Research Interests of Institutes and Centers

Applications will be considered of high programmatic interest if at least two of the three or more participating health care systems are Federally Qualified Health Center (FQHC) networks or similar safety net health care systems. Applications that propose embedded pragmatic clinical or implementation trials that focus on improving heart, lung, blood, or sleep (HLBS) disorders in underserved U.S. patient populations who have suffered a disproportionate disease burden and that have the potential to reduce health disparities would be of high priority. Examples include but are not limited to:

General

• Assessments of parameters that drive sustainable delivery of evidence-based treatments that lower risk for HLBS disorders in underserved U.S. patient populations
• Effectiveness of approaches to reduce HLBS disorder risk among populations with health disparities

Cardiovascular

• Effectiveness of approaches to improve the management of all types of heart failure in underserved U.S. patient populations
• Effectiveness of strategies to address biological and nonbiological factors/barriers (e.g., structural, social, and behavioral) that predispose young or middle-aged adults in underserved U.S. patient populations to cardiovascular risk
• Translation or implementation of the lower systolic hypertension goals into practice settings in underserved U.S. patient populations
• Effectiveness of approaches to prevent and manage obesity in primary care settings in underserved U.S. patient populations
• Assessments of referral models that promote appropriate utilization of technology (e.g., implantable cardioverter–defibrillator placement) in underserved U.S. patient populations
• Assessments of the utilization of personalized health records or other methods to capture patient-reported outcomes for cardiovascular disease prevention and management
• Effectiveness of strategies to reduce the risk of stroke in patients with atrial fibrillation, including screening
• Effectiveness of intervention in the treatment of asymptomatic severe aortic stenosis
• Effectiveness of approaches to improve the peripartum and postpartum management and continued monitoring of hypertension, diabetes, and obesity (risk factors that predispose to later cardiovascular morbidity) in underserved U.S. patient populations
• Implementation of strategies to engage older adults in routine physical activity in underserved U.S. patient populations to improve cardiovascular health (as well as the health of other organ systems and overall health)
• Interventions to engage cardiac rehabilitation participation of patients who have indications for cardiac rehabilitation in underserved U.S. patient populations
• Interventions to reduce any health disparity in pharmacologic management of patients with diabetes and heart failure in underserved U.S. patient populations
• Effectiveness of technology to monitor and manage patients with chronic cardiovascular-predisposing conditions (e.g., diabetes and hypertension) in underserved U.S. patient populations
• Translation or implementation of strategies from transition and timing from acute to chronic compensated heart failure
• Effectiveness of strategies to reduce cardiovascular events by SGLPT2 in cardiorenal syndrome
• Effectiveness of exercise rehabilitation training to improve HFpEF outcomes
• Effectiveness of wearables for detecting asymptomatic atrial fibrillation in moderate-risk populations
• Effectiveness of health literacy interventions to mitigate social determinants of health and improve heart failure outcomes in the Medicare population
• Effectiveness of interventions to address electronic health record–identified social determinants of health risk and effect on heart failure outcomes
• Effectiveness of strategies for early airway stabilization in out-of-hospital cardiac arrest (OHCA)
• Effectiveness of endovascular stabilization in OHCA cardiogenic shock
• Effectiveness of strategies for early metabolic support in OHCA
• Effectiveness of a public neighborhood network based on iPhone regional connectivity and local citizen-based cardiopulmonary resuscitation
• Effectiveness of strategies to reduce the risk of amputation in patients with peripheral artery disease (PAD)/critical limb ischemia including referral for arterial testing in underserved U.S. patient populations
• Effectiveness of strategies for smoking cessation in young and middle-aged adults in underserved U.S. patient populations
• Effectiveness of approaches to implement home-based supervised exercise therapy in adults with PAD in underserved U.S. patient populations
• Implementation of guideline-directed medical therapy for PAD into practice settings in underserved U.S. patient populations
• A pragmatic trial in diabetic medication/dietary management seems reasonable since we know that diabetes is both a huge cardiovascular risk factor due to its effects on the vasculature and a big problem in underserved communities

Lung or Sleep

• Use of computer decision support systems to rapidly screen, evaluate, diagnose, and manage sleep disorders in routine care to reduce the risk of cardiovascular disease
• Effectiveness of virtual pulmonary rehabilitation to reduce hospital readmissions in chronic obstructive pulmonary disease patients without private insurance
• Use of tailored patient navigator services for high-utilization asthma patients in Federally Qualified Health Centers
• Pragmatic strategies to increase adherence to pain, agitation/sedation, and delirium guidelines in mechanically ventilated patients
• Effectiveness of preoperative screening and treatment of sleep-disordered breathing on surgical morbidity, mortality, and rehospitalization
• Effectiveness of and adherence to thresholds for oxygen administration in preterm babies

Blood Disorders

• Effectiveness of hydration protocols to manage acute sickle cell disease events in the emergency room
• Effectiveness of health promotion and education for hemophilia patients to promote adopting and sustaining health behaviors that optimize physical functioning
• Effectiveness of blood banking policies and procedures to prevent adverse outcomes related to transfusions
• Effectiveness of patient education to prevent deep vein thrombosis

Implementation

• Assessments of health system characteristics associated with successful implementation of any protocol-based treatment strategy for HLBS disorders
• Tests of sustainable implementation strategies for HLBS disorder guidelines across various health care systems that employ implementation research primary outcome metrics (i.e., measures of acceptability, adoption, appropriateness, costs, fidelity, penetration, and sustainability)

Examples of research topic areas that may be relevant to this FOA for NIA include, but are not limited to:

• Comparison of effectiveness of treatment strategies for comorbid conditions that occur frequently in combination with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD)
• Evaluation of beneficial and adverse outcomes from differing management strategies for multiple chronic conditions, testing an intervention, or coordinating several interventions
• Evaluation of benefits and harms of screening for cognitive impairment in community-dwelling older adults in primary care–relevant settings, and effect on decision making, patient, family or caregiver, and/or societal outcomes
• Evaluation of benefits and harms of interventions for mild cognitive impairment or mild-to-moderate dementia in older adults in terms of decision making, patient, family or caregiver, and/or societal outcomes
• Incorporation of specific palliative care services (e.g., symptom management, establishment of care goals consistent with patient and family preferences, discontinuation of potentially unnecessary treatments) into care of older adults within and/or across specific settings
• Development and validation of effective strategies to reconcile medication type and dose across care setting transitions (e.g., hospital to home, home to hospital including intermediate care such as between inpatient units, rehabilitation facilities, and nursing homes)
• Evaluation of interventions for managing postoperative cognitive decline in health care settings, including hospitals and rehabilitation facilities
• Effectiveness of incorporating an automated notification system into an electronic pharmacy ordering system that alerts providers to the potential for drug-drug interactions or adverse drug effects in individual patients meeting specific age-associated clinical parameters (e.g., creatinine clearance: body surface area)
• Effectiveness of an automated electronic health record notification system that identifies older patients at increased risk of major bleeding based on hematologic/coagulation factors, medications, renal function, or anthropomorphic and/or other variables
• Effectiveness of incorporating geriatric assessment (i.e., systematic assessment of functional, cognitive, medical, and other parameters) into care of older adults referred for invasive medical or surgical procedures
• Effectiveness of anticoagulation strategies for nonvalvular atrial fibrillation in patients older than 80 years, including those with multiple chronic conditions and/or renal dysfunction
• Evaluation of the long-term benefits and harms of bisphosphonate medication for low bone density or osteoporosis, comparing continued use of pharmacotherapy with an alternative of discontinuation
• Behavioral economics-based interventions that change choice architectures to improve health care of older adults
• Effectiveness of simple, scalable incentive-based interventions to improve health-promoting behavior in midlife and/or older adults in one or more of the following settings: workplaces, community, nursing homes, assisted living facilities, rehabilitation facilities
• Technology-based interventions to improve affect regulation and emotional well-being of midlife and/or older adults with chronic health conditions, or of their caregivers
• Assessment of new organizational and delivery models, which include innovations and care coordination, in home health care and adult day services for frail older adults

Study topics for pragmatic trials of interest to NIAMS include:

Approaches to improve the management of chronic rheumatic, muscle, bone, joint, and/or skin diseases in adults and children, particularly through testing the use of different regimens to optimize outcomes and reduce known risks

NINR supports research that builds the scientific foundation for nursing practice and policy across diverse clinical and community settings to advance the prevention, detection, and management of disease and disability across the lifespan. NINR encourages research that integrates factors at multiple levels to identify their roles in health, health improvement, and health inequities with the goal of improving the health of individuals, families, and populations by translating science to maximize the impact of findings on practice and policy. In the context of this FOA, priority will be given to studies that propose projects that:

• Study social needs care, integrating services that address health-related social risk factors and social needs within the context of clinical practice and health care delivery
• Projects that are targeted at medically underserved, uninsured, and underinsured populations

NIMHD is interested in multilevel pragmatic intervention studies within the context of health care systems that serve primarily or a significant number of patients from populations with health disparities. NIH-designated U.S. health disparity populations include Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, Native Hawaiians and other Pacific Islanders, socioeconomically disadvantaged populations, underserved rural populations, and sexual and gender minorities.

The term “multilevel” refers to the multidimensional framework of determinants relevant to understanding and addressing minority health and health disparities. This concept is further described under the NIMHD Research Framework.

We also encourage investigators to use metrics of social determinants of health based on the PhenX toolkit.

In addition to the research objectives described above, NIMHD is primarily interested in the following topics:

• Multilevel interventions (including health care coordination) focused on reducing unnecessary or preventable emergency care utilization
• Multilevel interventions focused on reducing delayed health care system response to needed emergency care, especially in remote or low-income settings and for patients for whom English is not their primary language
• Interventions testing the incorporation of technology to enhance communication between the patient and the health care system and promote patient agency and decision making (especially patient-reported outcomes related to pharmacologic or surgical treatments) and/or medical adherence
• Interventions focused on older adult wellness aimed at reducing polypharmacy and serious or incapacitating medication side effects, and accounting for sociocultural determinants of health
• Studies focused on enhancing timely access to services conspicuously delayed for many patients from populations with health disparities, including but not limited to postsurgical and postcardiac and poststroke rehabilitation and care; physical/occupational medicine therapy after injury or surgery, or as part of routine care; primary and continuity of care after recovery from cancer; and primary and continuity of care after recovery from mental health disorders or drug use relapse
• Multilevel interventions on facilitating access and referral to timely palliative and/or end-of-life care for patients from populations with health disparities, especially those living in remote areas and for whom English is not their primary language. Interventions that integrate cultural perspectives, caregivers or family members or the patient’s social network, and social determinants of health are of interest

NCCIH is interested in pragmatic or implementation trials that evaluate the effectiveness of complementary interventions or how to implement these interventions into health care delivery. The complementary interventions proposed should have strong evidence of efficacy to warrant their inclusion in health care delivery. Applications will be considered of high programmatic priority if they propose projects that study a mind and body or integrated approach for one of the following high-priority topic areas: management of chronic pain syndromes; promotion of whole person health, health restoration, emotional well-being, or resilience; prevention or treatment of symptoms including sleep disorders or disturbances, depression, anxiety, post-traumatic stress (disorder), and obesity; improvement of minority health and elimination of disparities in priority health conditions; the role of social and structural determinants of health; enhancement of adherence to medications or prescribed behavioral approaches (e.g., physical activity and healthy eating); reduction of inappropriate use of medications or substances (e.g., substance use disorder or medications that are contraindicated in specific patient populations).

Applications are not responsive to this FOA if they propose trials of regulated products (dietary supplements, devices, or biologics) for indications that have not been approved or cleared by the U.S. Food and Drug Administration.

ODP is the lead office at NIH responsible for assessing, facilitating, and stimulating research in disease prevention. In partnership with the 27 NIH Institutes and Centers, ODP strives to increase the scope, quality, dissemination, and impact of NIH-supported prevention research. ODP is interested in providing co-funding support for research that has strong implications for disease prevention and health equity and that includes innovative and appropriate design, measurement, and analysis methods. ODP has a particular interest in projects that develop and/or test interventions to prevent the leading risk factors and causes of death (vizhub.healthdata.org/gbd-compare; cdc.gov/nchs/fastats/leading-causes-of-death.htm. Accessed June 3, 2021). For additional information about ODP’s research priorities and interests, please refer to the ODP Strategic Plan for Fiscal Years 2019–2023.

ODP does not award grants; therefore, applications must be relevant to the objectives of at least one of the participating NIH Institutes and Centers listed in this announcement. Please contact the relevant Institute or Center scientific/research contact(s) listed for questions regarding its research priorities and funding.

It is expected that the pragmatic and implementation trials supported under this FOA will recruit women in sufficient numbers to better understand the influence of sex as a variable.