NCI Funding Opportunities in NCI Funding Opportunities in Health Services and Outcomes Health Services and Outcomes ResearchResearch

Steven B. Clauser, Ph.D.Steven B. Clauser, Ph.D.

Chief, Outcomes Research Branch Chief, Outcomes Research Branch Applied Research ProgramApplied Research Program

Division of Cancer Control and Population Sciences Division of Cancer Control and Population Sciences http://appliedresearch.cancer.gov/http://appliedresearch.cancer.gov/

Academy Health Annual MeetingAcademy Health Annual MeetingWashington, DC June 9, 2008Washington, DC June 9, 2008

Session OutlineSession Outline Who We Are and What We Do Who We Are and What We Do

Organizational contacts and expertise Organizational contacts and expertise HSR priority areas related to key branch missionsHSR priority areas related to key branch missions

NCI Research Resources for Health NCI Research Resources for Health Services and Outcomes Research Services and Outcomes Research Investigators Investigators NCI Funding for HSR-related research NCI Funding for HSR-related research Potential research resources and consortia Potential research resources and consortia

connections for extramural investigators connections for extramural investigators

Funding Opportunities for Junior and Funding Opportunities for Junior and Mid-level InvestigatorsMid-level Investigators

Office ofCancer Survivorship

Dr. Julia H. Rowland

Office ofCancer Survivorship

Dr. Julia H. Rowland

Applied CancerScreening ResearchDr. Steve Taplin (Acting)

Applied CancerScreening ResearchDr. Steve Taplin (Acting)

Basic and Biobehavioral

ResearchDr. Paige McDonald

Basic and Biobehavioral

ResearchDr. Paige McDonald

Health Communicationand

Informatics ResearchDr. Bradford Hesse

Health Communicationand

Informatics ResearchDr. Bradford Hesse

Health PromotionResearch

Dr. Linda Nebeling

Health PromotionResearch

Dr. Linda Nebeling

Tobacco ControlResearch

Dr. Cathy Backinger

Tobacco ControlResearch

Dr. Cathy Backinger

Health Services andHealth Services andEconomicsEconomics

Dr. Martin BrownDr. Martin Brown

Health Services andHealth Services andEconomicsEconomics

Dr. Martin BrownDr. Martin Brown

OutcomesOutcomesResearchResearch

Dr. Steven ClauserDr. Steven Clauser

OutcomesOutcomesResearchResearch

Dr. Steven ClauserDr. Steven Clauser

Risk Factor Monitoringand Methods

Dr. Susan Krebs-Smith

Risk Factor Monitoringand Methods

Dr. Susan Krebs-Smith

Surveillance ResearchProgram

Dr. Brenda K. Edwards

Surveillance ResearchProgram

Dr. Brenda K. Edwards

Cancer StatisticsMr. David Stinchcomb

Cancer StatisticsMr. David Stinchcomb

Statistical Researchand Applications

Dr. Eric Feuer

Statistical Researchand Applications

Dr. Eric Feuer

Epidemiology andGenetics Research

ProgramDr. Deborah Winn

(Acting)

Epidemiology andGenetics Research

ProgramDr. Deborah Winn

(Acting)

Methods andTechnologies Branch

Dr. Mukesh Verma

Methods andTechnologies Branch

Dr. Mukesh Verma

Modifiable Risk FactorsDr. Britt Reid

Modifiable Risk FactorsDr. Britt Reid

Behavioral ResearchProgram

Dr. Robert T. Croyle(Acting)

Behavioral ResearchProgram

Dr. Robert T. Croyle(Acting)

Applied ResearchApplied ResearchProgramProgram

Dr. Rachel Ballard-BarbashDr. Rachel Ballard-Barbash

Applied ResearchApplied ResearchProgramProgram

Dr. Rachel Ballard-BarbashDr. Rachel Ballard-Barbash

DCCPS ORGANIZATION CHART

Office of the DirectorOffice of the DirectorDr. Robert T. Croyle, DirectorDr. Robert T. Croyle, Director

Office of the DirectorOffice of the DirectorDr. Robert T. Croyle, DirectorDr. Robert T. Croyle, Director

Host SusceptibilityDr. Mukesh Verma (Acting)

Host SusceptibilityDr. Mukesh Verma (Acting)

Clinical and Translational Epidemiology

Dr. Deborah Winn (Acting)

Clinical and Translational Epidemiology

Dr. Deborah Winn (Acting)

Revised 5/08

ARP STAFF EXPERTISE

Health Services Research

Cancer Screening

Outcomes Measurement

Cost-EffectivenessAnalysis

Health Disparities

Quality/Patterns of Care

Diet, Physical Activity, Tobacco

Energy Balance and Cancer

Risk Modeling

Genetics and Family History

http://appliedresearch.cancer.gov/about/staff/

Health Services and Health Services and Economics BranchEconomics Branch

The Branch’s mission: The Branch’s mission: Support, conduct, and coordinate research on Support, conduct, and coordinate research on

the dissemination of effective cancer-related the dissemination of effective cancer-related health services into community practice. health services into community practice.

Study demographic, social, economic, and Study demographic, social, economic, and health system factors as they relate to health system factors as they relate to providing preventive, screening, diagnostic, providing preventive, screening, diagnostic, and treatment services for cancer. and treatment services for cancer.

Improve cancer outcomes, reduce cancer-Improve cancer outcomes, reduce cancer-related health disparities, and reduce the related health disparities, and reduce the burden of cancer to patients, their families, burden of cancer to patients, their families, and society.and society.

HSEB carries out its mission HSEB carries out its mission by….by….

Monitoring cancer-related health services Monitoring cancer-related health services utilization and outcomes among individuals utilization and outcomes among individuals in the general population and among in the general population and among selected population subgroups; selected population subgroups;

Monitoring the dissemination and effective Monitoring the dissemination and effective delivery of cancer-related health services by delivery of cancer-related health services by community-based health care providers and community-based health care providers and health care delivery organizations; health care delivery organizations;

Assessing the role of economic factors Assessing the role of economic factors related to the equitable, efficient, and related to the equitable, efficient, and effective provision of cancer-related health effective provision of cancer-related health services; services;

developing and disseminating data resources developing and disseminating data resources to support policy-relevant researchto support policy-relevant research

http://healthservices.cancer.gov/about/http://healthservices.cancer.gov/about/

Outcomes Research Outcomes Research BranchBranch

The Branch mission: The Branch mission: Coordinate and sponsor research to Coordinate and sponsor research to

measure, evaluate, and improve measure, evaluate, and improve patient-centered outcomes of cancer patient-centered outcomes of cancer care delivery across the cancer care care delivery across the cancer care continuum. continuum.

ORB is particularly interested in ORB is particularly interested in morbidity and mortality outcomes, morbidity and mortality outcomes, patient symptoms and health-related patient symptoms and health-related quality of life, and patient experience quality of life, and patient experience of and satisfaction with health care.of and satisfaction with health care.

ORB carries out it’s mission ORB carries out it’s mission by….by….

Enhancing the state of the science of outcomes Enhancing the state of the science of outcomes measurement, especially patient-reported outcomes; measurement, especially patient-reported outcomes;

Assessing, monitoring, and enhancing patient-Assessing, monitoring, and enhancing patient-centered cancer care at all levels -- the provider-centered cancer care at all levels -- the provider-patient interaction, the health care organization, patient interaction, the health care organization, and the health care system;and the health care system;

Translating research findings into care delivery Translating research findings into care delivery products and strategies for use by public and private products and strategies for use by public and private decision makers, who provide, pay for, regulate, set decision makers, who provide, pay for, regulate, set standards for, and make personal decisions about standards for, and make personal decisions about cancer care; and cancer care; and

Evaluating innovative programs designed to improve Evaluating innovative programs designed to improve the effectiveness and efficiency of providing the effectiveness and efficiency of providing evidence-based practice throughout the cancer care evidence-based practice throughout the cancer care continuum. continuum.

http://outcomes.cancer.gov/http://outcomes.cancer.gov/

Health Services/Outcomes Research is Relevant Health Services/Outcomes Research is Relevant Across the Cancer ContinuumAcross the Cancer Continuum

• Obesity diagnosis and management

• Risk Assessment Communication/

Counseling • Cancer chemo- prevention

• Cancer Screening Recommenda-tions and Practices

• End-of-Life Care

• Use of Evidence-

Based Therapies• Pain Management

• Follow-up of cancer survivors

Prevention Detection Treatment SurvivorshipDiagnosis

• Risk Assessment (Cancer genetics)

• Timely Diagnosis and Referral

Cross Cutting Topics• Access to Care • Health Disparities • Economics of Cancer Care• Quality of Care • Quality of Life/Patient Centered Care

DCCPS Source of DCCPS Source of Funding and Expenditures Funding and Expenditures

(FY07)(FY07)

DCCPS

Cancer Control RPG Collaborations

In-house

6% IAA/MOUContracts

13%

RFA/PA32%

Investigator Initiated49%

Fu

nd

ing

So

urc

esE

xpen

dit

ure

s

Distribution of ARP Funding Distribution of ARP Funding Related to Health Related to Health Services/Outcomes Research in Services/Outcomes Research in 20072007 Total Funding (Control+RPG) =$32.6M

Total grants - 91

OAD $5.4M 16%

HSEB $18.2M

55%

ORB $4.7M 16%

RFMB $4.1M

13%

12

ARP Health Services/Outcomes ARP Health Services/Outcomes Related Grant Funding, 1998-Related Grant Funding, 1998-

20072007 Growth in Funded Grants

1931

41

66

8292

0

20

40

60

80

100

1999 2000 2002 2004 2006 200705

101520253035

1998 2002 2006

Growth in Grant Dollars(in millions)

Building Infrastructure for Building Infrastructure for

Extramural InvestigatorsExtramural Investigators

NCI Health Service Research ResourcesNCI Health Service Research Resources

Data Resources for Data Resources for InvestigatorsInvestigators Cancer Registry Based ResourcesCancer Registry Based Resources

SEERSEER Patterns of Care/Quality of Care StudiesPatterns of Care/Quality of Care Studies SEER-Medicare Linked DatabasesSEER-Medicare Linked Databases

Consumer and Healthcare Provider Consumer and Healthcare Provider SurveysSurveys National Health Interview Survey Cancer National Health Interview Survey Cancer

Control ModuleControl Module California Health Interview SurveyCalifornia Health Interview Survey National Survey of Colorectal Cancer National Survey of Colorectal Cancer

Screening Practices – 2000, 2006Screening Practices – 2000, 2006 Public Health Research ResourcesPublic Health Research Resources

Cancer Planet Cancer Planet Outcomes Research ResourcesOutcomes Research Resources

PROMIS Quality of Life Measures and CAT PROMIS Quality of Life Measures and CAT applicationsapplications

Example:Example: SEER-Medicare Data SEER-Medicare Data Are Useful for Research Across the Are Useful for Research Across the Cancer ContinuumCancer ContinuumScreening/ Diagnosis/ Survivorship Secondary Terminal Care Detection & Treatment Occurrence

Use of PSA testing, mammography, sigmoidoscopy/colonoscopy 

Patterns of care

Peri-operative complications

Volume outcomes studies

Comorbidities

Health disparities

Late effects of treatment

Post-diagnostic surveillance

Treatment of prevalent cancers

Survival

Rates of recurrence/second primaries

Relationship of second events to initial treatment and ongoing surveillance

Use of hospice

End-of-life patterns of care

Over 150 SEER-Medicare articles in print

What would youlike to measure in your study?

Domain definitions

item content review

item characteristics

Click below for:

or select a box on the right and proceed

http://www.nihpromis.org

pain

emotional distress

physicalfunction

fatigue

social roleparticipation

Example:Example: PROMIS Measure PROMIS Measure

WebsiteWebsite

NCI Health Services Research NCI Health Services Research NetworksNetworks

National, multi-site research networks National, multi-site research networks thatthat Can enroll large cohorts of individualsCan enroll large cohorts of individuals Track receipt of cancer control services Track receipt of cancer control services

longitudinally at the patient, provider, and longitudinally at the patient, provider, and health system levels health system levels

Investigate impact of interventions on patient-Investigate impact of interventions on patient-centered outcomescentered outcomes

Current ExamplesCurrent Examples Breast Cancer Surveillance Consortium (BCSC)Breast Cancer Surveillance Consortium (BCSC) Cancer Research Network (CRN)Cancer Research Network (CRN) Cancer Care Outcomes Research and Cancer Care Outcomes Research and

Surveillance Consortium (CanCORS)Surveillance Consortium (CanCORS)

NCI Consortium-based NCI Consortium-based Research PlatformsResearch Platforms

P r e p a r e d f o r D r . [ N a m e ]

F r o m [ B e g i n Q t r ] t o [ E n d Q t r ] B a s e d o n [ n u m b e r ] s m o k e r s s e e n

9 0 t h P e r c e n t i l e = T o p 1 0 % p a r t i c i p a t i n g p r i m a r y c a r e p r o v i d e r s a t y o u r h e a l t h p l a n .

S p e c i f i c E v i d e n c e - B a s e d W a y s t o A s s i s t Y o u r P a t i e n t s W h o S m o k e

1 . E n c o u r a g e N i c o t i n e R e p l a c e m e n t T h e r a p y o r B u p r o p r i o n p r e s c r i p t i o n i f p a t i e n t i s i n t e r e s t e d

2 . W r i t e a r e f e r r a l t o S m o k i n g C e s s a t i o n C l a s s e s o r t h e Q u i t L i n e a t [ p h o n e ]

3 . H e l p p a t i e n t d e v e l o p a s p e c i f i c a c t i o n p l a n f o r q u i t t i n g b y s e t t i n g a q u i t d a t e a n d l i s t i n g p o s s i b l e c o p i n g s t r a t e g i e s ( e . g . t e l l o t h e r s a b o u t q u i t d a t e , t h r o w i n g c i g a r e t t e s a w a y )

T h e 5 A ’ s S t r a t e g i e s R e c o m m e n d e d b y t h e N a t i o n a l C a n c e r I n s t i t u t e a n d t h e U S T o b a c c o P r e v e n t i o n T a s k F o r c e

A S K : U p d a t e s m o k i n g s t a t u s e v e r y v i s i t

A D V I S E : P a t i e n t t o q u i t i n a p e r s o n a l l y r e l e v a n t w a y

A S S E S S : P a t i e n t r e a d i n e s s t o m a k e q u i t a t t e m p t w i t h i n t h e n e x t 8 0 d a y s

A S S I S T : P a t i e n t t o s e t q u i t d a t e a n d m a k e a c o p i n g p l a n f o r q u i t t i n g a n d / o r r e l a p s e p r e v e n t i o n

A R R A N G E : F o l l o w - u p s u p p o r t b y p h o n e , v i s i t , o r e m a i l w i t h i n a f e w w e e k s o f q u i t d a t e

Y o u r F i r s t Q u a r t e r R e s u l t sB a s e d o n I n f o r m a t i o n R e c o r d e d i n H e a l t h C o n n e c t

9 2 %

5 2 %

2 2 %2 7 %

1 . 8 %0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

A s k A d v i s e A s s e s s A s s i s t A r r a n g e

Perc

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Y o u 9 0 t h P e r c e n t i l e

5 0 4 0 3 a 9 / 0 4 C H R

U s i n g E l e c t r o n i c M e d i c a l R e c o r d s t o H e l p Y o u r P a t i e n t s Q u i t S m o k i n g

Breast Cancer Surveillance Consortium Cancer Research Network

$$$$$$$$$$$$$$$$$$$$$$

Health Services/Outcomes Health Services/Outcomes Research Funding Research Funding

Opportunities at NClOpportunities at NCl

NCI Funding NCI Funding Mechanisms Mechanisms for for Junior and Mid-level Junior and Mid-level

InvestigatorsInvestigators K-Awards – NCI Training Awards K-Awards – NCI Training Awards

R03 – Small Research Grants in R03 – Small Research Grants in Behavioral and Social Sciences Behavioral and Social Sciences

R21 – Exploratory/Developmental GrantsR21 – Exploratory/Developmental Grants

R01 – Research ProjectsR01 – Research Projects http://deainfo.nci.nih.gov/flash/awardshttp://deainfo.nci.nih.gov/flash/awards

.htm.htm

General Grant Applications General Grant Applications InstructionsInstructions http://deainfo.nci.nih.gov/flash/awards.htmhttp://deainfo.nci.nih.gov/flash/awards.htm

Current Health Services Current Health Services Research Program Research Program AnnouncementsAnnouncements

PA-02-005: Economic Studies in Cancer Prevention, PA-02-005: Economic Studies in Cancer Prevention,

Screening and Care(R01, R21) Screening and Care(R01, R21) http://grants.nih.gov/grants/guide/pa-files/PA-02-005.htmlhttp://grants.nih.gov/grants/guide/pa-files/PA-02-005.html

PA-02-006: Cancer Surveillance Using Health Claims-Based PA-02-006: Cancer Surveillance Using Health Claims-Based Data System(R01, R21) Data System(R01, R21) http://grants.nih.gov/grants/guide/pa-files/PA-02-006.htmlhttp://grants.nih.gov/grants/guide/pa-files/PA-02-006.html

PA-02-015: Enhanced Understanding of ColorectalPA-02-015: Enhanced Understanding of ColorectalCancer Screening(R21) Cancer Screening(R21)

http://grants.nih.gov/grants/guide/pa-files/PA-02-015.htmlhttp://grants.nih.gov/grants/guide/pa-files/PA-02-015.html

PA-05-090: Methodology and Measurement in the PA-05-090: Methodology and Measurement in the Behavioral Behavioral

and Social Sciences(R01, R21) and Social Sciences(R01, R21)

http://grants1.nih.gov/grants/guide/pa-files/PA-05-090.htmlhttp://grants1.nih.gov/grants/guide/pa-files/PA-05-090.html

NCI Funding Mechanisms for NCI Funding Mechanisms for Dissemination and Implementation Dissemination and Implementation ResearchResearch

R03 – Small Research GrantsR03 – Small Research Grants Dissemination and Implementation Dissemination and Implementation

Research in HealthResearch in Health http://grants2.nih.gov/grants/guide/pa-fhttp://grants2.nih.gov/grants/guide/pa-f

iles/PAR-06-071.htmliles/PAR-06-071.html

R21 – Exploratory/Developmental GrantsR21 – Exploratory/Developmental Grants Dissemination and Implementation Dissemination and Implementation

Research in Health Research in Health http://grants2.nih.gov/grants/guide/pa-fhttp://grants2.nih.gov/grants/guide/pa-f

iles/PAR-06-072.htmliles/PAR-06-072.html

R01 – Research ProjectsR01 – Research Projects Dissemination and Implementation Dissemination and Implementation

Research in HealthResearch in Health http://grants1.nih.gov/grants/guide/pa-fhttp://grants1.nih.gov/grants/guide/pa-f

iles/PAR-06-039.htmliles/PAR-06-039.html

For further information on For further information on anything presented today -- anything presented today -- including most appropriate including most appropriate

NCI contacts, email ….NCI contacts, email ….Steven Clauser, Ph.D. Steven Clauser, Ph.D.

Chief, Outcomes Research Chief, Outcomes Research BranchBranch

Clausers@mail.nih.govClausers@mail.nih.govMartin Brown, Ph.D.Martin Brown, Ph.D.

Chief, Health Services & Chief, Health Services & Economics BranchEconomics Branch

Brownm@mail.nih.govBrownm@mail.nih.gov