[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]



=======================================================================
-----------------------------------------------------------------------

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