Federal Register / Vol. 66, No. 124 / Wednesday, June 27, 2001 / Notices 34225

Dated: June 17, 2001.

Thomas A. Scully, Administrator,

Health Care Financing Administration.

[FR Doc. 01–16025 Filed 6–26–01; 8:45 am]

BILLING CODE 4120–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Notice of a Cooperative Agreement to

Develop and Manage a Program for

Faculty Leadership in Interdisciplinary

Education to Promote Patient Safety

(FLIEPPS)

The Health Resources and Services

Administration (HRSA) announces that

applications will be accepted for a

Cooperative Agreement for fiscal year

(FY) 2001 to Develop and Manage a

Program for Faculty Leadership in

Interdisciplinary Education to Promote

Patient Safety (FLIEPPS).

The purpose of this Cooperative

Agreement is to develop a ‘‘train the

trainers’’ program to create nurse and

physician faculty leaders in

interdisciplinary education specifically

directed toward enhancing patient

safety. Graduates of the program could

then lead in the training of other faculty

in curricula and techniques in

interdisciplinary education to promote

patient safety. The ultimate goal of this

program is to bridge the separate

cultures of practice in medicine and

nursing by expanding numbers of

professionals who are trained to work

together in teams to improve systems for

safe patient care and to prevent errors.

Authorizing Legislation

This Cooperative Agreement is

solicited under the following authorities

of titles VII and VIII of the Public Health

Service (PHS) Act: (1) Section 747, as

amended, which authorizes grants for

training of physicians who plan to teach

in training programs for primary care

medicine (family medicine, general

internal medicine, general pediatrics,

and/or geriatrics); and (2) section 811, as

amended, which authorizes grants to

strengthen programs that enhance

advanced nurse education and practice.

The Federal role in the conduct of this

Cooperative Agreement is substantial

and will be maintained by the Bureau of

Health Professions (BHPr) staff through

technical assistance and guidance to the

awardee considerably beyond the

normal stewardship responsibilities in

the administration of grant awards. This

Federal role may include any or all of

the following:

(a) Technical assistance and

participation in the planning,

development, and implementation of all

phases of the program, including

consultation about contracts and

agreements developed during the

implementation of the program, all

curricula developed for the program,

content and staffing of training

workshops, and the development of an

evaluation plan for the project which

would be initiated at its inception;

(b) Assistance with identification of

Federal and other organizations with

whom collaboration is essential in order

to further the Cooperative Agreement

mission and to develop specific

strategies to support the work of these

related activities;

(c) Participation in the development

of funding projections;

(d) Participation in the development

of data collection systems and

procedures;

(e) Participation in appropriate

meetings, committees, subcommittees,

and working groups related to the

Cooperative Agreement and its projects

as well as site visits.

The successful applicants will be

included in the overall program

activities of the Department of Health

and Human Services (HHS) in patient

safety and will participate in the

programs and support services that will

be offered by the Patient Safety Research

Coordinating Center supported under a

contract from the Agency for Healthcare

Research and Quality (AHRQ). The

Cooperative Agreements are part of an

overall HHS funding effort to improve

patient safety research, demonstration

and education through a series of RFAs

and Cooperative Agreements (related

RFAs are listed at www.ahrq.gov,

particularly the AHRQ Patient Safety

Research Dissemination and Education

RFA that was published on April 23,

2001).

Availability of Funds

Up to $400,000 will be available in FY

2001 to fund one award for the first

year. Funding may be continued to

complete a 3-year total project period. It

is expected that the award will be made

on or before September 30, 2001.

Support beyond the first year of the

project period will be based on the

achievement of satisfactory progress and

the availability of funds.

Background

In September 2000, shortly after the

Institute of Medicine (IOM) published

its widely discussed report: ‘‘To Err is

Human: Building a Safer Health

System’’ (Kohn, Corrigan and

Donaldson, National Academy Press,

Washington, DC, 2000), the Council on

Graduate Medical Education (COGME)

and the National Advisory Council on

Nurse Education and Practice

(NACNEP) jointly focused on nursephysician collaboration in a report

entitled, ‘‘Collaborative Education

Models to Ensure Patient Safety.’’

COGME–NACNEP joint

recommendations stressed the need for

changing the norms of professional

education and practice so that

physicians and nurses would function

as part of collaborative teams to improve

patient safety and the overall quality of

care. COGME and NACNEP are charged

with advising and reporting to the

Secretary of HHS and the Congress on

workforce, education, and practice

improvement policies.

These joint Advisory Council

recommendations highlighted the

critical importance of developing

educational leaders in interdisciplinary

education to promote patient safety to

effect positive changes toward

developing systems of care that stress

professional collaboration and

teamwork.

This Cooperative Agreement requests

the planning, development, and

implementation of interdisciplinary

educational and training programs for

the education of physicians and nurses

directed toward improving patient

safety. This will involve the

development of formal curricula in

interdisciplinary leadership and

training in interdisciplinary teamwork

focused on building safer systems of

patient care. Curricula must include

both didactic and experiential learning

(in both simulations and practice

settings) with each team being

supported by a mentor. In particular,

safety issues must target those areas of

care which require physician-nurse

communication, especially recognition

and elimination of situations which

create discontinuities in communication

and apparent responsibilities that may

increase the likelihood of errors.

Curricula must contain elements that

emphasize cultural competency, to

broaden physicians’ and nurses’

understanding of how differences in

race, ethnicity, language, gender, and

sexual orientation may affect

communication between physicians,

nurses, and patients, interpretations of

patients’ histories and responses to

recommendations and, thereby, affect

patient safety.

Educational efforts will be directed at

teams of faculty sponsored by health

care organizations (universities,

teaching hospitals, ambulatory centers

or consortia involved in training). Each

team to be trained must include at least

34226 Federal Register / Vol. 66, No. 124 / Wednesday, June 27, 2001 / Notices

several allopathic or osteopathic

physicians and nurses, but must include

at least one allopathic or osteopathic

physician and one nurse. Inclusion of

trained medical educators must be

encouraged.

Programs may be directed toward

developing faculty leaders for

undergraduate, graduate, and/or

continuing professional education for

those who provide clinical care. Faculty

leadership development programs must

address: (1) The development of

curricular design for collaborative

education of physicians and nurses, and

improvement in leadership and

interdisciplinary teaching skills; (2) the

development of interdisciplinary

collaborative curricula designed to

promote patient safety. The emphasis

must be on improving communications

and teamwork, and identifying and

reducing discontinuities in patient care

routines and systems, which will

eliminate common sources of errors. At

the completion of the specified

educational and training program, the

trainees must be certified by the

awardee through a mechanism

determined during the initial planning

phase as competent faculty to develop

and lead collaborative programs in

interdisciplinary education to enhance

patient safety in their own

organizations. The awardee will be

expected to perform a comprehensive

outcome evaluation of all efforts

delivered through this Cooperative

Agreement. Evaluations of the

individual projects supported by this

Cooperative Agreement must be

reported along with the evaluation of

the overall faculty leadership

development program as proposed and

implemented through the overall plan.

Applicants must show experience in

professional faculty development,

physician-nurse collaborative

interdisciplinary education, and/or

addressing practical patient safety

issues, or be able to demonstrate their

expertise in these areas.

Eligible Applicants

Eligible applicants are accredited

schools of nursing, schools of medicine

and osteopathic medicine, academic

health centers, public and nonprofit

private hospitals, and other public or

private nonprofit entities which provide

educational programs for

undergraduate, graduate, or graduate

medical and nursing education.

Applicants should have a

demonstrable track record in (1) The

design and implementation of training

or educational programs for physicians

and nurses; (2) inter-disciplinary

education and/or training for physicians

and nurses; and (3) experience and/or

expertise in education to improve

patient safety.

Funding Preference

A funding preference is defined as the

funding of a specific category or group

of approved applications ahead of other

categories or groups of applications. The

following preferences are available

under this Cooperative Agreement:

As provided in section 791(a) of the

PHS Act, preference will be given to any

qualified applicant that: (a) Has a high

rate for placing graduates in practice

settings having the principal focus of

serving residents of medically

underserved communities, or (b) during

the 2-year period preceding the fiscal

year for which such an award is sought,

has achieved a significant increase in

the rate of placing graduates in such

settings; or (c) qualifies for the funding

preference by meeting the criteria for a

new program.

Definition of High Rate: At least 20

percent of graduates from academic

years 1998, 1999, and 2000 devote at

least 50 percent of their time working in

clinical practice in medically

underserved community (MCH) settings.

Definition of Significant Increase:

During the past two years (1999 and

2000), the rate of placing graduates in

MUC settings has increased at least 50

percent (with a minimum of 2

graduates) and at least 15 percent from

the last year are working in MUC

settings.

Established clinical sites identified

under the ‘‘medically underserved

community’’ definition are used as

proxies for rural and underserved

populations.

The term ‘‘medically underserved

community (MUC)’’ means an urban or

rural area or population that:

(a) Is eligible for designation under

section 332 as a Health Professional

Shortage Area (HPSA);

(b) Is eligible to be served by a

Migrant Health Center under section

330 of the PHS Act, a Community

Health Center under section 330 of the

Act, a grantee under section 330 of the

Act (relating to homeless individuals),

or a grantee under section 330 of the Act

(relating to residents of public housing);

(c) Is eligible for certification under

section 1861(aa)(2) of the Social

Security Act (relating to rural health

clinics); or

(d) Is designated by a State Governor

(in consultation with the medical

community) as a shortage area or MUC.

(Section 799B(6) of the PHS Act.)

In reference to section 332 (HPSA)

listed above, the following instructions

apply:

(a) To determine if any applicant fits

the standards for eligibility when they

are not so designated, the applicant

must demonstrate that an application

has been submitted for such designation

and include proof of acceptance of that

application from the designating

authority.

(b) The MUC preference will not be

applied without proof of approval of

that application.

For new programs (those having

graduated three or fewer classes),

applicant proposals will be evaluated by

the criteria in the Act used to define a

‘‘new program’’ and a preference will be

given to those new programs that meet

at least four of the following seven

criteria:

(1) The mission statement of the

program identifies a specific purpose of

the program as being the preparation of

health professionals to serve

underserved populations.

(2) The curriculum of the program

includes content which will help to

prepare practitioners to serve

underserved populations.

(3) Substantial clinical training

experience is required under the

program in MUCs.

(4) A minimum of 20 percent of the

clinical faculty of the program spend at

least 50 percent of their time providing

or supervising care in MUCs.

(5) The entire program, or a

substantial portion of the program, is

physically located in a MUC.

(6) Student assistance, which is

linked to service in MUC’s following

graduation, is available to the students

in the program.

(7) The program provides a placement

mechanism for deploying graduates to

MUCs.

As provided in section 805 of the PHS

Act, a funding preference will be

applied to approved applications that

will substantially benefit rural OR

underserved populations, OR help meet

public health nursing needs in State or

local health departments.

These statutory general preferences

will only be applied to applications that

rank above the 20th percentile of

applications recommended for approval

by the peer review group.

Special Consideration

A special consideration is the

enhancement of priority scores by

individual merit reviewers of approved

applications which address special

areas of concern.

Section 747(c)(3) provides for a

special consideration to be given to

projects that prepare practitioners to

care for underserved populations and

other high risk groups such as the

Federal Register / Vol. 66, No. 124 / Wednesday, June 27, 2001 / Notices 34227

elderly, individuals with HIV/AIDS,

substance abusers, homeless, and

victims of domestic violence.

Section 811(f)(3) provides for a

special consideration to eligible entities

that agree to expend the award to train

advanced education nurses who will

practice in HPSAs designated under

section 332.

Review Criteria

The specific review criteria used to

review and rank applications are

included in the application guidance

that will be provided to each potential

applicant. Applicants should pay strict

attention to addressing these criteria, as

they are the basis upon which

applications will be judged by the

reviewers.

The following generic review criteria

are also applicable to this Cooperative

Agreement:

(a) That the estimated cost to the

Government of the project is reasonable

considering the level and complexity of

activity and the anticipated results.

(b) That project personnel are well

qualified by training and/or experience

for the support sought, and the

applicant organization or the

organization to provide training has

adequate facilities and manpower.

(c) That insofar as practical, the

proposed activities, if well executed, are

capable of attaining project objectives.

(d) That the project objectives are

capable of achieving the specific

program objectives defined in the

program announcement and the

proposed results are measurable.

(e) That the method for evaluating

proposed results includes criteria for

determining the extent to which the

program has achieved its stated

objectives and the extent to which the

accomplishment of objectives can be

attributed to the program.

(f) That, insofar as practical, the

proposed activities, when

accomplished, are replicable, national

in scope, and include plans for broad

dissemination.

Letters of Intent and Deadline Date

Applicants are encouraged to submit

a letter of intent to apply for this request

for applications for a Cooperative

Agreement. The letter is requested to

assist staff in planning for the review

based on anticipated number of

applications. The letter of intent is due

by July 11, 2001. Simultaneously mail

or e-mail one copy of the letter to each

of the following representatives from the

Division of Medicine and Dentistry and

the Division of Nursing within the

Bureau:

Dr. Richard D. Diamond, Medical

Officer, Policy and Special Projects

Branch, Division of Medicine and

Dentistry, Bureau of Health

Professions, HRSA, Room 9A–27,

ParklawnBuilding, 5600 Fishers Lane,

Rockville, MD 20867; or e-mail

address at rdiamond@hrsa.gov. Dr.

Diamond’s telephone number is (301)

443–1082.

Dr. Madeleine Hess, Deputy Chief,

Nursing Special Initiatives and

Program Systems Branch,Division of

Nursing, Bureau of Health

Professions, HRSA, Room 9–35,

ParklawnBuilding, 5600 Fishers Lane,

Rockville, MD 20867; or e-mail

address at mhess@hrsa.gov. Dr. Hess’

telephone number is (301) 443–6336.

Application Requests, Dates and

Address

Federal Register notices and the

application form and guidance for this

Cooperative Agreement are available on

the HRSA web site address at http://

bhpr.hrsa.gov/grants2001/. Applicants

may also request a hard copy of these

materials from the HRSA Grants

ApplicationCenter (GAC) at 1815 North

Fort Myer Drive, Suite 300, Arlington,

VA 22209; telephone number 1–877–

477–2123. The GAC e-mail address is:

hrsagac@hrsa.gov.

In order to be considered for

competition, applications for this

Cooperative Agreement must be

received by mail or delivered to the

GAC no later than July 27, 2001.

Completed applications must be

submitted to the GAC at the above

address. Applications received after the

deadline date or sent to any address

other than the Arlington, Virginia

address above will be returned to the

applicant and not reviewed.

National Health Objectives for the Year

2010

The PHS urges applicants to submit

their work plans that address specific

objectives of Healthy People 2010,

which potential applicants may obtain

through the Superintendent of

Documents, Government Printing

Office, Washington, DC 20402–9325

(telephone: (202) 783–3238). Particular

attention should focus on Healthy

People 2010 Workforce Objectives, such

as Objectives 1–8 (achieving minority

representation in the health professions)

and 23–8 (incorporating specific

competencies into the public health

workforce).

Smoke-Free Workplace

The PHS strongly encourages all grant

recipients to provide a smoke-free

workplace; to promote the non-use of all

tobacco products; and to promote Pub.

L. 103–227, the Pro-Children Act of

1994, which 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.

Additional Information

Questions concerning programmatic

aspects of the Cooperative Agreement

may be directed to the same

representatives of the Division of

Medicine and Dentistry and the

Division of Nursing listed above in the

Letters of Intent section of this notice.

Paperwork Reduction Act

The standard application form HRSA–

6025–1, the HRSA Competing Training

Grant Application, has been approved

by the Office of Management and

Budget (OMB) under the Paperwork

Reduction Act. The OMB clearance

number is 0915–0060. If the methods for

developing the proposed comprehensive

outcome evaluation of all efforts

delivered through thisCooperative

Agreement (as described in the

Background section of this notice) falls

under the purview of the Paperwork

Reduction Act, awardees will assist

HRSA in seeking OMB clearance for

proposed data collection activities.

This program is not subject to the

provisions of Executive Order 12372,

Intergovernmental Review of Federal

Programs (as implemented through 45

CFR part 100). This program is also not

subject to the Public Health Systems

Reporting Requirements.

Dated: June 19, 2001.

Elizabeth M. Duke,

Acting Administrator.

[FR Doc. 01–16023 Filed 6–26–01; 8:45 am]

BILLING CODE 4160–15–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Resources and Services

Administration

Notice of Cooperative Agreements to

Develop, Implement and Evaluate Safe

Practices at the Patient Care Delivery

Level Through Collaborative,

Interdisciplinary Education To Prepare

Physicians and Advanced Practice

Nurses

The Health Resources and Services

Administration (HRSA) announces that

applications will be accepted for

Cooperative Agreements for fiscal year

(FY) 2001 to Develop, Implement and

Evaluate Safe Practices at the Patient