Announcement of Requirements and Registration for: “Innovations in Measuring and Managing Addiction Treatment Quality” Challenge, 1922-1926 [2015-00394]
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Federal Register / Vol. 80, No. 9 / Wednesday, January 14, 2015 / Notices
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OMB approval is requested for 3
years. There are no costs to respondents
other than their time. The total
estimated annualized burden hours are
83.
ESTIMATED ANNUALIZED BURDEN HOURS
Type of
respondents
Form name
Principal Investigators .......................
6 Month Report ................................
12 Month Report ..............................
Dated: January 7, 2015.
Karla Bailey,
NCI Project Clearance Liaison, National
Institutes of Health.
[FR Doc. 2015–00393 Filed 1–13–15; 8:45 am]
BILLING CODE 4140–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
Announcement of Requirements and
Registration for: ‘‘Innovations in
Measuring and Managing Addiction
Treatment Quality’’ Challenge
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Authority: 15 U.S.C. 3719.
Award Approving Official: Dr. Nora
Volkow, Director, National Institute on
Drug Abuse (NIDA)
SUMMARY: Through the ‘‘Innovations in
Measuring and Managing Addiction
Treatment Quality’’ Challenge (the
‘‘Challenge’’), the National Institute on
Drug Abuse (NIDA), a component of the
National Institutes of Health (NIH),
challenges the general public to make
concrete advances toward improving the
quality of addiction treatment.
Specifically, through this Challenge,
NIDA hopes to incentivize the
development of innovative concepts for
quality measurement and quality
management systems based on the latest
science of addiction and its treatment
and of quality measurement and
management. These new concepts
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Number of
respondents
15
15
would be game-changing because they
would go beyond current performance
measurement concepts in that they
would not be limited by the data
commonly available in current provider
and payer data systems. Instead, they
would (a) more directly reflect the
clinical effects that can and should be
expected from high-quality addiction
treatment; (b) capture what clinicians
and provider organizations need to
measure to help them provide highquality addiction treatment; and (c)
provide a solid basis for measuring
clinician and provider performance that
may be used by patients and other
purchasers to select and incent highquality treatment. NIDA believes that
the development of such quality
measures and management systems has
the potential to meaningfully improve
the quality of addiction treatment both
by giving clinicians and providers the
information they need to assess and
improve the quality of the care they
provide and by providing tools patients
and purchasers can use to shop for the
highest quality providers, allowing
market forces to provide another
incentive for improvement.
DATES:
(1) Submission Period begins January
14, 2015, 9:00 a.m., ET
(2) Submission Period ends June 1,
2015, 5:00 p.m., ET
(3) Judging Period June 2, 2015 and July
15, 2015, 2015
(4) Winners Announced September 30,
2015
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Average
time per
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(in hours)
1
1
Total annual
burden hours
90/60
4
23
60
FOR FURTHER INFORMATION CONTACT:
Sarah Q. Duffy, Ph.D., Associate
Director for Economics Research,
Division of Epidemiology, Services and
Prevention Research, National Institute
on Drug Abuse, Phone: 301–443–6504
Email duffys@nida.nih.gov.
SUPPLEMENTARY INFORMATION:
Subject of the Challenge
Scientific knowledge about addiction
and its treatment has increased
markedly over the past several years.
We have a better understanding of the
effects of drugs on the brain. We also
have new, more effective treatments. At
the same time, new health care payment
and delivery models are emerging that
may provide opportunities to further
enhance the quality of addiction
treatment.
It has long been recognized that
health care may be improved through
the development and use of quality
measures and management systems
through which they can be collected,
reported, monitored, and improved
[Ref.1]. Quality measures are meant to
reflect aspects of the care provided, or
outcomes achieved that assess the
health care quality. Health care quality
has been defined as ‘‘the degree to
which health care services for
individuals and populations increase
the likelihood of desired outcomes and
are consistent with current professional
knowledge’’ [Ref 2.]. In 2006 the
Institute of Medicine recommended
developing and implementing a quality
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Federal Register / Vol. 80, No. 9 / Wednesday, January 14, 2015 / Notices
measurement and reporting
infrastructure as part of an overall
strategy for enhancing the care provided
in the field of addiction treatment [Ref.
3]. It is also the case that the availability
of strong quality measures, as described
below, and management systems
through which they can be reported,
monitored, and acted upon, is a vital
component of payment and delivery
reforms in the public and private sectors
[Ref. 4].
Controlling the growth of health care
costs without adversely affecting care
requires strong quality measures. Strong
quality measures are those that can be
directly improved by clinicians,
treatment programs, and/or health care
systems. Such quality measures either
directly or indirectly (as proxy
measures) measure aspects of patient
functioning, health, or well-being,
improvements in which are strongly and
causally related to desired
improvements in patient functioning,
health or well-being. Strong quality
measures may also be used by patients
and payers to select high-quality
providers thereby promoting change in
the marketplace [Ref. 5].
Traditionally, three types of measures
have been used to track aspects of
treatment quality: Structural measures,
process measures, and outcome
measures [Ref. 6]. In the United States,
quality measurement in addiction
treatment largely has focused on process
measures which measure the actual care
provided, for example whether or not a
patient received a certain medication,
and outcome measures which measure
how patients responded to treatment.
The most commonly used process
measures in addiction treatment are the
Washington Circle treatment initiation
and engagement measures, both of
which seek to measure the quality of
initial care provided within health plans
or treatment systems [Ref. 7]. Under the
Washington Circle treatment initiation
measure, the standard is met when a
patient receives a treatment visit within
14 days of diagnosis, while the standard
under the engagement measure is met
when a patient has two or more visits
within 30 days of that initial treatment
visit. Some state substance abuse
treatment agencies have used these
measures to provide feedback to
providers to aid their quality
improvement efforts or incentivize
improvements via performance-based
contracting [Ref. 8]. Still, the most
recent National Committee on Quality
Assurance State of Health Care Quality
report shows that less than 15 percent
of insured patients received care that
met the engagement measure standard
in commercial, Medicaid, and Medicare
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health plans in 2012, rates similar to
those achieved in 2004 [Ref. 9].
Moreover, there is limited evidence of a
causal relationship between having met
either standard and improvements in
patients’ functioning, health, or wellbeing.
Another commonly used process
measure of addiction treatment
quality—the length of stay in
treatment—has likewise shown limited
evidence of effectiveness [Ref. 10].
The most prominent outcome
measure initiative is the Substance
Abuse and Mental Health Services
Administration’s (SAMHSA) National
Outcome Measures (NOMs). The NOMs
are based on administrative data that
states are required to report to
SAMHSA. They assess the extent of
changes in measures such as drug use,
homelessness, and employment
between time of treatment admission
and time of discharge. While measures
of initial treatment attendance, length of
stay in treatment, and changes in use
and other outcomes between admission
and discharge meet important needs,
they are insufficient to assess key
aspects of providers’ contributions to
the outcomes of care. Importantly, they
do not signal to providers and systems
what they need to do clinically to
improve the quality of addiction
treatment to the highest possible level.
Specifically, they do not answer the
following questions fundamental to
informing providers how to improve the
care they provide to patients, many of
whom have a chronic, relapsing,
disorder and may require multiple
treatment episodes:
• What clinical effects can reasonably
be expected from high-quality, state-ofthe-art addiction treatment? How can
these clinical effects be measured?
Abstinence is thought by many to be the
ultimate outcome and goal of treatment.
But, to date, there is no type of
treatment that has been scientifically
shown to deliver complete and
sustained abstinence, after a single
episode of care, every time, even under
ideal conditions. Absent that, it is
critical to determine and measure what
changes high-quality treatment can and
should deliver in patients with a
condition that can be chronic and
relapsing. What clinical changes
significantly improve the chances a
patient will progress toward reduced
use, sustained abstinence and
improvements in other important goals
often crucial to recovery, such as
improved health, employment
performance, and healthy relationships,
over time?
• How can improvements in this
measure or set of measures be achieved,
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both clinically and within a provider
setting or system of care? While
development and specification of
measures are important, equally
important is a carefully thought-out and
comprehensive conceptual framework
or model. Such a model would address
the following types of questions: What
would it take for the proposed measures
to be useful in improving quality? What
does a clinician need to do so the
patient can improve on this measure?
What resources, including data
collection, storage, and analysis, are
needed to use the measures to assess
quality and improve care? What are the
likely current levels of this measure and
how much might it be improved? What
unintended consequences might result
from attempts to improve this measure?
What might be the effect on the provider
industry when providers begin to
improve this measure?
• How could patients and payers use
these measures to help them select and
incent providers? Informed purchasing
by patients and payers is key to most
efforts in the United States that seek to
improve quality and control costs.
Accurate quality measures are essential
to these efforts. How can the proposed
measures be tailored to the
characteristics of individual patients?
How can they be fairly compared across
providers? How can they be presented
in a way that patients and payers can
readily obtain and use them to make
decisions?
• How might these measures and
systems be evaluated and improved
once they are implemented? Research
can provide important information
about how measures and systems are
likely to work. But it is also important
to understand how measures and
systems are implemented in nonresearch settings and how they perform
there. In addition, quality measurement
and managements systems must often be
dynamic. Measures may need to be
dropped or replaced because they either
have been improved as much as
possible or did not work as intended.
Measures may also need to be updated
to incorporate new knowledge about
addiction and its treatment, or because
of changes in how care is delivered and
paid for. How might these types of
evaluation and improvements occur
within the proposed measurement and
management system?
NIDA is seeking innovative, forwardlooking concepts synthesizing the latest
scientific findings from a broad array of
relevant disciplines to address these
questions.
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Statutory Authority of the Funding
Source
This Challenge is consistent with and
advances the mission of NIDA as
described in 42 U.S.C. 285o. The general
purpose of NIDA is to conduct and
support biomedical and behavioral
research and health services research,
research training, and health
information dissemination with respect
to the prevention of drug abuse and the
treatment of drug abusers. Consistent
with this authority, one of NIDA’s
strategic goals is to support research to
improve the quality of addiction
treatment. Novel measures, conceptual
models, and related research agendas
that achieve the goals underlying this
Challenge will rely on the latest science
and help set priorities for future
research and, accordingly, will support
this strategic goal.
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Rules for Participating in the Challenge
1. To be eligible to win a prize under
this Challenge, an individual or entity:
a. Shall have registered to participate
in the Challenge under the rules
promulgated by NIDA and published in
this Notice;
b. Shall have complied with all the
requirements in this Notice;
c. In the case of a private entity, shall
be incorporated in and maintain a
primary place of business in the United
States, and in the case of an individual,
whether participating singly or in a
group, shall be a citizen or permanent
resident of the United States. However,
non-U.S. citizens and non-permanent
residents can participate as a member of
a team that otherwise satisfies the
eligibility criteria. Non-U.S. citizens and
non-permanent residents are not eligible
to win a monetary prize (in whole or in
part). Their participation as part of a
winning team, if applicable, may be
recognized when the results are
announced.
d. In the case of an individual,
whether participating singly or in a
group, must be at least 18 years old at
the time of entry;
e. May not be a Federal entity.
f. May not be a Federal employee
acting within the scope of his/her
employment, and further, in the case of
HHS employees, may not work on their
submission(s) during assigned duty
hours;
g. May not be an employee of the
National Institutes of Health (NIH), a
judge of the Challenge, or any other
party involved with the design,
production, execution, or distribution of
the Challenge or the immediate family
of such a party (i.e., spouse, parent,
step-parent, child, or step-child).
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2. Federal grantees may not use
Federal funds to develop their
Challenge submissions unless use of
such funds is consistent with the
purpose of their grant award and
specifically requested to do so due to
the Challenge design.
3. Federal contractors may not use
Federal funds from a contract to develop
their Challenge submissions or to fund
efforts in support of their Challenge
submission.
4. Submissions must not infringe
upon any copyright or any other rights
of any third party. Each participant
warrants that he or she is the sole author
and owner of the work and that the
work is wholly original.
5. By participating in this Challenge,
each individual (whether competing
singly or in a group) and entity agree to
assume any and all risks and waive
claims against the Federal Government
and its related entities (as defined in the
COMPETES Act), except in the case of
willful misconduct, for any injury,
death, damage, or loss of property,
revenue, or profits, whether direct,
indirect, or consequential, arising from
their participation in the Challenge,
whether the injury, death, damage, or
loss arises through negligence or
otherwise.
6. Based on the subject matter of the
Challenge, the type of work that it will
possibly require, as well as an analysis
of the likelihood of any claims for death,
bodily injury, or property damage, or
loss potentially resulting from Challenge
participation, no individual (whether
competing singly or in a group) or entity
participating in the Challenge is
required to obtain liability insurance or
demonstrate financial responsibility in
order to participate in this Challenge.
7. By participating in this Challenge,
each individual (whether competing
singly or in a group) or entity agrees to
indemnify the Federal Government
against third party claims for damages
arising from or related to Challenge
activities.
8. An individual or entity shall not be
deemed ineligible because the
individual or entity used Federal
facilities or consulted with Federal
employees during the Challenge if the
facilities and employees are made
available to all individuals and entities
participating in the Challenge on an
equitable basis.
9. Each individual (whether
competing singly or in a group) or entity
retains title and full ownership in and
to their submission and each participant
expressly reserves all intellectual
property rights (e.g., copyright) in their
submission. However, each participant
grants to NIDA, and others acting on
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behalf of NIDA, a royalty-free nonexclusive worldwide license to use,
copy for use, and display publicly all
parts of the submission for the purposes
of the Challenge. This license may
include posting or linking to the
submission on the official NIDA Web
site and making it available for use by
the public.
10. The NIH reserves the right, in its
sole discretion, to (a) cancel, suspend,
or modify the Challenge, and/or (b) not
award any prizes if no entries are
deemed worthy.
11. Each individual (whether
competing singly or in a group) or entity
agrees to follow applicable local, State,
and Federal laws and regulations.
12. Each individual (whether
participating singly or in a group) and
entity participating in this Challenge
must comply with all terms and
conditions of these rules, and
participation in this Challenge
constitutes each such participant’s full
and unconditional agreement to abide
by these rules. Winning is contingent
upon fulfilling all requirements herein.
Submission Requirements
Each submission for this Challenge
should consist of a white paper
describing a concept for an innovative
quality measurement and management
system to measure, manage, and
improve the quality of clinical care in
addiction treatment. The white paper
must describe a novel concept based on
the latest findings from relevant areas of
science. It must include the following
two sections:
1. A description of candidate clinical
effects of addiction treatment and how
these effects could be measured
(directly or by proxy); a discussion of
the likely level of these measures in the
current treatment system, how much
improvement might be achievable, how
the measure(s) could conceivably be
implemented, now or in the future, to
improve the quality of care; how the
resulting information could conceivably
be used to help patients and payers
select providers; and how the proposed
measures and systems might be
evaluated and improved once
implemented.
2. A research agenda addressing the
current state of relevant scientific
knowledge; the gaps that need to be
addressed to support the development,
testing, and use of these novel concepts,
measures, and systems; and a plan and
an estimated timeframe for filling those
gaps.
The white paper must not contain any
information directly identifying the
participants.
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Federal Register / Vol. 80, No. 9 / Wednesday, January 14, 2015 / Notices
Registration and Submission Process
To register for this Challenge,
participants must go to
www.challenge.gov and search for
‘‘Innovations in Measuring and
Managing Addiction Treatment Quality
Challenge’’. Click on the title to go to
the Challenge platform Web site, which
contains instructions on how to register
and submit.
All submissions must be in English.
Each submission must consist of a PDF
file, containing the white paper
document. The PDF documents must be
formatted to be no larger than 8.5’’ by
11.0’’, with at least 1 inch margins. The
white paper must be no more than 20
pages long. Font size must be no smaller
than 11 point Arial. The participant
must not use HHS’s logo or official seal
or the logo of NIH or NIDA in the
submission, and must not claim federal
government endorsement.
Amount of the Prize
Up to four monetary prizes may be
awarded: $35,000 for 1st Place, $30,000
for 2nd Place, $25,000 for 3rd Place, and
$10,000 for Honorable Mention for a
total prize award pool of up to $100,000.
The names of the winners and the titles
of their submissions will be posted on
the NIDA Web site. In addition, NIDA
may work with winners and a peerreviewed journal to publish articles
based on the white papers in a special
issue on the future of quality
measurement and management systems
in the field of addiction treatment. The
award approving official for this
Challenge is the Director of the National
Institute on Drug Abuse.
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Payment of the Prize
Prizes awarded under this Challenge
will be paid by electronic funds transfer
and may be subject to Federal income
taxes. The NIH will comply with the
Internal Revenue Service withholding
and reporting requirements, where
applicable.
Basis Upon Which Winner Will Be
Selected
The judging panel will make
recommendations to the Award
Approving Official based upon the
following five criteria and point
allocation:
1. Novelty of the concept (5 points):
Concepts are to move beyond the
existing quality measurement and
management paradigms and
administrative data elements commonly
used in the addiction treatment field.
They are to focus on clinical effects that
can be obtained as a direct result of
treatment in the context of what is often
a chronic, relapsing condition. How
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novel is the concept? Does it address
important clinical effects that are not
currently or adequately considered in
existing quality measurement and
improvement efforts in the addiction
treatment field?
2. Clinical effectiveness of the concept
(5 points): Are changes in the identified
effects something that high-quality
treatment could conceivably affect in a
meaningful way? How effective would
improvements in these clinical effects
likely be in addressing addiction and
improving other outcomes important to
patients and other purchasers of care?
3. Scientific basis for the concept (5
points): Concepts must rely on the latest
scientific understanding of addiction
and its treatment from a broad range of
fields, as well as the latest science of
quality measurement and management.
How meaningfully, comprehensively,
and effectively does the concept
incorporate these latest advances in
areas of science relevant to addiction, its
treatment, and quality improvement?
4. Quality of the conceptual model (5
points): How well is the conceptual
framework or model developed? How
well does it consider factors relevant to
the ultimate success of the concept?
How well does it address the clinical
means for improving the candidate
measures and potential unintended
consequences of implementing the
measures and using them to inform,
gauge, and reward improvement? How
well does it address the likely impact of
improvements in these measures on the
provider industry?
5. Potential for the concept to be
implemented and evaluated (5 points):
Concepts, and the measures and systems
derived from them, must have the
potential to be implemented and used in
at least some types of treatment
programs or other settings once all
relevant research gaps have been
addressed. Is it within the realm of
possibility that these concepts,
measures, or quality improvement
systems could be implemented in at
least some organizations once all of the
research gaps have been addressed?
How useful would the measures be to
patients and payers making purchasing
decisions? How reasonable is the plan
for how the measures and systems could
be evaluated and improved once
implemented?
6. Quality of the research agenda (5
points): How well does the research
agenda describe the gaps in the relevant
areas of science that need to be
addressed for this novel quality
measurement and management concept
to be achieved and implemented? Does
the agenda describe a logical, feasible
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plan and timeframe for addressing those
gaps?
Scores from each criterion will be
weighted equally. The score for each
submission will be the sum of the scores
from each of the 5 voting judges, for a
maximum of 150 points. NIH reserves
the right to make an award to
submissions scoring less than 150
points if NIH deems any sufficiently
meritorious. All submissions will be
held until after the deadline is reached
for a simultaneous judging process. NIH
reserves the right to disqualify and
remove any submission that is deemed,
in the judging panel’s discretion,
inappropriate, offensive, defamatory, or
demeaning.
The evaluation process will begin by
anonymizing and removing those that
are not responsive to this Challenge or
not in compliance with all rules of
eligibility. Submissions that are
responsive and in compliance may then
undergo a review by NIH program staff
with expertise in the relevant areas of
science. These program staff would be
asked to comment specifically on the
soundness of the scientific basis for the
project, the likelihood that any scientific
advances needed for the concept to meet
fruition are within the realm of
possibility, and the quality of the
research agenda, all as they relate to the
program official’s area of expertise.
Judges will examine all responsive and
compliant submissions, as well
comments from program staff, if any,
and score the entries in accordance with
the judging criteria outlined above.
Judges will meet to discuss the most
meritorious submissions. Final
recommendations will be determined by
a vote of the judges.
Challenge Judges
Director, National Institute on Drug
Abuse—Ex Officio
Deputy Director, Center for Clinical
Trials Network, National Institute on
Drug Abuse
Acting Director, Division of
Epidemiology, Services, and
Prevention Research, National
Institute on Drug Abuse
Chief, Science Policy Branch, Office of
Science Policy and Communication,
National Institute on Drug Abuse
Program Officer, Behavioral and
Integrative Treatment Branch (BITB),
Division of Clinical Neuroscience and
Behavioral Research, National
Institute of Drug Abuse
Program Director for Health Services
Research, Division of Treatment and
Recovery Research, National Institute
on Alcohol Abuse and Alcoholism
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Additional Information (References)
1. Eddy, 1998. ‘‘Performance Measurement:
Problems and Solutions.’’ Health Affairs
17(4): 7–25.
2. Institute of Medicine, 1999. Measuring the
Quality of Health Care: A Statement by
the National Roundtable on Health Care
Quality. Washington, DC: National
Academy Press.
3. Institute of Medicine (US) Committee on
Crossing the Quality Chasm Adaptation
to Mental Health and Addictive
Disorders, 2006. Improving Quality of
Health Care for Mental and SubstanceUse Conditions. Washington, DC:
National Academies Press.
4. Fisher et al., 2011. ‘‘Building a Path to
Accountable Care’’, New England Journal
of Medicine 365:2445–2447.
5. McClellan, 2011. ‘‘Reforming Payments to
Healthcare Providers: The Key to
Slowing Healthcare Cost Growth while
Improving Quality?’’ The Journal of
Economic Perspectives 25(2): 69–92.
6. Donabedian A, 1980. Explorations in
Quality Assessment and Monitoring: The
Definition of Quality and Approaches to
its Assessment. Ann Arbor, MI. Health
Administration Press.
7. Garnick DW, et al., 2002. ‘‘Establishing the
Feasibility of Performance Measures for
Alcohol and Other Drugs.’’ Journal of
Substance Abuse Treatment 23(4):375–
385.
8. Garnick, DW, et al., 2011. ‘‘Lessons from
Five States: Public Sector Use of the
Washington Circle Performance
Measures.’’ Journal of Substance Abuse
Treatment. 40(3):241–254.
9. National Committee on Quality Assurance,
2013. Improving Quality and Patient
Experience: The State of Health Care
Quality 2013. Washington, DC.
10. Harris, AHS, et al., 2012 Longer LOS is
Not Associated with Better Outcomes in
VHA’s Substance Abuse Residential
Rehabilitation Treatment Programs.
Journal of Behavioral Health Services
Research 39(1): 68–79.
Dated: January 5, 2015.
Nora D. Volkow,
Director, National Institute on Drug Abuse,
National Institutes of Health.
[FR Doc. 2015–00394 Filed 1–13–15; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
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amended (5 U.S.C. App.), notice is
hereby given of the following meetings.
The meetings will be closed to the
public in accordance with the
provisions set forth in sections
552b(c)(4) and 552b(c)(6), Title 5 U.S.C.,
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13:56 Jan 13, 2015
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as amended. The grant applications and
the discussions could disclose
confidential trade secrets or commercial
property such as patentable material,
and personal information concerning
individuals associated with the grant
applications, the disclosure of which
would constitute a clearly unwarranted
invasion of personal privacy.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; AREA:
Oncological Sciences Grant Applications.
Date: January 29, 2015.
Time: 11:00 a.m. to 5:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892.
Contact Person: Sally A Mulhern, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 6214,
MSC 7804, Bethesda, MD 20892, (301) 435–
5877, mulherns@csr.nih.gov.
Name of Committee: Surgical Sciences,
Biomedical Imaging and Bioengineering
Integrated Review Group; Medical Imaging
Study Section.
Date: February 5–6, 2015.
Time: 8:00 a.m. to 5:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Sir Francis Drake Hotel, 450 Powell
Street at Sutter, San Francisco, CA 94102.
Contact Person: Xiang-Ning Li, MD, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 5112,
MSC 7854, Bethesda, MD 20892, 301–435–
1744, lixiang@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel; Membrane
Biophysics.
Date: February 5–6, 2015.
Time: 2:00 p.m. to 3:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Hyatt Regency Bethesda, One
Bethesda Metro Center, 7400 Wisconsin
Avenue, Bethesda, MD 20814.
Contact Person: Mike Radtke, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 4176,
MSC 7806, Bethesda, MD 20892, 301–435–
1728, radtkem@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel;
Hypertension and Microcirculation.
Date: February 6, 2015.
Time: 10:00 a.m. to 12:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892,
(Telephone Conference Call).
Contact Person: Katherine M Malinda,
Ph.D., Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 4140,
MSC 7814, Bethesda, MD 20892, 301–435–
0912, Katherine_Malinda@csr.nih.gov.
Name of Committee: Molecular, Cellular
and Developmental Neuroscience Integrated
PO 00000
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Review Group; Molecular
Neuropharmacology and Signaling Study
Section.
Date: February 9–10, 2015.
Time: 8:00 a.m. to 12:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Lorien Hotel & Spa, 1600 King
Street, Alexandria, VA 22314.
Contact Person: Deborah L Lewis, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 4183,
MSC 7850, Bethesda, MD 20892, 301–408–
9129, lewisdeb@csr.nih.gov.
Name of Committee: Center for Scientific
Review Special Emphasis Panel;
Macromolecular Structure and Function B.
Date: February 9–10, 2015.
Time: 1:00 p.m. to 2:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: National Institutes of Health, 6701
Rockledge Drive, Bethesda, MD 20892.
Contact Person: David R Jollie, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 4166,
MSC 7806, Bethesda, MD 20892, (301) 437–
7927, jollieda@csr.nih.gov.
Name of Committee: Brain Disorders and
Clinical Neuroscience Integrated Review
Group; Pathophysiological Basis of Mental
Disorders and Addictions Study Section.
Date: February 11–12, 2015.
Time: 8:00 a.m. to 5:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Embassy Suites—Baltimore, 222 St.
Paul Place, Baltimore, MD 201202.
Contact Person: Boris P Sokolov, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 5217A,
MSC 7846, Bethesda, MD 20892, 301–408–
9115, bsokolov@csr.nih.gov.
Name of Committee: Healthcare Delivery
and Methodologies Integrated Review Group;
Dissemination and Implementation Research
in Health Study Section.
Date: February 11, 2015.
Time: 8:00 a.m. to 5:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Hyatt Regency Bethesda, One
Bethesda Metro Center, 7400 Wisconsin
Avenue, Bethesda, MD 20814.
Contact Person: Martha L Hare, Ph.D.,
Scientific Review Officer, Center for
Scientific Review, National Institutes of
Health, 6701 Rockledge Drive, Room 3154,
Bethesda, MD 20892, (301) 451–8504,
harem@mail.nih.gov.
Name of Committee: Digestive, Kidney and
Urological Systems Integrated Review Group;
Xenobiotic and Nutrient Disposition and
Action Study Section.
Date: February 11, 2015.
Time: 8:00 a.m. to 6:00 p.m.
Agenda: To review and evaluate grant
applications.
Place: Doubletree Hotel Bethesda
(Formerly Holiday Inn Select), 8120
Wisconsin Avenue, Bethesda, MD 20814.
Contact Person: Martha Garcia, Ph.D.,
Scientific Reviewer Officer, Center for
E:\FR\FM\14JAN1.SGM
14JAN1
Agencies
[Federal Register Volume 80, Number 9 (Wednesday, January 14, 2015)]
[Notices]
[Pages 1922-1926]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2015-00394]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Announcement of Requirements and Registration for: ``Innovations
in Measuring and Managing Addiction Treatment Quality'' Challenge
Authority: 15 U.S.C. 3719.
Award Approving Official: Dr. Nora Volkow, Director, National
Institute on Drug Abuse (NIDA)
SUMMARY: Through the ``Innovations in Measuring and Managing Addiction
Treatment Quality'' Challenge (the ``Challenge''), the National
Institute on Drug Abuse (NIDA), a component of the National Institutes
of Health (NIH), challenges the general public to make concrete
advances toward improving the quality of addiction treatment.
Specifically, through this Challenge, NIDA hopes to incentivize the
development of innovative concepts for quality measurement and quality
management systems based on the latest science of addiction and its
treatment and of quality measurement and management. These new concepts
would be game-changing because they would go beyond current performance
measurement concepts in that they would not be limited by the data
commonly available in current provider and payer data systems. Instead,
they would (a) more directly reflect the clinical effects that can and
should be expected from high-quality addiction treatment; (b) capture
what clinicians and provider organizations need to measure to help them
provide high-quality addiction treatment; and (c) provide a solid basis
for measuring clinician and provider performance that may be used by
patients and other purchasers to select and incent high-quality
treatment. NIDA believes that the development of such quality measures
and management systems has the potential to meaningfully improve the
quality of addiction treatment both by giving clinicians and providers
the information they need to assess and improve the quality of the care
they provide and by providing tools patients and purchasers can use to
shop for the highest quality providers, allowing market forces to
provide another incentive for improvement.
DATES:
(1) Submission Period begins January 14, 2015, 9:00 a.m., ET
(2) Submission Period ends June 1, 2015, 5:00 p.m., ET
(3) Judging Period June 2, 2015 and July 15, 2015, 2015
(4) Winners Announced September 30, 2015
FOR FURTHER INFORMATION CONTACT: Sarah Q. Duffy, Ph.D., Associate
Director for Economics Research, Division of Epidemiology, Services and
Prevention Research, National Institute on Drug Abuse, Phone: 301-443-
6504 Email duffys@nida.nih.gov.
SUPPLEMENTARY INFORMATION:
Subject of the Challenge
Scientific knowledge about addiction and its treatment has
increased markedly over the past several years. We have a better
understanding of the effects of drugs on the brain. We also have new,
more effective treatments. At the same time, new health care payment
and delivery models are emerging that may provide opportunities to
further enhance the quality of addiction treatment.
It has long been recognized that health care may be improved
through the development and use of quality measures and management
systems through which they can be collected, reported, monitored, and
improved [Ref.1]. Quality measures are meant to reflect aspects of the
care provided, or outcomes achieved that assess the health care
quality. Health care quality has been defined as ``the degree to which
health care services for individuals and populations increase the
likelihood of desired outcomes and are consistent with current
professional knowledge'' [Ref 2.]. In 2006 the Institute of Medicine
recommended developing and implementing a quality
[[Page 1923]]
measurement and reporting infrastructure as part of an overall strategy
for enhancing the care provided in the field of addiction treatment
[Ref. 3]. It is also the case that the availability of strong quality
measures, as described below, and management systems through which they
can be reported, monitored, and acted upon, is a vital component of
payment and delivery reforms in the public and private sectors [Ref.
4].
Controlling the growth of health care costs without adversely
affecting care requires strong quality measures. Strong quality
measures are those that can be directly improved by clinicians,
treatment programs, and/or health care systems. Such quality measures
either directly or indirectly (as proxy measures) measure aspects of
patient functioning, health, or well-being, improvements in which are
strongly and causally related to desired improvements in patient
functioning, health or well-being. Strong quality measures may also be
used by patients and payers to select high-quality providers thereby
promoting change in the marketplace [Ref. 5].
Traditionally, three types of measures have been used to track
aspects of treatment quality: Structural measures, process measures,
and outcome measures [Ref. 6]. In the United States, quality
measurement in addiction treatment largely has focused on process
measures which measure the actual care provided, for example whether or
not a patient received a certain medication, and outcome measures which
measure how patients responded to treatment.
The most commonly used process measures in addiction treatment are
the Washington Circle treatment initiation and engagement measures,
both of which seek to measure the quality of initial care provided
within health plans or treatment systems [Ref. 7]. Under the Washington
Circle treatment initiation measure, the standard is met when a patient
receives a treatment visit within 14 days of diagnosis, while the
standard under the engagement measure is met when a patient has two or
more visits within 30 days of that initial treatment visit. Some state
substance abuse treatment agencies have used these measures to provide
feedback to providers to aid their quality improvement efforts or
incentivize improvements via performance-based contracting [Ref. 8].
Still, the most recent National Committee on Quality Assurance State of
Health Care Quality report shows that less than 15 percent of insured
patients received care that met the engagement measure standard in
commercial, Medicaid, and Medicare health plans in 2012, rates similar
to those achieved in 2004 [Ref. 9]. Moreover, there is limited evidence
of a causal relationship between having met either standard and
improvements in patients' functioning, health, or well-being.
Another commonly used process measure of addiction treatment
quality--the length of stay in treatment--has likewise shown limited
evidence of effectiveness [Ref. 10].
The most prominent outcome measure initiative is the Substance
Abuse and Mental Health Services Administration's (SAMHSA) National
Outcome Measures (NOMs). The NOMs are based on administrative data that
states are required to report to SAMHSA. They assess the extent of
changes in measures such as drug use, homelessness, and employment
between time of treatment admission and time of discharge. While
measures of initial treatment attendance, length of stay in treatment,
and changes in use and other outcomes between admission and discharge
meet important needs, they are insufficient to assess key aspects of
providers' contributions to the outcomes of care. Importantly, they do
not signal to providers and systems what they need to do clinically to
improve the quality of addiction treatment to the highest possible
level. Specifically, they do not answer the following questions
fundamental to informing providers how to improve the care they provide
to patients, many of whom have a chronic, relapsing, disorder and may
require multiple treatment episodes:
What clinical effects can reasonably be expected from
high-quality, state-of-the-art addiction treatment? How can these
clinical effects be measured? Abstinence is thought by many to be the
ultimate outcome and goal of treatment. But, to date, there is no type
of treatment that has been scientifically shown to deliver complete and
sustained abstinence, after a single episode of care, every time, even
under ideal conditions. Absent that, it is critical to determine and
measure what changes high-quality treatment can and should deliver in
patients with a condition that can be chronic and relapsing. What
clinical changes significantly improve the chances a patient will
progress toward reduced use, sustained abstinence and improvements in
other important goals often crucial to recovery, such as improved
health, employment performance, and healthy relationships, over time?
How can improvements in this measure or set of measures be
achieved, both clinically and within a provider setting or system of
care? While development and specification of measures are important,
equally important is a carefully thought-out and comprehensive
conceptual framework or model. Such a model would address the following
types of questions: What would it take for the proposed measures to be
useful in improving quality? What does a clinician need to do so the
patient can improve on this measure? What resources, including data
collection, storage, and analysis, are needed to use the measures to
assess quality and improve care? What are the likely current levels of
this measure and how much might it be improved? What unintended
consequences might result from attempts to improve this measure? What
might be the effect on the provider industry when providers begin to
improve this measure?
How could patients and payers use these measures to help
them select and incent providers? Informed purchasing by patients and
payers is key to most efforts in the United States that seek to improve
quality and control costs. Accurate quality measures are essential to
these efforts. How can the proposed measures be tailored to the
characteristics of individual patients? How can they be fairly compared
across providers? How can they be presented in a way that patients and
payers can readily obtain and use them to make decisions?
How might these measures and systems be evaluated and
improved once they are implemented? Research can provide important
information about how measures and systems are likely to work. But it
is also important to understand how measures and systems are
implemented in non-research settings and how they perform there. In
addition, quality measurement and managements systems must often be
dynamic. Measures may need to be dropped or replaced because they
either have been improved as much as possible or did not work as
intended. Measures may also need to be updated to incorporate new
knowledge about addiction and its treatment, or because of changes in
how care is delivered and paid for. How might these types of evaluation
and improvements occur within the proposed measurement and management
system?
NIDA is seeking innovative, forward-looking concepts synthesizing
the latest scientific findings from a broad array of relevant
disciplines to address these questions.
[[Page 1924]]
Statutory Authority of the Funding Source
This Challenge is consistent with and advances the mission of NIDA
as described in 42 U.S.C. 285o. The general purpose of NIDA is to
conduct and support biomedical and behavioral research and health
services research, research training, and health information
dissemination with respect to the prevention of drug abuse and the
treatment of drug abusers. Consistent with this authority, one of
NIDA's strategic goals is to support research to improve the quality of
addiction treatment. Novel measures, conceptual models, and related
research agendas that achieve the goals underlying this Challenge will
rely on the latest science and help set priorities for future research
and, accordingly, will support this strategic goal.
Rules for Participating in the Challenge
1. To be eligible to win a prize under this Challenge, an
individual or entity:
a. Shall have registered to participate in the Challenge under the
rules promulgated by NIDA and published in this Notice;
b. Shall have complied with all the requirements in this Notice;
c. In the case of a private entity, shall be incorporated in and
maintain a primary place of business in the United States, and in the
case of an individual, whether participating singly or in a group,
shall be a citizen or permanent resident of the United States. However,
non-U.S. citizens and non-permanent residents can participate as a
member of a team that otherwise satisfies the eligibility criteria.
Non-U.S. citizens and non-permanent residents are not eligible to win a
monetary prize (in whole or in part). Their participation as part of a
winning team, if applicable, may be recognized when the results are
announced.
d. In the case of an individual, whether participating singly or in
a group, must be at least 18 years old at the time of entry;
e. May not be a Federal entity.
f. May not be a Federal employee acting within the scope of his/her
employment, and further, in the case of HHS employees, may not work on
their submission(s) during assigned duty hours;
g. May not be an employee of the National Institutes of Health
(NIH), a judge of the Challenge, or any other party involved with the
design, production, execution, or distribution of the Challenge or the
immediate family of such a party (i.e., spouse, parent, step-parent,
child, or step-child).
2. Federal grantees may not use Federal funds to develop their
Challenge submissions unless use of such funds is consistent with the
purpose of their grant award and specifically requested to do so due to
the Challenge design.
3. Federal contractors may not use Federal funds from a contract to
develop their Challenge submissions or to fund efforts in support of
their Challenge submission.
4. Submissions must not infringe upon any copyright or any other
rights of any third party. Each participant warrants that he or she is
the sole author and owner of the work and that the work is wholly
original.
5. By participating in this Challenge, each individual (whether
competing singly or in a group) and entity agree to assume any and all
risks and waive claims against the Federal Government and its related
entities (as defined in the COMPETES Act), except in the case of
willful misconduct, for any injury, death, damage, or loss of property,
revenue, or profits, whether direct, indirect, or consequential,
arising from their participation in the Challenge, whether the injury,
death, damage, or loss arises through negligence or otherwise.
6. Based on the subject matter of the Challenge, the type of work
that it will possibly require, as well as an analysis of the likelihood
of any claims for death, bodily injury, or property damage, or loss
potentially resulting from Challenge participation, no individual
(whether competing singly or in a group) or entity participating in the
Challenge is required to obtain liability insurance or demonstrate
financial responsibility in order to participate in this Challenge.
7. By participating in this Challenge, each individual (whether
competing singly or in a group) or entity agrees to indemnify the
Federal Government against third party claims for damages arising from
or related to Challenge activities.
8. An individual or entity shall not be deemed ineligible because
the individual or entity used Federal facilities or consulted with
Federal employees during the Challenge if the facilities and employees
are made available to all individuals and entities participating in the
Challenge on an equitable basis.
9. Each individual (whether competing singly or in a group) or
entity retains title and full ownership in and to their submission and
each participant expressly reserves all intellectual property rights
(e.g., copyright) in their submission. However, each participant grants
to NIDA, and others acting on behalf of NIDA, a royalty-free non-
exclusive worldwide license to use, copy for use, and display publicly
all parts of the submission for the purposes of the Challenge. This
license may include posting or linking to the submission on the
official NIDA Web site and making it available for use by the public.
10. The NIH reserves the right, in its sole discretion, to (a)
cancel, suspend, or modify the Challenge, and/or (b) not award any
prizes if no entries are deemed worthy.
11. Each individual (whether competing singly or in a group) or
entity agrees to follow applicable local, State, and Federal laws and
regulations.
12. Each individual (whether participating singly or in a group)
and entity participating in this Challenge must comply with all terms
and conditions of these rules, and participation in this Challenge
constitutes each such participant's full and unconditional agreement to
abide by these rules. Winning is contingent upon fulfilling all
requirements herein.
Submission Requirements
Each submission for this Challenge should consist of a white paper
describing a concept for an innovative quality measurement and
management system to measure, manage, and improve the quality of
clinical care in addiction treatment. The white paper must describe a
novel concept based on the latest findings from relevant areas of
science. It must include the following two sections:
1. A description of candidate clinical effects of addiction
treatment and how these effects could be measured (directly or by
proxy); a discussion of the likely level of these measures in the
current treatment system, how much improvement might be achievable, how
the measure(s) could conceivably be implemented, now or in the future,
to improve the quality of care; how the resulting information could
conceivably be used to help patients and payers select providers; and
how the proposed measures and systems might be evaluated and improved
once implemented.
2. A research agenda addressing the current state of relevant
scientific knowledge; the gaps that need to be addressed to support the
development, testing, and use of these novel concepts, measures, and
systems; and a plan and an estimated timeframe for filling those gaps.
The white paper must not contain any information directly
identifying the participants.
[[Page 1925]]
Registration and Submission Process
To register for this Challenge, participants must go to
www.challenge.gov and search for ``Innovations in Measuring and
Managing Addiction Treatment Quality Challenge''. Click on the title to
go to the Challenge platform Web site, which contains instructions on
how to register and submit.
All submissions must be in English. Each submission must consist of
a PDF file, containing the white paper document. The PDF documents must
be formatted to be no larger than 8.5'' by 11.0'', with at least 1 inch
margins. The white paper must be no more than 20 pages long. Font size
must be no smaller than 11 point Arial. The participant must not use
HHS's logo or official seal or the logo of NIH or NIDA in the
submission, and must not claim federal government endorsement.
Amount of the Prize
Up to four monetary prizes may be awarded: $35,000 for 1st Place,
$30,000 for 2nd Place, $25,000 for 3rd Place, and $10,000 for Honorable
Mention for a total prize award pool of up to $100,000. The names of
the winners and the titles of their submissions will be posted on the
NIDA Web site. In addition, NIDA may work with winners and a peer-
reviewed journal to publish articles based on the white papers in a
special issue on the future of quality measurement and management
systems in the field of addiction treatment. The award approving
official for this Challenge is the Director of the National Institute
on Drug Abuse.
Payment of the Prize
Prizes awarded under this Challenge will be paid by electronic
funds transfer and may be subject to Federal income taxes. The NIH will
comply with the Internal Revenue Service withholding and reporting
requirements, where applicable.
Basis Upon Which Winner Will Be Selected
The judging panel will make recommendations to the Award Approving
Official based upon the following five criteria and point allocation:
1. Novelty of the concept (5 points): Concepts are to move beyond
the existing quality measurement and management paradigms and
administrative data elements commonly used in the addiction treatment
field. They are to focus on clinical effects that can be obtained as a
direct result of treatment in the context of what is often a chronic,
relapsing condition. How novel is the concept? Does it address
important clinical effects that are not currently or adequately
considered in existing quality measurement and improvement efforts in
the addiction treatment field?
2. Clinical effectiveness of the concept (5 points): Are changes in
the identified effects something that high-quality treatment could
conceivably affect in a meaningful way? How effective would
improvements in these clinical effects likely be in addressing
addiction and improving other outcomes important to patients and other
purchasers of care?
3. Scientific basis for the concept (5 points): Concepts must rely
on the latest scientific understanding of addiction and its treatment
from a broad range of fields, as well as the latest science of quality
measurement and management. How meaningfully, comprehensively, and
effectively does the concept incorporate these latest advances in areas
of science relevant to addiction, its treatment, and quality
improvement?
4. Quality of the conceptual model (5 points): How well is the
conceptual framework or model developed? How well does it consider
factors relevant to the ultimate success of the concept? How well does
it address the clinical means for improving the candidate measures and
potential unintended consequences of implementing the measures and
using them to inform, gauge, and reward improvement? How well does it
address the likely impact of improvements in these measures on the
provider industry?
5. Potential for the concept to be implemented and evaluated (5
points): Concepts, and the measures and systems derived from them, must
have the potential to be implemented and used in at least some types of
treatment programs or other settings once all relevant research gaps
have been addressed. Is it within the realm of possibility that these
concepts, measures, or quality improvement systems could be implemented
in at least some organizations once all of the research gaps have been
addressed? How useful would the measures be to patients and payers
making purchasing decisions? How reasonable is the plan for how the
measures and systems could be evaluated and improved once implemented?
6. Quality of the research agenda (5 points): How well does the
research agenda describe the gaps in the relevant areas of science that
need to be addressed for this novel quality measurement and management
concept to be achieved and implemented? Does the agenda describe a
logical, feasible plan and timeframe for addressing those gaps?
Scores from each criterion will be weighted equally. The score for
each submission will be the sum of the scores from each of the 5 voting
judges, for a maximum of 150 points. NIH reserves the right to make an
award to submissions scoring less than 150 points if NIH deems any
sufficiently meritorious. All submissions will be held until after the
deadline is reached for a simultaneous judging process. NIH reserves
the right to disqualify and remove any submission that is deemed, in
the judging panel's discretion, inappropriate, offensive, defamatory,
or demeaning.
The evaluation process will begin by anonymizing and removing those
that are not responsive to this Challenge or not in compliance with all
rules of eligibility. Submissions that are responsive and in compliance
may then undergo a review by NIH program staff with expertise in the
relevant areas of science. These program staff would be asked to
comment specifically on the soundness of the scientific basis for the
project, the likelihood that any scientific advances needed for the
concept to meet fruition are within the realm of possibility, and the
quality of the research agenda, all as they relate to the program
official's area of expertise. Judges will examine all responsive and
compliant submissions, as well comments from program staff, if any, and
score the entries in accordance with the judging criteria outlined
above. Judges will meet to discuss the most meritorious submissions.
Final recommendations will be determined by a vote of the judges.
Challenge Judges
Director, National Institute on Drug Abuse--Ex Officio
Deputy Director, Center for Clinical Trials Network, National Institute
on Drug Abuse
Acting Director, Division of Epidemiology, Services, and Prevention
Research, National Institute on Drug Abuse
Chief, Science Policy Branch, Office of Science Policy and
Communication, National Institute on Drug Abuse
Program Officer, Behavioral and Integrative Treatment Branch (BITB),
Division of Clinical Neuroscience and Behavioral Research, National
Institute of Drug Abuse
Program Director for Health Services Research, Division of Treatment
and Recovery Research, National Institute on Alcohol Abuse and
Alcoholism
[[Page 1926]]
Additional Information (References)
1. Eddy, 1998. ``Performance Measurement: Problems and Solutions.''
Health Affairs 17(4): 7-25.
2. Institute of Medicine, 1999. Measuring the Quality of Health
Care: A Statement by the National Roundtable on Health Care Quality.
Washington, DC: National Academy Press.
3. Institute of Medicine (US) Committee on Crossing the Quality
Chasm Adaptation to Mental Health and Addictive Disorders, 2006.
Improving Quality of Health Care for Mental and Substance-Use
Conditions. Washington, DC: National Academies Press.
4. Fisher et al., 2011. ``Building a Path to Accountable Care'', New
England Journal of Medicine 365:2445-2447.
5. McClellan, 2011. ``Reforming Payments to Healthcare Providers:
The Key to Slowing Healthcare Cost Growth while Improving Quality?''
The Journal of Economic Perspectives 25(2): 69-92.
6. Donabedian A, 1980. Explorations in Quality Assessment and
Monitoring: The Definition of Quality and Approaches to its
Assessment. Ann Arbor, MI. Health Administration Press.
7. Garnick DW, et al., 2002. ``Establishing the Feasibility of
Performance Measures for Alcohol and Other Drugs.'' Journal of
Substance Abuse Treatment 23(4):375-385.
8. Garnick, DW, et al., 2011. ``Lessons from Five States: Public
Sector Use of the Washington Circle Performance Measures.'' Journal
of Substance Abuse Treatment. 40(3):241-254.
9. National Committee on Quality Assurance, 2013. Improving Quality
and Patient Experience: The State of Health Care Quality 2013.
Washington, DC.
10. Harris, AHS, et al., 2012 Longer LOS is Not Associated with
Better Outcomes in VHA's Substance Abuse Residential Rehabilitation
Treatment Programs. Journal of Behavioral Health Services Research
39(1): 68-79.
Dated: January 5, 2015.
Nora D. Volkow,
Director, National Institute on Drug Abuse, National Institutes of
Health.
[FR Doc. 2015-00394 Filed 1-13-15; 8:45 am]
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