late applications will not be
considered in the current competition and will be returned to the
applicant.
Where to Obtain Additional Information
To receive additional written information call (404) 332-4561. You
will be asked to leave your name, address and phone number and will
need to refer to Announcement 565. You will receive a complete program
description, information on application procedures, and application
forms.
If you have questions after reviewing the contents of all the
documents, business management technical assistance may be obtained
from Georgia L. Jang, Grants Management Specialist, Grants Management
Branch, Procurement and Grants Office, Centers for Disease Control and
Prevention (CDC), 255 East Paces Ferry Road, NE., Mailstop E13,
Atlanta, GA 30305, telephone (404) 842-6814. Programmatic technical
assistance may be obtained from Roy M. Fleming, Sc.D., Associate
Director for Grants, National Institute for Occupational Safety and
Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton
Road, NE., Building 1, Room 3053, Mailstop D30, Atlanta, GA 30333,
telephone (404) 639-3343.
Please refer to Announcement 565 when requesting information and
submitting an application.
Potential applicants may obtain a copy of ``Healthy People 2000''
(Full Report: Stock No. 017-001-00474-0) or ``Healthy People 2000
(Summary Report, Stock No. 017-001-00473-1) referenced in the
``Introduction'' through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325, telephone (202) 512-1800.
Dated: May 12, 1995.
Diane D. Porter,
Acting Director, National Institute for Occupational Safety and Health,
Centers for Disease Control and Prevention (CDC).
[FR Doc. 95-12201 Filed 5-17-95; 8:45 am]
BILLING CODE 4163-19-P
