2010 PECASE Awards

On November 5, President Obama named 85 researchers recipients of the Presidential Early Career Awards for Scientists and Engineers, the highest honor bestowed by the United States government on science and engineering professionals in the early stages of their independent research careers. "Awardees are selected for their pursuit of innovative research at the frontiers of science and technology and their commitment to community service as demonstrated through scientific leadership, public education, or community outreach. Winning scientists and engineers have received research grants for up to five years to further their studies in support of critical government missions."

The Presidential early career awards embody the high priority the Administration places on producing outstanding scientists and engineers to advance the Nation's goals, tackle grand challenges, and contribute to the American economy.  "Science and technology have long been at the core of America's economic strength and global leadership," stated President Obama.  "I am confident that these individuals, who have shown such tremendous promise so early in their careers, will go on to make breakthroughs and discoveries that will continue to move our nation forward in the years ahead." 

The PECASE awards were established by President Clinton in 1996 and are coordinated by the Office of Science and Technology Policy within the Executive Office of the President.

Social and behavioral science PECASE recipients include:

*Amy Finkelstein, Professor of Economics, Massachusetts Institute of Technology:  Finkelstein isthe co-Director of the Public Economics Program at the National Bureau of Economic Research, where she is a Research Associate. She is a co-editor of the Journal of Public Economics.   Her research is in the areas of public finance and health economics. Her two primary research interests are market failures and government intervention in insurance markets, and the impact of public policy on the health care sector.

*Alfredo Fontanini, Assistant Professor of Neurobiology & Behavior, Stony Brook University:  His lab's research relies on a combination of behavioral, psychophysical and electrophysiological methods to monitor networks of neurons interacting in response to sensory stimulation in behaving animals.

*Ana P. Martinez-Donate, Assistant Professor at the Department of Population Health Sciences, University of Wisconsin - Madison: Her research interests include HIV prevention and tobacco control, with emphasis on Latino populations and health disparities. Her work is characterized by the application of a behavioral ecological framework to the analysis of determinants of health-related behaviors and the development of intervention strategies at the population level.

*Kimberly Nixon, Assistant Professor, University of Kentucky College of Pharmacy:   Nixon's Lab uses cutting edge neuroanatomical, biochemical and behavioral techniques to identify the mechanism by which alcohol not only inhibits neural stem cell proliferation and adult neurogenesis, but also how it promotes neurogenesis in recovery and abstinence from alcoholism.

*Mauricio R. Delgado, Psychology Department, Rutgers, The State University of New Jersey:  Delgado's group is using functional magnetic resonance imaging to investigate how the human brain learns from positive and negative reinforcers, and how this information is used to guide decision-making.  Specifically, the goal of the project is to investigate how negative reinforcement influences human brain and behavior, as a precursor to understanding how humans learn to cope with potential negative outcomes - outcomes  that can influence decision-making in maladaptive ways, such as  drug abuse.

*David Amodo, Assistant Professor of Psychology and Neural Science, New York University:  His research examines the roles of social cognition and emotion in the regulation of behavior, and the neural mechanisms underlying these processes. Amodo's work examines these processes in the context of prejudice and stereotyping.  His interests extend to the areas of motivation and health psychology. In each area, issues of behavioral regulation are central and the focus is on mechanism.  Although the questions that guide his work address classic social psychological issues, Amodo's approach is interdisciplinary.

*Laura E. Schulz, Professor of Cognitive Sciences, Massachusetts Institute of Technology:  Herresearch looks at: 1) how children infer the concepts and causal relations that enable them to engage in accurate prediction, explanation, and intervention; 2) the factors that support curiosity and exploration, allowing children to engage in effective discovery and 3) how the social-communicative context (e.g., demonstrating evidence, explaining events, disagreeing about hypotheses) affects children's learning.

*Rachel Werner, Assistant Professor of Medicine, Division of General Internal Medicine, University of Pennsylvania and Core Investigator, VA HSR&D Center for Health Equity Research and Promotion (CHERP):  Werner's research seeks to understand the role of quality improvement initiatives on provider behavior, the organization of health care, racial disparities, and overall health care quality.  Her work was among the first to recognize that public reporting of quality information may worsen racial disparities.

*Jennifer G. Cromley, Assistant Professor of Educational Psychology, Temple University:  Her research concerns the cognitive and motivational foundations of comprehension of textbooks, especially the role of diagrams and other visual representations in science text.

*Robert Blum, Professor, William H. Gates Sr. Chair, Department of Population, Family & Reproductive Health, Johns Hopkins University:  His research is in the areas of adolescent sexuality, chronic illness and international adolescent health care issues.

NIH Health Economics for Health Care Reform Funding Opportunities

In May, the National Institutes of Health (NIH) launched the Common Fund Health Economics program designed to address the evolving needs of the health care sector for economic research. The program goals include fostering the collection of data that will be most useful for policy-relevant analysis; examining the economic effects of changes in incentives for consumers, providers and insurers; exploring the ways in which structure and organization on the supply side of the medical market affect health care spending and clinical outcomes; investigating the potential of preventive measures to improve health and mitigate cost growth.  The first two of multiple-planned Funding Opportunities Announcements (FOA) were recently released.  Funding for the program is expected to total $68 million across seven years.

Integrating Comparative Effective Research into Care Delivery through Economic Incentives

The National Institutes of Health (NIH) has issued a Common Fund initiative, Integrating Comparative Effective Research into Care Delivery through Economic Incentives (RFA-RM-111-001),soliciting exploratory and developmental applications proposing to advance knowledge on the ways in which comparative effectiveness research (CER) can be used to maximize the value of health care delivery in the U.S.  The funding opportunity announcement (FOA) is part of the Common Fund initiative on Health Economics for Health Care Reform which is designed to address the evolving needs of the health care sector for economic research.   Letters of intent are due December 18, 2010. Applications are due January 18, 2011.

The health care system's rapid adoption of emerging medical technologies has provided enormous clinical benefits.  At the same time, technological change has been cited as one of the key factors underlying the growth in health care spending, "in part because the added clinical benefits of new medical services are not always weighed against the added costs before those services enter common clinical practice.   Accordingly, this FOA is designed to promote research on how economic incentives can promote the integration of CER findings into the decisions calculus of players, providers and patients.  The FOA hopes to address the following topics:

<   Payer Incentives - It is not clear that private payers make optimal use of CER data in coverage decisions or in setting payments even though they might have financial incentives to do so.  The FOA seeks research that would identify ways in which payers would be encouraged to make greater use of CER findings.

<   Provider Incentives - Physicians and other providers are known to respond to financial incentives.  The FOA solicits research on how provider incentives can be altered in ways that would help maximize the value of the care which they provide based on information from CER.  Areas of interests include changes in the financial incentives that providers face and other types of changes such as "nudges" that are based on behavioral economics research.  Factors that facilitate or obstruct the adoption of CER-based care delivery in accountable care organizations are also of interest.

<   Consumer Incentives - Research in health economics has established that consumption of medical care is at least somewhat sensitive to the level of cost-sharing which patients face.  The funding opportunity announcement encourages research that would examine the welfare implications of basing cost-sharing levels on CER findings under some clinical circumstances.

<   Assessing Potential Savings from Implementing CER Findings - There is considerable uncertainty around the question of if implementing CER findings result in more selective use of some costly services thus leading to potential substantially lower spending levels.  Research is solicited that would assess potential savings from implementing CER for public and private payers.

The Market for Long-Term Care Insurance

Long-term care (LTC) represents a substantial uninsured financial risk in the U.S.  LTC services are financed a variety of ways, including drawing on personal savings, using private insurance policies, or receiving assistance from public programs such as Medicare and Medicaid.   LTC services, in many cases, are donated by family and friends.  The accompanying personal and economic cost can be great given the prolonged periods in which the care is provided.   The risk of LTC expenses appears to be an example of the type of risk from which individuals would seek to protect themselves via the purchase of an insurance policy.  Yet, research shows that very few elderly or nonelderly individuals purchase private insurance policies that would cover the costs of long-term care such as nursing home or home care services.  At the same time, many lack sufficient savings to pay for adequate LTC in the event that it is needed. 

The Patient Protection and Affordable Care Act created the Community Living Assistance Services and Supports (CLASS) program, a new program intended to provide consumers with the opportunity to obtain protection from financial losses due to the need for LTC services.   It is a voluntary LTC insurance plan that would provide modest cash benefits that could be used to defray the costs of care in community or institutional settings.  After paying premiums for five years, enrollees who meet certain disability criteria are eligible to receive cash benefits based on the degree of disability (no less than $50 per day).  CLASS offers the potential to reduce the exposure to financial risk that elderly and disabled people face, though significant challenges remain in implementing the program. 

The NIH has released a FOA, The Market for Long-Term Care Insurance (RFA-RM-11-002), soliciting research on the economics of long-term care, including topics related to the CLASS program, private and public LTC insurance, and related topics.  Examples of areas of research that would be supported by this FOA include:

�  Factors Influencing the Decision to Purchase LTC Insurance - Research is encouraged that would add to knowledge on factors contributing to the availability of LTC insurance and the decision to purchase it. 

�  Implementing the CLASS Program - The statute calls for between two and six benefit levels, but does not specify either the number of levels or the amount of the benefit.  It does not require individuals to participate, and with no medical underwriting to exclude them, people with a high likelihood of needing benefits might disproportionately enroll in the program.  One potential problem is that a selectively high-risk group of enrollees could drive up premiums and create what economists call an "insurance spiral."  To address that problem, the program is limited to persons who work, and enrollees must pay premiums for five years before receiving benefits.  The FOA encourages research that would inform the ways in which CLASS can be best implemented, including research which would estimate the optimal levels for premiums and cash benefits, and optimal numbers of benefit tiers.

�  Effects on Informal Caregivers - The FOA encourages research on the possible effects of changes in the LTC insurance market on the incentives facing informal caregivers, broadly speaking.

Letters of intent are due December 18, 2010.  Applications are due January 18, 2010.  For more information on the Common Fund Initiative on Health Economics for Health Care Reform see http://commonfund.nih.gov/healtheconomics/.

AHRQ:  Advances in Patient Safety through Simulation Research:  Applications Wanted

Patient safety is a major part of the portfolio for the Agency for Healthcare Research and Quality (AHRQ).  In 1999, the Institute of Medicine released To Err is Human:  Building a Safer Health System, which estimated that between 44,000 and 98,000 American die each year as a result of medical errors.  The report found that preventable adverse events arise from problems inherent in a complex and fragmented health care system rather than poor performance by individual providers.  Accordingly, the report called for systematic change in health care practice.  AHRQ was directed by the Congress to lead a national effort to reduce medical errors and improve patient safety through appropriately targeted research.  The initial patient safety grants focused on reporting systems; clinical informatics; the working conditions of providers; Centers of Excellence for multiple, programmatic projects; developing Centers for new researchers, and education and dissemination efforts.

AHRQ is currently interested in supporting a diverse set of projects that develop, test and evaluate various simulation approaches for the purpose of improving the safe delivery of health care.   According to the agency, simulation in health care predominately is a training technique that exposes individuals and teams to realistic clinical challenges through the use of mannequins, task trainers, virtual reality, standardized patients or other forms, and allows participants to experience in real-time the consequences of their decisions and actions.  The principal advantage of simulation is that it provides a safe environment for health care practitioners to acquire valuable experience without putting patients at risk.  Simulation also can be used as a test-bed to improve clinical processes and to identify failure modes or other areas of concern in new procedures and technologies that might otherwise be unanticipated and serve as threats to patient safety.  AHRQ is seeking applications that address a variety of simulation techniques, clinical settings, provider groups, priority populations, patient conditions, and threats to safety. 

In FY 2006 and FY 2007, AHRQ awarded approximately $10 million to 19 investigators to advance knowledge in how simulation can improve patient safety across diverse healthcare disciplines, settings and populations. The grants were two-year cooperative agreements and covered a diverse range of simulated clinical applications.  In FY 2008, AHRQ, along with other organizations, supported an academic emergency medicine consensus conference that was organized to help define a national research agenda for maximizing effective use of simulation across undergraduate, graduate, and continuous medical education.  In FY 2010, the agency released a Request for Applications (RFA), entitled Improving Patient Safety through Simulation Research, for which it received a high volume response.  Those applications are currently undergoing the review process.

AHRQ believes that to make the same advances in healthcare with simulation that other hazardous industries have made will take an expanded, programmatic effort.  There remain a vast number of research challenges that need to be addressed for simulation in healthcare to reach its full potential.  In responding to these challenges on a more steady and on-going basis, AHRQ is releasing this new program announcement (PA), Advances in Patient Safety through Simulation Research (PAR-11-024).  The application process opens on December 25, 2010.  The announcement will use the AHRQ Research Demonstration and Dissemination Project (R18) grant mechanism.  The individual researcher, sponsored by his/her institution will be solely responsible for planning, directing, and executing the proposed project.   Applications may be up to 36 months in duration with a budget supported by AHRQ not to exceed $350,000 total costs per year. 

The range of simulation issues which are of interest to AHRQ, and applications addressing relevant simulation challenges (and issues not stated below) include:

Individual Performance

�  What are the core individual skills or competencies within key provider groups that have potential to be enhanced with different types of simulation?

�  What are the appropriate performance measures for crucial nursing, medical and surgical procedures?

�  How are acceptable levels of individual performance established for particular procedures or processes?  Can criterion levels be established for different levels of proficiency -- novice, intermediate, and expert?

�  How much variation among trainees is there with respect to rate of skill acquisition and performance levels achieved?  Does simulation help to reduce the variation?  

�  What does skilled performance look like as fixed periods of time elapse with no practice?  Are certain dimensions of skilled performance more subject to skill decay with the passage of time than others?

�  How much simulation retraining is needed to restore decayed performance to an earlier established level of proficiency?  For intricate, risky procedures, can simulation performance criteria be established to assess readiness for performing such procedures on actual patients?

Team Performance

�  What are the core team skills or competencies of key provider groups that can be enhanced with simulation and that are linked to successful patient outcomes?  Are additional skills and competencies required for addressing the needs of patients with disabilities or less commonly encountered health care issues?

�  What are the appropriate performance measures for individuals within teams and for team performance when the team is the unit of analysis and measurement? 

�  What are the distinguishing differences, if any, between ad hoc teams versus fixed teams with respect to skill acquisition and performance levels achieved?

�  How can simulations be used to enhance the resilient and adaptive capacity of teams in responding to the unexpected in acute-care and non-acute-care settings?   

�  Are there distinct differences in team performance metrics and methodologies for technical, specialty-specific behaviors versus non-technical, generic team behaviors? 

Organizational Performance

�  Can simulations be used to help health care entities become high reliability or learning organizations; that is, can scenarios be created that exercise a continuity of safety across the transitions of patient care (e.g., transfer of patients from in-patient to out-patient settings)?

�  Can simulation or modeling techniques be used to assess how hospitals can satisfy simultaneous demands for patient safety, worker safety, efficiency, disaster/surge capacity, and environmental sustainability?

�  How can simulations be used as usability test-beds for medical devices and new technology to enhance organizational performance in in-patient as well as ambulatory facilities?

�  Can simulations be used to highlight the needed communication and coordination requirements across Federal health departments, state health officials, and emergency operations centers in situations requiring rapid response? 

�  How can simulations be used to address the cognitive, affective, perceptual, and system-based challenges associated with poor diagnostic performance?

Methodological Issues

�  What types of simulation and methodological approaches stand the best chance of demonstrating a convincing link between performance in the simulation and patient safety outcomes? 

�  Are there agreed-upon nomenclatures, taxonomies, and metrics for the tasks, skills, and procedures that make up different provider specialty areas to guide and aggregate research findings?

�  What are the metrics and designs for demonstrating positive transfer to training to the clinical setting?  Are the metrics and designs sensitive to negative transfer of training as well?  Can experiences and assignments in the clinical setting be used to augment and further reinforce the skills acquired in the simulated setting?

�  How should concerns relating to variable patient acuity and complexity or to those with less commonly encountered special needs be factored into designs and metrics?

�  What are the greatest threats to internal and external validity that currently exist in healthcare simulation research? 

�  What are the advantages, limitations, or unique considerations associated with virtual reality, mannequin-based simulation, in situ techniques, hybrid configurations, moulage preparations, standardized patients or other forms of simulation likely to have an impact on effectiveness?

Educational and Training Issues

�  What are the analyses or methods used to identify clinical areas of vulnerability or performance deficiencies for which training and simulation is appropriate?

�  What are the methods used to allocate tasks that need to be trained to training devices and simulation experiences?  Does it make educational, cost-effectiveness, or practical sense to partition and assign tasks to desktop trainers, part-task trainers, and simulators in an integrated crawl-walk-run approach to achieve greater proficiency?

�  How does one maximize the total learning experience and not just the simulation experience? Are there principles from the psychology of learning, instructional systems design, cognitive work analysis, and adult learning theory that can be adapted and put to good use?  What happens after the de-brief to solidify what has been learned and to promote new learning?

�  What types of performance records are kept on individuals or teams to track performance levels achieved and for appropriate assignment to more advanced levels of training, simulation and problem solving? 

�  How can simulation be used reliably by entities responsible for accreditation of clinical programs and certification of specialists to ensure that standards, knowledge, and skills are maintained at the highest levels of quality and safety?

For more information or to apply see http://grants.nih.gov/grants/guide/pa-files/PAR-11-024.html.

AHRQ:  Patient Safety and Medical Liability Reform Planning Projects

The 1999 Institute of Medicine report, To Err is Human:  Building a Safer Health System,recommends development of event reporting systems that identify risks and hazards.  The IOM report and its findings spotlight a serious need to capture information that would help to improve quality and reduce harm to patients.  According to the IOM, a focus on patient safety improves health care by learning from adverse events that harm patients, parallel situations in which no harm occurs, and near miss events caught before they harm the patient.  The IOM also emphasizes the need to create a culture of safety in which the health care providers and practitioners (institutions and individuals, respectively), as defined by the Centers for Medicare and Medicaid Services (CMS) learn from events in order to intervene, improve, and actively search for opportunities to reduce actual or potential harm to patients.  Yet in many cases, health care organizations may implicitly discourage adverse event reporting.  Health workers may fear employer reprisal or potential litigation from other parties. 

A recent AHRQ-supported survey finds that virtually all hospitals reported they have centralized adverse-event-reporting systems, although characteristics varied.  Evidence of lack of organizational support for reporting and learning from events also comes from AHRQ's Hospital Survey on Patient Safety Culture (HSOPS), a hospital staff survey designed to help hospitals assess the culture of patient safety in their institutions.   Among other areas, hospital staff report difficulties with non-punitive response to error.  An atmosphere of trust in which people are encouraged, even rewarded, for providing essential safety-related information; but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior is needed.

More complete integration of risk management activities and patient safety efforts would benefit health care. AHRQ-supported research, however, finds that documenting the relationship between implementing "Safe Practices" and risk management activities such as medical liability litigation has proven to be a major challenge.  Too often providers have not integrated or coordinated risk management and patient safety activities well.  Traditional risk management focuses on limiting financial liability using a deny and defend approach instead of focusing on identifying risks and hazards that lead to litigation in the first place.

AHRQ has released a FOA, Patient Safety and Medical Liability Reform Planning Project (PAR-11-023), soliciting planning grants that would lead to the later implementation of a demonstration project on patient safety and medical liability reform.  Specifically, the planning effort must focus on:  putting patient safety first and working to reduce preventable injuries; fostering better communication between doctors and their patients; ensuring that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and reducing liability premiums. 

The projects must: (1) be designed to optimize promising practices that address both ensuring and improving patient safety, as well as reducing health care costs and (2) focus on the connections between patient safety and medical liability claims. 

Applicants will have wide discretion and flexibility in designing their patient safety and medical liability innovations that meet the goals identified.  Proposals should seek comprehensive solutions that improve patient safety and address the underlying causes of the malpractice problem. 

AHRQ encourages applications that involve collaborations of States, health systems, and risk management organizations.  Recognizing the impact issues related to patient safety and medical liability have on priority populations, projects submitted should specifically address issues related to priority populations.  AHRQ priority populations include:  low income groups; minority groups; women; children; the elderly; and individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care. 

Since this FOA is for planning grants, applicants must include specific planning or design methods and approaches that would lead to a final plan for a demonstration project.  Planning methodologies must be clearly delineated and demonstrate a complete understanding of the planning and/or design process.

The total costs awarded for grants funded under the FOA will not exceed $300,000.  Projects may be up to 12 months long.  Applications may be submitted after January 16, 2011.  For more information or to apply see http://grants.nih.gov/grants/guide/pa-files/PAR-11-023.html.

Science of Research on Discrimination and Health:  A Call for Papers

The Applied Research and the Behavioral Research Programs of the Division of Cancer Control and Population Sciences (DCCPS) of the National Cancer Institute (NCI) are sponsoring a special theme issue of the American Journal of Public Health to highlight results of recent research on the measurement and impact of discrimination in the health care setting. 

Studies appropriate for consideration for inclusion in the special issue include, but are not limited to:

�  Descriptive and analytic studies that examine racial/ethnic discrimination as a risk factor for racial/ethnic disparities in disease incidence, treatment, and outcomes;

�  Studies that report on the development of new data collection modalities and the evaluation of existing data collection instruments/modalities for measuring discrimination or response to discrimination;

�  Studies that report on innovative methods of measuring racial/ethnic discriminatory behavior, perception of exposure to racial/ethnic discrimination, and novel approaches to analyzing quantitative and qualitative data for the purpose of describing discriminatory behavior and exposure to racial/ethnic discrimination;

�  Studies that examine the impact of institutional racism in health care delivery systems or policies and its contribution to racial/ethnic health disparities;

�  Studies that report findings from the development and evaluation of cross-cultural communication interventions aimed at reducing discriminatory behavior, the perception of exposure to racial/ethnic discrimination, and the health-related consequences of racial/ethnic discrimination;

�  Studies that examine bias/discriminatory attitudes, beliefs, and behaviors that may influence/limit access to diagnostic technologies and therapies for racial/ethnic minorities;

�  Studies that examine the biological and psychosocial pathways that link exposure to discrimination and health.

Interested individuals should submit a brief abstract of the proposed paper by December 31, 2010 to Ms. Michelle Murray via e-mail at [email protected].  Authors will be notified of the status of their abstract no later than January 31, 2011. Address any questions to Ms. Michelle Murray or Dr. Vickie Shavers at the e-mail listed above (preferred) or at (301) 594-1725.  For more information see http://conference.novaresearch.com/SRDH.